bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concurrent vitrectomy for persistent pupillary membrane complicated by severe myopia and vitreomacular traction syndrome
Authors: Nishi Hiroyuki , Kohmoto Ryohsuke , Mimura Masashi , Fukumoto Masanori , Sato Takaki , Kida Teruyo , Ikeda Tsunehiko 
Published: June 2020

Abstract

Introduction:
In cases of persistent pupillary membrane (PPM), the eye is usually slightly microphthalmic and emmetropia or hyperopia is often present, yet severe myopia is reportedly rare. Here we presented a case of PPM complicated by vitreomacular traction syndrome and posterior staphyloma due to severe myopia.

Patient concerns:
This study involved a 63-year-old female patient who had been diagnosed with bilateral PPM at a local eye clinic and who was subsequently referred to our department for a more detailed examination due to a recent decrease of visual acuity.

Diagnoses:
Slit-lamp microscopy examination revealed bilateral PPM. The ocular fundus revealed peripapillary conus and myopic change in both eyes. Optical coherence tomography examination revealed no particular abnormalities in the right eye, yet did show findings indicative of vitreomacular traction syndrome in the left eye.

Interventions:
In both eyes, we performed surgical removal of the PPM, phacoemulsification aspiration, and intraocular lens implantation, yet in the patient's left eye, vitrectomy was also performed.

Outcomes:
After surgery, the patient's visual acuity improved in both eyes.

Conclusion:
The findings in this case show that when required, vitrectomy should be considered based upon the preoperative Optical coherence tomography findings for PPM.
Interventions to reduce burnout of physicians and nurses
Authors: Zhang Xiu-jie , Song Yingqian , Jiang Tongtong , Ding Ning , Shi Tie-ying 
Published: June 2020

Abstract

Objective:
Numerous systematic reviews and meta-analyses on the interventions to reduce burnout of physicians and nurses have been published nowadays. This study aimed to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses.

Methods:
Researches have been conducted within Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL published from inception to 2019. In addition, a manual search for relevant articles was also conducted using Google Scholar and ancestral searches through the reference lists from articles included in the final review. Two reviewers independently selected and assessed, and any disagreements were resolved through a larger team discussion. A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Data from each study were extracted independently using a pre-standardized data abstraction form. The the Risk of Bias in Systematic reviews and assessment of multiple systematic reviews (AMSTAR) 2 tool were used to evaluate risk of bias and quality of included articles.

Results:
A total of 22 studies published from 2014 to 2019 were eligible for analysis. Previous studies have examined burnout among physicians (n = 9), nurses (n = 6) and healthcare providers (n = 7). The MBI was used by majority of studies to assess burnout. The included studies evaluated a wide range of interventions, individual-focused (emotion regulation, self-care workshop, yoga, massage, mindfulness, meditation, stress management skills and communication skills training), structural or organizational (workload or schedule-rotation, stress management training program, group face-to-face delivery, teamwork/transitions, Balint training, debriefing sessions and a focus group) and combine interventions (snoezelen, stress management and resiliency training, stress management workshop and improving interaction with colleagues through personal training). Based on the Risk of Bias in Systematic reviews and AMSTAR 2 criteria, the risk of bias and methodological quality included studies was from moderate to high.

Conclusions:
Burnout is a complicated problem and should be dealt with by using bundled strategy. The existing overview clarified evidence to reduce burnout of physicians and nurses, which provided a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety.
Changes of retinal and choroidal capillary blood flow in macula after an acute intraocular pressure elevation
Authors: Ma Ziwei , Pan Xuefeng , Zhou Danni , Zhu Zhuangzhi , Xu Aiping , Shi Peng , Chen Hong 
Published: June 2020

