bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated Corrective Saccades in the Bilateral Posterior Canal Stimulation During the Video Head Impulse Test: A Marker of Central Vestibulopathy?
Authors: Hurtado Genoveva , Poth Elizabeth A. , Monaghan Neil P. , Nguyen Shaun A. , Rizk Habib G. 
Published: December 2024

Objectives:
This study aimed to determine if the presence of corrective saccades during video head impulse test (vHIT) stimulation of the bilateral posterior semicircular canals (PSCs) correlated with other vestibular test results, demographics, symptoms, or diagnoses.

Design:
This study was a retrospective chart review where 1006 subjects’ vHIT records were screened with 17 subjects meeting inclusion criteria for isolated bilateral PSC saccades.

Results:
Of the 1006 patients undergoing vHIT testing, only 1.7% had isolated bilateral PSC saccades. The median age of subjects was 73 years, with a range of 61 to 85 years. Statistical significance was identified between groups with abnormal PSC vHIT gain and abnormal ocular vestibular evoked myogenic potential results as well as those with 1 to 2 diagnoses.

Conclusions:
Our study confirms the rarity of isolated bilateral PSC vHIT saccades and as well as association with central vestibulopathy. Correlations with other vestibular test results, demographics, symptoms, or diagnoses may be strengthened with future large-scale studies. Further understanding of the clinical utility of isolated bilateral PSC vHIT saccades is needed. Patients with bilateral PSC vHIT abnormalities may benefit from a comprehensive neurological evaluation and consultation.
Comparing Patient-Reported Outcomes in Patients Undergoing Lumbar Fusion for Degenerative Spondylolisthesis With Predominant Back Pain Versus Predominant Leg Pain Symptoms
Authors: Kaul Aayush , Wolf Jacob C. , Anwar Fatima N. , Roca Andrea M. , Khosla Ishan , Loya Alexandra C. , Medakkar Srinath S. , Jacob Kevin C. , Patel Madhav R. , Pawlowski Hanna , Parsons Alexander W. , Vanjani Nisheka N. , Prabhu Michael C. , Federico Vincent P. , Sayari Arash J. , Lopez Gregory D. , Singh Kern 
Published: December 2024

Study Design:
Retrospective review.

Objective:
This study aims to compare postoperative patient-reported outcome measures (PROMs) in predominant back pain (PBP) versus predominant leg pain (PLP) patients following lumbar fusion for degenerative spondylolisthesis (DS).

Summary of Background Data:
Prior studies comparing PROMs in patients undergoing lumbar fusion with PBP versus PLP symptoms have included heterogeneous spinal pathology and restricted analysis to posterior fusion techniques.

Methods:
Demographics, perioperative characteristics, complications, and PROMs from a retrospective single-surgeon database were collected for primary, elective, and single-level lumbar fusion for DS. Preoperative/postoperative PROMs included visual analog scale (VAS)-back/leg pain (VAS-BP/VAS-LP), Oswestry disability index (ODI), 12-Item Short Form Physical and Mental Composite Score (SF-12 PCS/MCS), and Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF). Preoperative VAS-BP>VAS-LP established the PBP cohort and VAS-LP>VAS-BP established the PLP cohort. The average follow-up was 23.4±2.8 months. Improvement in PROMs (ΔPROM) at 6 weeks (ΔPROM-6W) and final follow-up (ΔPROM-FF) were calculated. χ2 and the Student t test analyzed categorical and continuous variables, respectively. Postoperative PROMs, ΔPROMs, and MCID achievement rates were compared between groups with multivariate linear or logistic regression.

Results:
In total, 166 patients were selected with 108 in the PBP cohort. Both cohorts saw improvements in all PROM scores over time. The PBP cohort reported significantly greater ΔPROM-6W and ΔPROM-FF for VAS-BP (P<0.003). The PLP cohort reported greater ΔPROM-6W and ΔPROM-FF for VAS-LP and ΔPROM-FF for SF-12 PCS (P<0.014). MCID achievement rates for VAS-BP were higher in the PBP cohort, and VAS-LP MCID achievement rates were higher in the PLP cohort (P<0.015).

