bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factor Structure of the Disabilities of the Arm, Shoulder and Hand Questionnaire in Upper Extremity Nerve Injury
Authors: Novak Christine B. , Mackinnon Susan E. , Anastakis Dimitri J. , McCabe Steven J. 
Published: November 2019

Background:
This study evaluated the validity of the factor structure of the Disabilities of the Arm, Shoulder and Hand questionnaire to assess upper extremity disability in patients with upper extremity nerve injury.

Methods:
Data were used from previous cross-sectional studies of patients with upper extremity nerve injuries. Research ethics approval was obtained for secondary data analyses. Descriptive and factor analyses were performed.

Results:
Patients (n = 242; 170 men and 72 women) with upper extremity nerve injury included distal nerve (n = 131), brachial plexus (n = 88), and single proximal shoulder nerve (n = 23). The mean Disabilities of the Arm, Shoulder and Hand questionnaire score was 47.3 ± 22. For the questionnaire, a three-factor structure had the highest variance and no overlap between factors. The factors related to (1) light effort tasks, (2) greater effort tasks, and (3) work/social activity limitations and pain. Brachial plexus injuries had significantly higher overall questionnaire scores compared to distal and single proximal nerve injuries. The light effort factor scores were significantly lower in single proximal nerve injuries compared with brachial plexus and distal nerve injuries. Nondominant compared to dominant hand involvement revealed no difference in overall questionnaire scores but significantly higher dominant hand scores in the light effort factor (p = 0.001).

Conclusions:
In patients with nerve injury, the factor analysis of the Disabilities of the Arm, Shoulder and Hand questionnaire indicated a multifactor construct. These domains should be considered when using the questionnaire and may be helpful to assess disability related to specific tasks in different nerve injuries and with dominant hand involvement.
Perioperative Risks Are Similar for Normal versus Selected High–Body Mass Index Patients Undergoing Outpatient Hand and Elbow Surgery
Authors: Warrender William , Jones Christopher , Selverian Stephen , Lutsky Kevin , Banner Lauren , Beredjiklian Pedro K. 
Published: November 2019

Background:
Many ambulatory surgery centers use body mass index as a screening tool to make admissions decisions because of complication risks associated with high–body mass index patients. The objective of this investigation was to evaluate perioperative complications in a cohort of high–body mass index patients undergoing hand and elbow surgery at an ambulatory surgery center. The authors’ hypothesis was that anesthesia-related complications for this cohort would be similar to those of a normal–body mass index group.

Methods:
The authors retrospectively reviewed data from all hand and elbow procedures performed on patients with a high body mass index (>40 kg/m2). One hundred eighty-nine high–body mass index patients and 189 normal–body mass index patients were included in the analysis.

Results:
The average weight-based dosage of propofol was similar in both groups but was lower in the high–body mass index group for midazolam and fentanyl. Two high–body mass index patients had oxygen desaturations in the postanesthesia care unit. No patients developed complications related to anesthesia. In the high–body mass index group, one patient developed hypotension in the postanesthesia care unit, was admitted to the emergency room for monitoring, but was discharged the following morning.

Conclusions:
Outpatient hand surgical care of high–body mass index patients can be performed safely. Body mass index alone should not be considered as an absolute contraindication for surgery. Careful patient selection, evaluation of comorbidities, and close involvement of the anesthesia and medical teams are critical.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Wound Complications, Additional Ventilation Requirement, Prolonged Stay, and Readmission in Primary Palatoplasty: A Risk Factor Analysis of 3616 Patients
Authors: Blough Jordan T. , Purnell Chad A. , Chow Ian , Gosain Arun K. 
Published: November 2019

Background:
The present study examined risk factors associated with 30-day palatoplasty complications based on analysis of national data.

Methods:
Primary palatoplasties were identified in the 2012 to 2015 Pediatric National Surgical Quality Improvement Program database. Cases were analyzed with multivariate regression to investigate predictors for wound healing complications, additional ventilation requirement, prolonged stay (>3 days), and readmission.