Abstract
The aim of this study was to investigate the changes of retinal vessel density (VD) and choriocapillary blood flow area (CBFA) in macula after an acute intraocular pressure (IOP) elevation observed using optical coherence tomography angiography.
This was a prospective comparative study of subjects with narrow anterior chamber angles who underwent laser peripheral iridotomies (LPIs). The IOP was measured before and 1 hour after the LPI. The retinal VDs and CBFAs of the macula were measured using optical coherence tomography angiography at the baseline and 1 hour after the LPI.
A total of 88 eyes of 88 individuals were enrolled in our study, and 70 eyes of 70 individuals finally completed the study with a mean IOP rise of 10.2 ± 7.5 mm Hg after the LPI. The VDs and areas of foveal avascular zone of all of the subjects did not differ significantly between the measurements obtained at the baseline and 1 hour after the LPI (P > .05). However, there were statistically significant differences in the CBFAs at the baseline and 1 hour after the LPI (P < .05). Based on the magnitude of the rise in the IOP, we divided the subjects into three groups: group A = IOP rise ≤ 10 mm Hg, group B = 10 mm Hg < IOP rise ≤20 mm Hg, and group C = IOP rise > 20 mmHg. The VDs of the macula measured at the baseline were significantly different from the measurements obtained 1 hour after the LPI in group C in either the superficial retinal layer or deep retinal layer (P < .05). Compared with baseline, the CBFAs measured at 1 hour after the LPI were decreased in group B and group C (P < .05).
In these subjects with narrow antenior chamber, the blood flow in macula began to be affected with the acute IOP rise greater than 10 mm Hg. It was confirmed that the retina and choroid showed some different ability to regulate its blood flow in response to changes in IOP.
Critically ill patients with COVID-19 with ECMO and artificial liver plasma exchange
Authors: Liu Jian , Dong Yong-Quan , Yin Jie , He Guojun , Wu Xiaoxin , Li Jianping , Qiu Yunqing , He Xuelin 
Published: June 2020

Abstract
COVID-19 is an emerging infectious disease capable of causing severe pneumonia. We aimed to characterize a group of critically ill patients in a single-center study.
This was a retrospective case series of 23 patients with confirmed COVID-19-related critical illness in the intensive care unit (ICU) of a hospital in Hangzhou Zhejiang Province between January 22 and March 20, 2020.
Of the 23 critically ill patients, the median age was 66 years (interquartile range [IQR] 59–80 years). The median time from disease onset to ICU admission was 10 days (IQR 6–11 days), to mechanical ventilation (MV) was 11 days (IQR 7.75–13 days), to artificial liver plasma exchange was 12 days (IQR 9.75–14.75 days), and to extracorporeal membrane oxygenation (ECMO) was 22 days (IQR 17.5–30 days). Nine patients required high flow oxygen. Fourteen patients received MV. Six required ECMO. Nine received artificial liver plasma exchange. Mortality was 0 at day 28.
Mortality was 0 at day 28 in our single-center study. Extracorporeal membrane oxygenation reduced the requirements for ventilator support. Artificial liver plasma exchange significantly reduced inflammatory cytokine levels. These supportive therapies helped to extend the patients’ survival times and increase the chance of follow-up treatments.
Association of Protein and Genetic Biomarkers With Response to Lumbar Epidural Steroid Injections in Subjects With Axial Low Back Pain
Authors: Schaaf Stephen , Huang Wan , Perera Subashan , Conley Yvette , Belfer Inna , Jayabalan Prakash , Tremont Katie , Coelho Paulo , Ernst Sara , Cortazzo Megan , Weiner Debra , Vo Nam , Kang James , Sowa Gwendolyn 
Published: June 2020

Objective
The purpose of this observational study was to examine the association of protein and genetic biomarkers with pain and pain-related disability in individuals with axial low back pain undergoing epidural steroid injections.

Design
Forty-eight adults with axial low back pain undergoing an epidural steroid injection were recruited from an academic medical center. Blood samples were assayed at baseline and follow-up for plasma proteins and functional single-nucleotide polymorphisms associated with pain. Data regarding pain and function were collected at baseline and follow-up. The characteristics of responders (defined as 50% improvement in pain score) and nonresponders were compared, and the association between response and baseline biomarkers was examined.