Conclusion:
Regardless of predominant pain location, patients-reported improvements in all PROs at the final follow-up. Patients with PLP-reported greater improvement in leg pain and physical function and patients with PBP-reported greater back pain improvement.
DIEP Flap Weights in Immediate 1-stage and 2-stage Breast Reconstruction: Considering Chest Wall Deformity
Authors: Inoue Mariko , Aoki Hironobu , Kamegai Mina , Ogawa Rei 
Published: December 2024

Background:
There are advantages and disadvantages to both immediate 1-stage and 2-stage autologous-breast reconstruction. The 2-stage procedure may suffer from a hitherto overlooked difficulty: the tissue expander may induce chest wall depression that may require using a heavier-than-expected flap to generate symmetrical breasts. We conducted a retrospective observational study to assess this phenomenon.

Methods:
Consecutive patients who underwent 1-stage or 2-stage unilateral autologous-breast reconstruction with a deep inferior epigastric perforator flap were included. The 2 groups were compared in terms of age, body mass index, mastectomized tissue weight, inset-flap weight, and percentage additional flap weight (defined as [inset-mastectomy]/mastectomy × 100). The latter reflects the amount of additional flap tissue relative to mastectomized tissue that was needed to generate symmetrical breasts. The chest wall deformity after tissue expansion in the 2-stage patients was quantitated with computed tomography.

Results:
Patients’ healthy and affected breasts were symmetrical before surgery (P > 0.05). Compared with the 1-stage patients (n = 37), the 2-stage patients (n = 31) only differed in terms of a significantly higher mean percentage additional flap weight (28% versus 12%, P = 0.0077). Relative to preoperative values, nearly all 2-stage patients had mild (74%) or moderate (19%) chest wall deformity before tissue expander removal.

Conclusions:
Due to tissue expander-induced chest wall deformity, 2-stage breast reconstruction may require a larger flap volume than is anticipated on the basis of preoperative volumetric measurements. Considering this phenomenon when choosing between immediate 1-stage and 2-stage reconstruction could potentially help improve patient outcomes.
PATHOGENESIS, PROGNOSIS, AND SURGICAL OUTCOMES OF FULL-THICKNESS MACULAR HOLES IN MACULAR TELANGIECTASIA TYPE 2
Authors: Carlà Matteo Mario , Cusato Mattia , Hu Lorenzo , Rizzo Stanislao 
Published: December 2024

Purpose:
Macular telangiectasia type 2 (MacTel2) is a rare disorder, affecting retina's vascular structure, and MacTel2-associated full-thickness macular holes (MHs) are extremely rare in general population. Since their management is still controversial, this literature review was aimed to gather evidences on the surgical management of MacTel2-associated MHs.

Methods:
A retrospective review on the Cochrane Central, PubMed, Web of Science, and ClinicalTrials.gov databases for articles regarding MacTel2 and MHs. The search period was set from January 2000 to February 2024, and any kind of article was taken into account.

Results:
We took into account 10 studies analyzing surgical outcomes of MacTel2-associated MHs, with a total number of 95 treated eyes. Different surgical techniques were used, with a better anatomical outcome after internal limiting membrane inverted flap surgery but with very controversial functional outcomes. In a comparative report, internal limiting membrane peeling alone (34 eyes) was associated with a 47% anatomical success rate, internal limiting membrane inverted flap (22 eyes) with 90% successful closure, and autologous retinal transplantation (five eyes) with a 100% success rate but without visual improvement.

Conclusion:
Since the exact pathophysiology of MacTel2 macular holes is not clear yet, even if the internal limiting membrane inverted flap technique could be an effective treatment for these patients, visual outcomes are poor. This underlines the necessity of a deeper comprehension of the pathophysiology of the disease and the development of new surgical approaches.
Visual and Anatomic Outcomes From Ultracomplex Retinal Detachment Repair in a Large County Hospital
Authors: Chen Ariel , Coffee Robert E. , Date Rishabh C. , Weng Christina Y. 
Published: December 2024

Purpose:
To evaluate outcomes of ultracomplex retinal detachment (UCRD) repairs performed at a large county hospital.

Materials and Methods:
Retrospective chart review of patients who underwent a UCRD repair, defined as a funnel retinal detachment (RD), RD associated with ocular trauma, or RD requiring retinectomy, 5000 centistoke silicone oil or perfluorocarbon heavy liquid (PFO). The outcomes examined were visual acuity (VA), anatomic success, and phthisis development.