Results:
In 3616 operations, mean age was 12.2 months and operative time was 135.4 minutes. The 30-day complication rate was 7.6 percent overall, including wound dehiscence/infection (3.4 percent), additional ventilation requirement (2.0 percent), and readmission (2.4 percent); 5.1 percent of patients required prolonged stays. Wound healing complications were not predicted by comorbidities. American Society of Anesthesiologists class 3 or greater (OR, 2.8; p = 0.033), neuromuscular disorder (OR, 3.5; p = 0.029), and nutritional support (OR, 2.9; p = 0.035) predicted additional ventilation requirement. Prolonged stays were predicted by requiring additional ventilation (OR, 14.7; p < 0.001) or American Society of Anesthesiologists class 3 or greater (OR, 1.8; p = 0.047), but preoperative ventilator dependence was protective (OR, 0.1; p = 0.012). Mean hospital stay was 1.6 days without an airway complication versus 5.0 days with. Readmissions were increased for patients requiring nutritional support (OR, 2.6; p = 0.025).

Conclusions:
This study represents one of the largest cohorts of palatoplasty patients analyzed to date. It identifies what can be learned from a nonspecific 30-day registry regarding cleft outcomes and, from its limitations, discusses what the future of cleft outcomes research might entail.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy
Authors: Hasmat Shaheen , Low Tsu-Hui , Krishnan Aparna , Coulson Susan , Ch’ng Sydney , Ashford Bruce G. , Croxson Glen , Clark Jonathan R. 
Published: November 2019

Background:
Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors’ experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy.

Methods:
A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes.

Results:
A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05).

Conclusion:
The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Relation of Optimism to Relative Telomere Length in Older Men and Women
Authors: Kim Eric S. , Tindle Hilary A. , Kubzansky Laura D. , Liu Simin , Duncan Meredith S. , Manson JoAnn E. , Springfield Sparkle , Salmoirago-Blotcher Elena , Shadyab Aladdin H. , Liu Buyun , Grodstein Francine , De Vivo Immaculata 
Published: November 2019

ABSTRACT

Objective
Mounting evidence suggests that higher optimism is associated with reduced risk of age-related morbidities and premature mortality. However, possible biological mechanisms underlying these associations remain understudied. One hypothesized mechanism is a slower rate of cellular aging, which in turn delays age-related declines in health.

Methods
We used data from two large cohort studies to test the hypothesis that higher optimism is associated with longer leukocyte telomere length. With cross-sectional data from the Health and Retirement Study (HRS; n = 6417; mean age = 70 years) and the Women’s Health Initiative (WHI; N = 3582; mean age = 63 years), we used linear regression models to examine the association of optimism with relative telomere length (assessed in leukocytes from saliva [HRS] or plasma [WHI]). Models adjusted for sociodemographics, depression, health status, and health behaviors.

Results
Considering both optimism and telomere length as continuous variables, we found consistently null associations in both cohorts, regardless of which covariates were included in the models. In models adjusting for demographics, depression, comorbidities, and health behaviors, optimism was not associated with mean relative telomere length (HRS: β = −0.002, 95% confidence interval = −0.014 to 0.011; WHI: β = −0.004, 95% confidence interval = −0.017 to 0.009).

Conclusions
Findings do not support mean telomere length as a mechanism that explains observed relations of optimism with reduced risk of chronic disease in older adults. Future research is needed to evaluate other potential biological markers and pathways.
Effective Radiation Dose Reduction in Computed Tomography With Iterative Reconstruction in Patients With Urinary Stone
Authors: Kim See Hyung 
Published: November 2019

Purpose
This study aimed to prospectively compare the image quality and visibility of urinary stone on computed tomographic (CT) images at multiple radiation exposure levels from the same patient reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE).

Methods
This study included 760 patients with urinary stone who underwent CT with simultaneous acquisition at 6 exposures per patient (100% filtered back projection, 75%, 50%, 37.5%, 25%, and 12.5% SAFIRE). Two radiologists independently assessed overall image quality, noise, and stone visibility by using a 5-point scale. Quantitative measurements, including the CT number, image noise, signal-to-noise ratio, contrast-to-noise ratio (CNR), and corresponding figure of merit (FOM), were compared for 100% versus 5 other radiation doses.