Results
Thirty-five percent of subjects were responders to injection. Responders had lower baseline plasma levels of chondroitin sulfate 846 and higher neuropeptide Y and serotonin levels than nonresponders, and baseline neuropeptide Y level correlated with change in disability levels. In addition, subjects with the variant allele for the catechol-O-methyltransferase single-nucleotide polymorphism demonstrated increased odds of responding to the injection.

Conclusions
These data identify candidates who may have utility for patient selection for spinal procedures and provide support for exploration in prospective studies to assess and validate their predictive ability.
Long-Term Health-Related Quality of Life after Four Common Surgical Treatment Options for Breast Cancer and the Effect of Complications: A Retrospective Patient-Reported Survey among 1871 Patients
Authors: Kouwenberg Casimir A. E. , de Ligt Kelly M. , Kranenburg Leonieke W. , Rakhorst Hinne , de Leeuw Daniëlle , Siesling Sabine , Busschbach Jan J. , Mureau Marc A. M. 
Published: June 2020

Background:
Differences in quality-of-life outcomes after different surgical breast cancer treatment options, including breast reconstruction, are relevant for counseling individual patients in clinical decision-making, and for (societal) evaluations such as cost-effectiveness analyses. However, current literature shows contradictory results, because of use of different patient-reported outcome measures and study designs with limited patient numbers. The authors set out to improve this evidence using patient-reported outcome measures in a large, cross-sectional study for different surgical breast cancer treatment options.

Methods:
Quality of life was assessed through the EQ-5D-5L, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23, and the BREAST-Q. Patients with different treatments were compared after propensity-weighted adjustment of pretreatment differences. The EQ-5D was used to value the effect of surgical complications.

Results:
A total of 1871 breast cancer patients participated (breast-conserving surgery, n = 615; mastectomy, n = 507; autologous reconstruction, n = 330; and implant-based reconstruction, n = 419). Mastectomy patients reported the lowest EQ-5D score (mastectomy, 0.805, breast-conserving surgery, 0.844; autologous reconstruction, 0.849; and implant-based reconstruction, 0.850) and functioning scores of the C30 questionnaire. On the BREAST-Q, autologous reconstruction patients had higher mean Satisfaction with Outcome, Satisfaction with Breasts, and Sexual Well-being scores than implant-based reconstruction patients. Complications in autologous reconstruction patients resulted in a substantially lower quality of life than in implant-based reconstruction patients.

Conclusions:
This study shows the added value of breast conservation and reconstruction compared with mastectomy; however, differences among breast-conserving surgery, implant-based reconstruction, and autologous breast reconstruction were subtle. Complications resulted in poorer health-related quality of life.
Nonsurgical Rhinoplasty: A Systematic Review of Technique, Outcomes, and Complications
Authors: Williams Lauren C. , Kidwai Sarah M. , Mehta Karan , Kamel George , Tepper Oren M. , Rosenberg Joshua D. 
Published: June 2020

Background:
Nonsurgical rhinoplasty using filler injections has become a common procedure in cosmetic practices. This is offered to patients that prefer a temporary outcome or would like to avoid general anesthesia. In addition, it can be used in postrhinoplasty patients to correct nasal deformities or irregularities. This systematic review highlights common filler types and injection techniques, and associated patient satisfaction and complications to further guide practitioners.

Methods:
A systematic review was performed using keywords and Medical Subject Headings search terms. PubMed, EmBase, the Cochrane Library, and Scopus were searched using the appropriate search terms. Data collected from each study included patient satisfaction and complications, in addition to injection material, location, and technique.

Results:
Four thousand six hundred thirty-two studies were found based on search criteria. After full-text screening for inclusion and exclusion criteria, 23 studies were included. A total of 1600 patients underwent nonsurgical rhinoplasty, most commonly with hyaluronic acid (73.38 percent), followed by calcium hydroxyapatite (12.44 percent). Nearly 95 percent of patients were satisfied with results, and there were only 26 relatively minor complications reported. There were no reports of vascular complications such as skin necrosis or visual compromise.