Results:
Fifty eyes met inclusion criteria; 7 (14%) had a funnel RD, 14 (28%) had a history of ocular trauma, 34 (68%) had a retinectomy, 19 (38%) used 5000 centistoke silicone oil, and 12 (24%) used PFO. The mean follow-up time was 10.9±6.9 months. At 3 months, vision had remained stable or improved for 64% of eyes and the macula was attached for 66% of eyes. The mean preoperative VA was 2.5±0.5 logMAR, and the mean VA at 3 months was 2.4±0.7 logMAR with no statistically significant difference (P=0.30). With multivariate regression, preoperative VA was a statistically significant predictive factor of postoperative VA at 3 months. Nine (18%) of eyes developed phthisis, a mean of 11.4±5.1 months after UCRD repair.

Conclusions:
Surgical intervention for UCRD can stabilize vision and achieve anatomic success.
Demographics of Ophthalmology and Optometry Practices and Changes in Utilization Patterns of Procedures and Services Following Private Equity Acquisition
Authors: Del Piero Juliet , Yennam Sowmya , Mukhopadhyay Anirudh , Chen Evan M. , Weng Christina Y. , Parikh Ravi 
Published: December 2024

Purpose:
To characterize private equity (PE) acquisition of ophthalmology and optometry practices and compare procedural utilization before and after acquisition.

Methods:
Ophthalmologists and optometrists in practices acquired from 2012 to 2016 were identified and characterized using an internet archive with an additional search in 2017 to characterize doctor turnover. United States Census Bureau and Internal Revenue Service Data were used to determine population health insurance and adjusted gross income (AGI). Healthcare Common Procedure Coding System codes were drawn from the Medicare database.

Results:
Six platform companies acquired 36 practices between 2012 and 2016, including 518 optometrists and 136 ophthalmologists with a net doctor decrease of 3% and 7%, respectively (years 2016 to 2017). PE firm-owned practices were primarily located in metropolitan core areas with above-average AGI and insurance coverage. Diagnostic procedures, total encounters, cataract surgery, and yttrium aluminum garnet (YAG) capsulotomy volume increased per physician 1-year post-acquisition. In adjusted difference-in-difference comparisons, cataract surgery (13.3% relative increase, P<0.001) and YAG capsulotomy (35.6% relative increase, P<0.001) remained significant. PE practices demonstrated an increase in cataract surgery procedures (28,813/platform pre-acquisition to 33,930/platform post-acquisition, P=0.015).

Conclusion:
PE acquisitions of ophthalmology and optometry practices were centered in metropolitan core areas with above-average AGI and insurance coverage. PE acquisition led to less optometrists and ophthalmologists employed at the practice. Overall, they exhibited doctor turnover with a net doctor decrease. When compared to non-PE doctors, PE-acquired doctors demonstrated an increase in cataract surgery and YAG capsulotomy volume. Overall, cataract surgery volume increased among PE practices after acquisition.
PRK plus crosslinking to correct refractive error after phakic intraocular lens repeated rotation: Bioptics Xtra
Authors: Balparda Kepa , Herrera-Chalarca Tatiana , Franco-Sánchez Isabela , López-Velásquez Mariana , Escobar-Giraldo Mariana 
Published: December 2024

Introduction:
Phakic intraocular lens (IOL) surgery is generally considered safe; however, spontaneous IOL rotation can occur in some patients. Repeat spontaneous rotation of the IOL presents a significant challenge that requires careful management.

Patient and Clinical Findings:
A 30-year-old man underwent bilateral phakic IOL implantation for high myopia in the context of a borderline cornea, characterized by keratometric asymmetry and anterior elevation at the location of the thinnest corneal point. The IOLs experienced spontaneous rotation, which was initially managed by surgical repositioning. However, the IOLs rotated spontaneously again less than a week after the repositioning.

Diagnosis, Intervention, and Outcomes:
The patient underwent topography-guided photorefractive keratectomy (PRK) combined with accelerated crosslinking (30 mW/cm2 for 90 seconds, totaling 2.7 J/cm2) in both eyes. 6-month post-PRK Xtra, his uncorrected vision improved to 20/20 in the right eye and 20/25 in the left eye. The IOLs have remained stable in their final rotated positions.

Conclusions:
This is the first reported case, to the authors' knowledge, of using PRK Xtra to manage residual refractive error in a patient experiencing repeated spontaneous rotation of phakic IOLs. This technique is feasible and may serve as an alternative to IOL exchange. It has been named “Bioptics Xtra.”
Postoperative complications and surgical outcomes of robotic versus laparoscopic pancreaticoduodenectomy: a meta-analysis of propensity-score-matched studies
Authors: Tang Gang , Zhang Jie , Zhang Linyu , Xia Lingying , Chen Rui , Zhou Rongxing 
Published: December 2024

Background:
Robotic pancreaticoduodenectomy (RPD) is used more commonly, but high-level evidence is still scarce. This meta-analysis aimed to compare the short-term outcomes between RPD and laparoscopic pancreaticoduodenectomy (LPD) using data collected from propensity score-matched (PSM) studies.