Results
Qualitative overall image quality, noise, and stone visibility according to the location were not inferior at 37.5% exposure compared with 100% exposure, except for the visualization of smaller stones <3 mm. The signal-to-noise ratio and CNR of CT images were increased at 50% exposure compared with 100% exposure. Computed tomographic images at 37.5% exposure reconstructed with SAFIRE had significantly more noise and a lower CNR compared with CT images reconstructed with filtered back projection, based on FOMnoise and FOMCNR. The size-specific dose estimation was 4.1 ± 0.8 mGy at 37.5% exposure.

Conclusion
Computed tomography performed at 37.5% exposure with SAFIRE may be diagnostically acceptable for the detection of clinically relevant stone.
Scientific Productivity in Rheumatology Among Countries of the Organisation for Economic Co-operation and Development and Its Correlation to National Economic Indicators
Authors: Lerman Tsahi T. , Reitblat Olga , Reitblat Tatiana 
Published: November 2019

Background
The purpose of this study was to examine the correlation between research productivity in the field of rheumatology and various updated economic indicators of Countries of the Organisation for Economic Co-operation and Development (OECD).

Methods
The number of documents published, number of citable documents, number of citations, citations per document, and the H-index for the 36 OECD countries in the field of rheumatology between 1996 and 2017 were obtained from the The Scimago Journal and Country rank source. The recent data regarding gross domestic product (GDP) per capita, total health spending as percent of GDP, and the gross domestic expenditure on research and development as percent of GDP were collected from the World Bank, OECD, and United Nations Educational, Scientific, and Cultural Organization Web sites, accordingly. The relationship between economic indicators and scientific productivity for each of the OECD countries was analyzed.

Results
A total of 132,314 documents were analyzed. A moderate to strong significance correlation was found between health expenditure and the number of documents published (r = 0.67, p < 0.001), number of citable documents (r = 0.68, p < 0.001), number of citation (r = 0.76, p < 0.001), and H-index (r = 0.77, p < 0.001).

Conclusions
This study provides a current highlight on the relationship between academic productivity in rheumatology and economic indicators of OECD countries. We showed a positive moderate to strong significant correlation between total health expenditure as percent of GDP and different bibliometric indicators, implying another possible advantage of national investment in this filed.
Burkitt’s Lymphoma Involving Multiple Hormone-Producing Organs on FDG PET/CT
Authors: Wen Zhe , Zhuang Hongming 
Published: November 2019

Abstract
Lymphoma involving many different organs can be occasionally observed. However, lymphoma involvement of multiple hormone-producing organs is rare. In this report, we described our FDG PET/CT findings in a 21-year-old man whose Burkitt's lymphoma involved not only lymph nodes, the spleen, the brain, and the bones, but also 4 organs in the endocrine system, including the thyroid, right adrenal, the pancreas, and the right testicle.
A Machine-Learning Approach Using PET-Based Radiomics to Predict the Histological Subtypes of Lung Cancer
Authors: Hyun Seung Hyup , Ahn Mi Sun , Koh Young Wha , Lee Su Jin 
Published: November 2019

Purpose
We sought to distinguish lung adenocarcinoma (ADC) from squamous cell carcinoma using a machine-learning algorithm with PET-based radiomic features.

Methods
A total of 396 patients with 210 ADCs and 186 squamous cell carcinomas who underwent FDG PET/CT prior to treatment were retrospectively analyzed. Four clinical features (age, sex, tumor size, and smoking status) and 40 radiomic features were investigated in terms of lung ADC subtype prediction. Radiomic features were extracted from the PET images of segmented tumors using the LIFEx package. The clinical and radiomic features were ranked, and a subset of useful features was selected based on Gini coefficient scores in terms of associations with histological class. The areas under the receiver operating characteristic curves (AUCs) of classifications afforded by several machine-learning algorithms (random forest, neural network, naive Bayes, logistic regression, and a support vector machine) were compared and validated via random sampling.