Conclusions:
Based on the authors’ review of the literature, nonsurgical rhinoplasty is an effective temporary alternative to traditional augmentation rhinoplasty for corrections of nasal shape with a high degree of patient satisfaction. Complications may be underreported, and thus further investigation is needed to better understand the true incidence of major complications related to vascular compromise.
Long-Term Effect of Multiple Operations on Psychosocial Function in Teenage Cleft Lip and Palate Patients
Authors: Potemra Hi’ilani M. K. , Lin Johnny , Bertrand Anthony A. , De Leon Fransia S. , Alford Jake A. , Hu Allison C. , Wilson Libby , Lee Justine C. 
Published: June 2020

Background:
Cleft lip and palate patients undergo a significant number of interventions during their childhood and adolescence. Although the intention of such interventions is to improve psychosocial functioning, there exists a paucity of data on the psychosocial outcomes of the burden of care on cleft children. In this work, the long-term effects of quantity and timing of childhood operations on teenagers with cleft lip and palate were evaluated.

Methods:
Cleft lip and palate patients (aged 14 to 17 years; n = 55) and an age-matched unaffected cohort (n = 14) prospectively enrolled from two institutions were administered the anger, anxiety, and depressive symptoms instruments from the Pediatric Patient-Reported Outcomes Measurement Information System. Total number of operations and operations stratified by age groups (0 to 7, 8 to 10, 11 to 13, and 14 to 17 years) were evaluated in relationship to instrument scores. Descriptive statistics, independent t tests, Pearson correlations, and multiple linear regression analyses were conducted.

Results:
No differences in overall psychosocial functioning were found between the cleft lip and palate and comparison groups. Total quantity of childhood operations did not correlate to psychosocial functioning of cleft lip and palate teenagers. However, multiple linear regression analyses demonstrated that increased number of operations in the 8- to 10-year-old age range predicted increased anxiety and depressive symptoms in teenagers (β = 0.38, p = 0.009; and β = 0.29, p = 0.03, respectively).

Conclusions:
It was previously reported by the authors’ group that the 8- to 10-year-old age range is an at-risk period for psychosocial distress in children with craniofacial anomalies. Their current work demonstrates that increased number of operations during this time frame may result in long-term consequences in anxiety and depression in cleft lip and palate patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Review of 602 Microtia Reconstructions: Revisions and Specific Recommendations for Each Subtype
Authors: Kim Ara , Lee Hojune , Oh Kap Sung 
Published: June 2020

Background:
Congenital microtia is highly variable in its clinical presentation, leading to many technical modifications to and controversies over treatment. The authors evaluated how surgical revisions and interdisciplinary interventions were involved in microtia reconstruction according to each subtype.

Methods:
Congenital unilateral microtia patients who underwent two-stage microtia reconstruction from June of 2001 to June of 2019 were reviewed. Patient and surgical variables were collected, including the type, number, and timing of surgical revisions, canaloplasty, and jaw operations. Data were presented in relation to each subtype of microtia (i.e., anotia, small/atypical but usable lobule, typical lobule, concha, and scapha).

Results:
From a total of 602 patients, 407 (67.6 percent) underwent some form of revisions and/or interventions in addition to the two stages of microtia reconstruction, with an average number of 2.2. The majority of small/atypical lobule cases underwent revisions to improve aesthetics, with lobule and inferior sulcus as the most problematic regions. Skin flap necrosis, with an overall rate of 4.0 percent, was most commonly found in the concha type. Except for anotia and small/atypical lobule, nearly one-third of all subtypes underwent canaloplasty, necessitating protective strategies against the circulation-threatening condition. A very small number of jaw operations (up to 7 percent) were performed in all subtypes.

