bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flexible Intramedullary Nail Fixation With Supplemental External Fixator for Unstable Pediatric Femur Fractures: A Case Series
Authors: Hayashi Brooke , Shahbazian Jonathan H. , Loveland Kerry , Gerardi Joseph A. 
Published: October 2021

Introduction:
Flexible intramedullary nail fixation (FIN) has become the preferred mode of treatment for femur fractures in elementary school aged children. One clear limitation of FIN is the inability to control length unstable femur fractures. This case series evaluates radiographic union rates, fracture alignment, and postoperative complications for a novel technique of FIN and adjunct external fixation in length unstable femur fractures.

Materials and Methods:
A retrospective chart review was performed using current procedural terminology coding to identify 10 pediatric femur fractures utilizing flexible nail fixation with supplemental external fixation in length unstable femur fractures. Electronic medical records were used to obtain demographic information and length of operative time. A picture archiving and communication system was utilized to review radiographs.

Results:
Combined FIN fixation and supplemental external fixation were used in ten pediatric patients with length unstable femur fractures. The average age at time of injury was 6.4 years (range: 3 to 8 years). The average duration of external fixation was 30 days with no pin site complications including infection or refracture. Average time to union was 54 days with no radiographic loss of reduction. There were no documented intraoperative or postoperative complications.

Conclusions:
The cases reviewed in this study support that in addition to FIN fixation for unstable pediatric femur fractures, a supplemental external fixator provides a viable option with all fractures obtaining union, acceptable alignment, no loss of reduction, and no postoperative complications. This technique may provide another tool in the orthopedist armamentarium and possibly as an alternative to submuscular plating.
Graft Thickness at 6 Months Postoperatively Predicts Long-Term Visual Acuity Outcomes of Descemet Stripping Automated Endothelial Keratoplasty for Fuchs Dystrophy and Moderate Phakic Bullous Keratopathy: A Cohort Study
Authors: Perone Jean-Marc , Goetz Christophe , Zevering Yinka , Derumigny Alexis , Bloch Florian , Vermion Jean-Charles , Lhuillier Louis 
Published: October 2021

Purpose:
It remains unclear whether preoperative central graft thickness (CGT) contributes to visual outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK). This retrospective cohort study examined the ability of preoperative and postoperative CGT to predict 12-month best spectacle–corrected visual acuity (BSCVA) after DSAEK for Fuchs endothelial corneal dystrophy/moderate pseudophakic bullous keratopathy/second graft.

Methods:
All consecutive patients who underwent DSAEK in 2015 to 2018 were included. The primary end point was 12-month BSCVA. DSAEK-CGT was measured preoperatively and 6 times between postoperative day 8 and month 12. Eyes were divided according to preoperative CGT 130 μm (ultrathin-DSAEK threshold) or 6-month postoperative CGT 100 μm (mean 6-month postoperative DSAEK-CGT). The t test assessed CGT evolution of the 4 groups over time. Multivariate analyses examined whether preoperative CGT or 6-month CGT categories predicted 12-month BSCVA. Multivariate analysis assessed the preoperative/perioperative factors that predicted 6-month CGT.

Results:
A total of 108 eyes (68 patients) underwent DSAEK. Preoperative CGT was >130 and ≤130 μm in 87 and 21 eyes, respectively. Postoperative CGT was >100 and ≤100 μm in 50 and 58 eyes, respectively. Thin 6-month postoperative grafts thinned significantly more relative to preoperative thickness than thick grafts (P < 0.001). Preoperative CGT subgroups did not show this difference. Six-month postoperative CGT (P = 0.01), but not preoperative CGT, predicted 12-month BSCVA. Preoperative CGT strongly predicted 6-month CGT (P = 0.0003).

Conclusions:
Postoperative, but not preoperative, DSAEK-CGT predicted 6-month BSCVA. The correlation between preoperative and postoperative CGT and interstudy variation in preoperative CGT measurement accuracy may explain literature disparities regarding the importance of preoperative CGT in DSAEK outcomes.
Clinical Factors for Determining the Severity of Lid Wiper Epitheliopathy in Dry Eye
Authors: Kato Hiroaki , Yokoi Norihiko , Watanabe Akihide , Komuro Aoi , Sonomura Yukiko , Sotozono Chie , Kinoshita Shigeru 
Published: October 2021

Purpose:
Lid wiper epitheliopathy (LWE) is an epitheliopathy of the marginal conjunctival portion of the eyelids that wipes the ocular surface during blinking. Although LWE is often observed in patients with dry eye, the factors determining LWE severity in dry eye remain unknown. Therefore, we investigated the relationship between LWE, tear abnormalities, and blinks in dry eye.

Methods:
This study involved 76 eyes of 76 female patients with dry eye (mean age: 57.2 yrs). In all eyes, tear meniscus radius, spread grade (SG) of the tear film lipid layer (ie, SG 1–5, with 1 being the best), fluorescein breakup time (FBUT), fluorescein breakup pattern, corneal and bulbar conjunctival epithelial damage (CED: 15 points maximum; CjED: 6 points maximum, respectively), upper eyelid LWE grade (3 points maximum), and Schirmer 1 test were evaluated. Blink rate, palpebral aperture height, upper eyelid opening/closing-phase amplitude, upper eyelid opening/closing-phase duration, and upper eyelid opening/closing-phase maximum velocity were measured by the use of a custom-made high-speed blink analyzer. Finally, the factors that determine the LWE grade were investigated by multiple regression analysis, in which the parameters were chosen using the stepwise procedure.