Results
We developed and validated a PET-based radiomic model predicting the histological subtypes of lung cancer. Sex, SUVmax, gray-level zone length nonuniformity, gray-level nonuniformity for zone, and total lesion glycolysis were the 5 best predictors of lung ADC. The logistic regression model outperformed all other classifiers (AUC = 0.859, accuracy = 0.769, F1 score = 0.774, precision = 0.804, recall = 0.746) followed by the neural network model (AUC = 0.854, accuracy = 0.772, F1 score = 0.777, precision = 0.807, recall = 0.750).

Conclusions
A machine-learning approach successfully identified the histological subtypes of lung cancer. A PET-based radiomic features may help clinicians improve the histopathologic diagnosis in a noninvasive manner.
Decreased GABA-A Receptor Binding in Association With β-Lactam Antibiotic Use
Authors: Flaus Anthime , Riaño Barros Daniela Alexandra , Hinz Rainer , Myers James F. , Lingford-Hughes Anne , Koepp Matthias J. , Hammers Alexander , McGinnity Colm Joseph 
Published: November 2019

Abstract
β-Lactam antibiotics are proconvulsive. In laboratory animals, this effect seems to be predominantly mediated through inhibition of GABA-A receptors, but it has not been demonstrated in humans in vivo. We report images of a [11C]Ro15-4513 PET from a 40-year-old man who had completed a 1-week course of flucloxacillin before it. Relative to healthy controls, the participant had significantly lower mean gray matter binding. These novel data suggest that, in humans, the proconvulsive effect of β-lactam antibiotics is mediated via either competition for the same benzodiazepine-binding site as [11C]Ro15-4513 or downregulation of GABA-A receptor expression.
Incidental Detection of Iliac Artery Occlusion on 3-Phase Bone Scintigraphy
Authors: Kim Myoung Hyoun , Kim Dae-Weung 
Published: November 2019

Abstract
Our patient was a 72-year-old man with absent activity of the right femoral artery and mildly decreased 99mTc-DPD activity on the right leg as indicated on the blood pool and delayed images, respectively. Subsequent peripheral angiography revealed a total occlusion of the right external iliac artery with good collateral flow. Careful review of blood flow and blood pool images of 3-phase bone scintigraphy could provide additional information about peripheral vascular disease.
Management of Intravenous Infiltration Injuries
Authors: Massand Sameer , Carr Logan , Schneider Emily , Johnson T. Shane 
Published: November 2019

Background
Intravenous (IV) lines are ubiquitous in hospital settings. These lines can malfunction, leaking noxious contents into subcutaneous tissue. Existing literature describes invasive intervention and complex treatment protocols. These persist despite significant changes in the composition and administration of IV agents. The purpose of this study is to examine the consequences of IV infiltrations at a tertiary medical center to update protocols and treatment algorithms.

Materials and Methods
This study is an observational, retrospective chart review performed at a tertiary care medical center. All inpatient plastic surgery consultations for IV infiltration were reviewed from 2011 to 2017. Patients were included if IV infiltration was suspected or documented. Data were collected for each injury regarding patient demographics, substance, and intervention.

Results
The plastic surgery service evaluated 381 IV infiltration injuries from 2011 to 2017, with 363 meeting the criteria. Injuries per year progressively increased, with 32 consultations in 2011 and 102 consultations in 2017. The vast majority of injuries identified (91%) were treated with only elevation and observation. The minority consisted of wound care (7%) performed by nursing or any form of incision, aspiration, or antidote injection (2%) performed by the physician. Of the 363 injuries, the most common infiltrates were noncytotoxic (35%), radiographic contrast (27%), and known vesicants (18%). Interestingly, a large portion of consultations were requested by other surgical services (32%).