Conclusions:
Over the two-decade cohort study of microtia reconstruction, revision and interdisciplinary operations were used differently for each subtype. An optimal management plan will be established with respect to type-specific conditions, including the level of difficulty in elevating the subcutaneous pedicle, usable vestige, and later effect of canaloplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Technical Refinements in Gender-Affirming Top Surgery
Authors: Gonzalez Eduardo , Frey Jordan D. , Bluebond-Langner Rachel 
Published: June 2020

Summary:
Chest masculinization is the most common gender-affirming operation performed. With increased access to care and improved insurance coverage, there has been a marked increase in the number of procedures performed. A video is presented with narration focused on the surgical technique of a “double-incision” mastectomy for gender-affirming chest masculinization. The Fisher grading scale used in technique selection of double-incision versus periareolar mastectomy, based on patient-specific anatomical parameters, is reviewed. Technical pearls for refinement of the double-incision top surgery technique for gender affirmation are then demonstrated.
Getting Good Results in Cosmetic Blepharoplasty
Authors: Alghoul Mohammed S. , Vaca Elbert E. , Mioton Lauren M. 
Published: June 2020

Learning Objectives:
After studying this article, the participant should be able to: 1. Accurately diagnose the cosmetic deformity and thoroughly understand the periorbital surface topography. 2. Develop a preoperative plan and pick the right operation. 3. Master technical tips. 4. Rejuvenate the lateral orbital area. 5. Manage complications.

Summary:
Getting good results in blepharoplasty requires understanding ideal surface topography, accurate diagnosis of the cosmetic deformity, thorough knowledge of anatomy, and careful technique to change the anatomy. Several approaches have been described; however, the procedure continues to have its shortcomings and share of complications that have both functional and cosmetic consequences. This continuing medical education article focuses on getting good results and maximizing success in upper and lower blepharoplasty through the discussion of five major components: diagnosis and understanding of the cosmetic deformity; preoperative planning; technical tips; rejuvenation of the lateral orbital area; and management of complications.
Orofacial outcomes in adolescents with perinatally infected HIV in antiretroviral therapy
Authors: Sampaio Juliana Diogo de Almeida , Jácome-Santos Humberto , Aires Amanda Vieira , Pinheiro João de Jesus Viana , Abreu Lucas Guimarães , Mesquita Ricardo Alves 
Published: June 2020

Objective:To assess the frequency of orofacial outcomes in adolescents with perinatally infected HIV in treatment with antiretroviral therapy (ART).Design:A Brazilian institution-based retrospective study analyzing medical charts and medication dispensing data.Methods:Medical records of 137 adolescents were reviewed. HIV viral load, CD4+T-cell count (CD4+), ART regimen, nonadherence events, and prolonged ART discontinuation were recorded. The frequency of each outcome was determined. Associations between the most frequent outcomes and both records of undetectable viral load and CD4+at least 500 cells/μl were carried out. Associations of lymphadenitis, Group 1 orofacial manifestations and Group 2 orofacial manifestations with records of Center for Disease Control and Prevention (CDC) category C illness were also performed. Odds ratio (OR), confidence intervals (CI) andPvalues were provided.Results:Cervical and submandibular lymphadenitis (45.25%), dental caries (32.84%) and periodontal issues (11.67%) were the most frequent orofacial outcomes. A detectable viral load (OR = 2.61, 95% CI 1.16--5.88) and CD4+less than 500 cells/μl (OR = 2.34, 95% CI 1.13--4.82) were associated with a greater risk of lymphadenitis. Orofacial outcomes associated with HIV were found in adolescents with longer ART discontinuation and a greater number of ART discontinuation events (P < 0.05). No association was found between records of CDC category C illness and group 1 orofacial manifestations, group 2 manifestations or lymphadenitis (P > 0.05).Conclusion:Orofacial outcomes, in particular, cervical and submandibular lymphadenitis were common among the adolescents assessed. Long-term ART and long-term exposure to HIV virus may have altered the orofacial outcome profile in adolescents perinatally infected by HIV.