Materials and methods:
We searched PubMed, Cochrane Library, Embase, and Web of Science databases for PSM studies comparing RPD and LPD. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated.

Results:
Ten PSM studies were included, encompassing 8106 patients (RPD group: 3695 patients; LPD group: 4411 patients). Compared with LPD, RPD was associated with a lower conversion rate (RR, 0.56) and blood transfusion rate (RR, 0.49), as well as a higher number of harvested lymph nodes (MD, 2.15). There were no significant differences observed in 30-day readmission (RR, 1.02), 90-day mortality (RR, 1.01), overall morbidity (RR, 0.94), major complications (RR, 1.06), operative time (MD, −8.00 min), blood loss (MD, −19.37 mL), reoperation (RR, 0.95), bile leak (RR, 0.93), chylous leak (RR, 1.40), postoperative pancreatic fistula (RR, 1.06), delayed gastric emptying (RR, 0.92), wound infection (RR, 1.12), length of stay (MD, −0.32 days), and R0 resection (RR, 0.98) between the groups.

Conclusions:
Although LPD and RPD had similar surgical outcomes, RPD had the perioperative advantage over LPD in decreasing conversion rates and blood transfusion rates and increasing the number of lymph nodes harvested. Further randomized controlled trials evaluating the potential advantages of RPD over LPD are warranted.
The role of artificial intelligence in the diagnosis, imaging, and treatment of thoracic empyema
Authors: Zumla Adam , Ahmed Rizwan , Bakhri Kunal 
Published: December 2024

Purpose of review
The management of thoracic empyema is often complicated by diagnostic delays, recurrence, treatment failures and infections with antibiotic resistant bacteria. The emergence of artificial intelligence (AI) in healthcare, particularly in clinical decision support, imaging, and diagnostic microbiology raises great expectations in addressing these challenges.

Recent findings
Machine learning (ML) and AI models have been applied to CT scans and chest X-rays to identify and classify pleural effusions and empyema with greater accuracy. AI-based analyses can identify complex imaging features that are often missed by the human eye, improving diagnostic precision. AI-driven decision-support algorithms could reduce time to diagnosis, improve antibiotic stewardship, and enhance more precise and less invasive surgical therapy, significantly improving clinical outcomes and reducing inpatient hospital stays.

Summary
ML and AI can analyse large datasets and recognize complex patterns and thus have the potential to enhance diagnostic accuracy, preop planning for thoracic surgery, and optimize surgical treatment strategies, antibiotic therapy, antibiotic stewardship, monitoring complications, and long-term patient management outcomes.
Incidence of Sexually Transmitted Infections and Pregnancy Among Adolescents Experiencing Sex Trafficking
Authors: Ficker Whitney , Ehrhardt-Humbert Lauren , Reynolds Stacy 
Published: December 2024

Objective:
There is a lack of data regarding the incidence of sexually transmitted infections (STIs) and pregnancy among adolescents experiencing sex trafficking. This study aimed to determine the incidence proportion of STIs and pregnancy among adolescents evaluated for sex trafficking at an urban tertiary children's hospital compared to the community adolescent population.

Methods:
This retrospective, cross-sectional study looked at adolescents aged 11 to 21 years experiencing sex trafficking from March 2019 to March 2022. Data were abstracted from the hospital's human trafficking advocacy team database and the electronic medical record (EMR), including demographics, type and setting of trafficking, presenting complaints, and STI and pregnancy test results. Using Fisher's exact test, the incidence of STIs and pregnancy among adolescents experiencing sex trafficking was compared to adolescents in the community using local county health department data.

Results:
Fifty-four patients met the eligibility criteria. Females comprised 93% (n = 50) of the group. The average age was 16 years. The racial demographics most represented were African American at 56% (n = 30) and White at 30% (n = 16). History of abuse prior to trafficking was found in 78% (n = 42). Incidence proportions of STIs, compared to county health data, are as follows: 64.8% for Chlamydia trachomatis (CT) versus 7.8% (OR, 22; 95% CI, 12–40), 51.9% for Neisseria gonorrhoeae (GC) versus 2.2% (OR, 47; 95% CI, 26–83), 9.3% for syphilis versus 0.1% (OR, 111; 95% CI, 34–283), and 5.6% for HIV versus 0.1% (OR, 83; 95% CI, 16–261). There was a high individual cumulative incidence of STIs among patients over time, and patients presented with a variety of presenting complaints. The incidence proportion for pregnancy was 11.1% compared to 1.3% (OR, 10; 95% CI, 3–22).