Conclusions
Although there is an increase in expert involvement for cases of IV infiltration injuries, the vast majority of these injuries are managed with minimal intervention. This is most likely owing to recent changes that have decreased the potential for harmful infiltration. Contrary to existing literature, invasive intervention is almost never indicated.
Unilateral Cleft Lip Repair
Authors: Ramly Elie P. , Eisemann Bradley S. , Kantar Rami S. , Alfonso Allyson R. , Wang Maxime , Diaz-Siso Jesus Rodrigo , Staffenberg David A. , Flores Roberto L. 
Published: November 2019

Background
There is no quantitative evidence supporting one unilateral cleft lip (UCL) repair technique over the other with regard to scarring. We sought to evaluate the difference between the extended Mohler and Millard techniques, using 3 scar assessment scales.

Methods
Postoperative frontal and basal photographs of patients undergoing UCL repair were reviewed. Three validated scar assessment scales were used: the Manchester Scar Scale (MSS), modified scar-rating scale (MSRS), and Stony Brook Scar Evaluation Scale. Lip and nose scars were rated by 5 independent raters using each of the scales. Interrater reliability was assessed using the intraclass correlation coefficient (ICC).

Results
Assessment of 116 images for 58 consecutive patients undergoing UCL repair (36 extended Mohler, 22 Millard) was performed. Interrater reliability was excellent for lip scars (ICCs, 0.903 [0.857–0.938] for MSS, 0.913 [0.872–0.944] for MSRS, and 0.850 [0.775–0.902] for SBES) and moderate for nose scar assessment (ICCs, 0.714 [0.579–0.816] for MSS, 0.693 [0.548–0.802] for MSRS, and 0.565 [0.359–0.720] for SBES). No statistically significant difference was found between the extended Mohler and Millard repairs in mean lip scar scores (MSS, 6.983 ± 1.469 vs 6.772 ± 1.175, P = 0.571; MSRS, 5.433 ± 1.530 vs 5.481 ± 1.290, P = 0.902; SBES, 3.633 ± 0.977 vs 3.446 ± 0.995, P = 0.483) or nose scar scores (MSS, 5.644 ± 1.131 vs 5.491 ± 0.689, P = 0.523; MSRS, 4.233 ± 0.987 vs 3.991 ± 0.705, P = 0.320; SBES, 3.933 ± 0.750 vs 4.018 ± 0.486, P = 0.603).

Conclusions
Using 3 validated scar assessment scales, no significant difference was found between the extended Mohler and Millard techniques in terms of lip or nose scars.
Meltblown Polylactic Acid Nanowebs as a Tissue Engineering Scaffold
Authors: Gazzola William H. , Benson Roberto S. , Carver Wayne 
Published: November 2019

Abstract
Polylactic acid (PLA) nanofiber nonwovens have recently come under more vigorous investigation for their use as tissue engineering scaffolds owing to its ability to mimic the physical properties of naturally occurring human extracellular matrix in a variety of host tissues. Currently, the majority of available research on PLA nanowebs has focused on their creation through electrospinning. The goal of this study was to evaluate meltblown nonwoven webs made of nanodiameter PLA fibers for their application as a tissue engineering scaffold. Meltblown PLA fabrics were produced with a variety of different crystallinities, tensile moduli, and pore diameters. One fabric with mechanical properties similar to human dermis was selected as a scaffold to study attachment, proliferation, and migration of human dermal fibroblasts over 1, 3, 7, and 14 days without the use of additional cell adhesion molecules. The 3-(4,5-dimethylthiazol-2-yl)-diphenyltetrazolium bromide assay showed good proliferation from day 1 to 3 (P = 0.026) and up to 7 days of culture (P = 0.005) but without increase from day 7 to 14. Electron microscopy demonstrated adequate cellular attachment and surface migration at 1, 3, 7, and 14 days. Finally, confocal microscopy was used to investigate cellular penetration into the scaffolds. The investigation found that cells were able to penetrate fully through the thickness of the scaffold. The successes of this initial experiment are promising and confirm that meltblown nanofiber nonwovens are a viable avenue for tissue engineering scaffolds. Hopefully, these conclusions will open the door for others to pursue research in this exciting field.