Conclusions:
Adolescents experiencing sex trafficking have a significantly higher rate of STIs and pregnancy than the community adolescent population.
Impact of Preoperative Lacrimal Sac Morphology on Postoperative Rhinostomy Shape and Prognosis in Endoscopic Dacryocystorhinostomy
Authors: Lim Kyungsu , Lee Shin Hyo , Roh Hong Gee , Shin Hyun Jin 
Published: December 2024

Purpose:
To determine the association between the preoperative shape of the lacrimal sac and the postoperative shape of a rhinostomy in patients undergoing endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction.

Material and Methods:
This retrospective study involved 180 cases among 129 patients. Preoperative dacryocystography (DCG) classified lacrimal sacs into constricted or cylindrical types based on their width relative to the nasolacrimal duct. Postoperative rhinostomy shapes were categorized into flat, ladle, and ice-scoop types according to the presence and visibility of borders between the lacrimal sac and nasal mucosa. Anatomic success required patency as verified by syringing, whereas functional success required the complete resolution of epiphora.

Results:
The 180 cases comprised 46 (25.7%) and 134 (74.3%) classified as constricted and cylindrical preoperative shapes, respectively. There were 24 flat, 92 ladle, and 64 ice-scoop types of rhinostomies observed postoperatively. The preoperative DCG shape influenced the postoperative rhinostomy shape, with constricted sacs more frequently resulting in flat-shaped rhinostomies, and cylindrical sacs more frequently resulting in ice-scoop-shaped rhinostomies. Functional success was more common in cylindrical and ladle-type sacs than in constricted types (P<0.001), and lower for flat-shaped rhinostomy than for the ladle and ice-scoop shapes (P=0.003).

Conclusions:
Lacrimal sac characteristics play a prominent role in determining the postoperative rhinostomy shape that is particularly relevant to functional outcomes. A preoperative cylindrical lacrimal sac and postoperative ice-scoop-shaped rhinostomy are predictive of functional success after endoscopic DCR. These observations will be crucial in creating a surgical plan and monitoring the postoperative rhinostomy configuration.
Residents' Exposure to Obstetric Anal Sphincter Injury: A 16-Year Temporal Trend
Authors: Pfeuti Courtney K. , Gugerty Lindsay , Occhino John A. , Chauhan Suneet P. 
Published: December 2024

Importance
Exposure to the surgical management of obstetric anal sphincter injuries (OASIS) is limited during obstetrics training.

Objectives
The objective of this study was to quantify residents' exposure to OASI repair during 4-year obstetrics and gynecology (OBGYN) residency and examine temporal trends over a 16-year period.

Study Design
This was a retrospective cohort study of residents' exposure to OASIS at a community academic hospital from 2007 to 2022. Individuals with documented OASIS (third- or fourth-degree laceration) by International Classification of Diseases, Ninth and Tenth Revisions, codes during vaginal delivery (VD), spontaneous vaginal delivery (SVD), or operative vaginal delivery (OVD), were included. Delivery rates and OBGYN resident positions were examined. Temporal trends in OASIS were analyzed in 4-year epoch to determine average resident exposure during OBGYN residency.

Results
During the 16-year study period, there were 103,234 deliveries (62% VD, 4% OVD, 34% cesarean delivery). Among VDs, there were 2,344 (3.4%) OASIS with 88.5% classified as third-degree and 11.5% as fourth degree. The OASI rate decreased from 4.2% (2007–2010) to 2.9% (2019–2022), whereas OBGYN residents increased by 49% (67 to 99; P < 0.001). Average resident exposure to OASIS decreased from 11 (2007–2010) to 5 (2019–2022; P = 0.55). Subclassification revealed that residents were exposed to 5 third-degree repairs and less than 1 fourth-degree repair, on average, during 2019–2022.

Conclusions
During 4 years of training, average resident exposure was to 7 OASIS, 6 third degree, and 1 fourth degree. Limited exposure to OASIS during residency may be detrimental, as surgical treatment is a complicated yet essential obstetric procedure that carries significant risk of patient morbidity and potential long-term sequelae. Therefore, reliance on supplementation with simulation may improve surgeon competence in OASI management.