Results:
Significant correlations were found between LWE grade and tear meniscus radius, SG, FBUT, CED, CjED, and Schirmer 1 test (P < 0.002). LWE grade was found to be described as −0.001 + (0.283 × SG) − (0.253 × FBUT) + (0.003 × upper eyelid closing-phase maximum velocity) (R2 = 0.57, P < 0.0001). The prevalence and grade of LWE were significantly higher in aqueous deficient dry eye.

Conclusions:
Tear volume, tear film stability, and blink should be considered as factors for determining LWE severity.
Central Toxic Keratopathy in Siblings After Laser-Assisted Keratomileusis: Case Report and Literature Review
Authors: Yim Cindi K. , Zhu Dagny 
Published: October 2021

Purpose:
The purpose of this study was to report an isolated case of 2 siblings who developed central toxic keratopathy (CTK) after undergoing laser-assisted keratomileusis (LASIK) on the same day.

Methods:
This was a case report and literature review.

Results:
Two sisters with no significant medical history underwent uncomplicated LASIK on the same day. Postoperative day 1 slitlamp examination findings were unremarkable. One week later, both patients returned for routine examination and were found to have a reduction in visual acuity, hyperopic shift, bilateral central opacification at the interface, and characteristic posterior stromal “mud cracks” or macrostriae most consistent with the entity CTK. The patients reported only mild ocular discomfort with minimal signs of inflammation. None of the other LASIK patients from the same surgery day nor any previous or following days thereafter developed any complications. The siblings were closely followed and treated with a short course of prophylactic topical antibiotics and rapid steroid taper, along with aggressive lubrication and long-term systemic treatment including oral doxycycline, vitamin C, and coenzyme Q10. Three months later, both patients had resolution of CTK with an uncorrected visual acuity of 20/20 or better in both eyes.

Conclusions:
CTK is a rare, noninflammatory but potentially sight-threatening entity most commonly associated with excimer laser ablation procedures. Its pathophysiology is poorly understood but likely multifactorial. Its isolated presentation in this case of 2 siblings suggests a possible underlying genetic predisposition, which has not been previously described. With careful monitoring and early supportive treatment, patients can have a complete and rapid resolution.
Best Indicators for Detecting Keratoconus Progression in Children: A Report From the Shahroud Schoolchildren Eye Cohort Study
Authors: Hashemi Hassan , Panahi Parsa , Asgari Soheila , Emamian Mohammad Hassan , Mehravaran Shiva , Fotouhi Akbar 
Published: October 2021

Purpose:
The purpose of this study was to investigate 3-year changes in keratoconus (KC) indices to determine the indicators of KC progression compared with age-related changes in children aged 6 to 12 years.

Methods:
In this report of the Shahroud Schoolchildren Eye Cohort Study, KC was diagnosed based on vision, refraction, tomography, and slitlamp examination findings. KC progression was defined as changes in refractive astigmatism or zonal maximum keratometry (Zonal Kmax-3 mm). Then, 3-year changes (Δ) in vision, refraction, and tomographic indices were compared between progressive KC and normal eyes. The best set of ∆parameters for distinguishing KC progression from age-related changes were determined using the area under curve (AUC).

Results:
Eighteen KC eyes and 10,422 normal eyes were analyzed. All KC cases showed progression after 3 years. Δindices were statistically different between the 2 groups except corrected distance visual acuity, anterior radius of curvature, irregularity index, and KC percentage index. The best Δindices, in descending order of AUC value, were index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry (all AUC > 0.9), followed by inferior–superior asymmetry, index of surface variance, minimum corneal thickness, index of height asymmetry, KC index, posterior radius of curvature, and Belin/Ambrósio total Deviation (AUC = 0.8–0.9).

Conclusions:
According to our findings, changes in index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry are the best indices for detecting KC progression in children younger than 12 years.
Otoplasty: a modified Chong-Chet technique with positive long-term results
Authors: Jović Darko , Preradović Ljubiša , Guzijan Aleksandar 
Published: October 2021

Abstract

Background:
In the last few decades, many techniques have been developed to correct prominent ear deformities. Modified Chong-Chet otoplasty represents a new and improved classical Chong-Chet procedure for prominent ear surgery. This study evaluates and compares the long-term results of standard Chong-Chet otoplasty with the modified technique.

Methods:
A retrospective study was conducted on patients undergoing otoplasty at the Special Hospital S-tetik Banja Luka between January 17, 2017, and February 5, 2019. The total number of patients undergoing the procedure was 129. The first group (48 patients) underwent otoplasty using the Chong-Chet technique, while the second group (81 patients) underwent a modified Chong-Chet procedure. All patients were randomly selected on the condition that the antihelix was absent.
The data were processed and analyzed using the Statistical Package for the Social Sciences version 24 using nonparametric tests (χ2 test, Mann–Whitney U test and Kruskal–Wallis test).

Results:
Every second patient was satisfied (19 patients were partially satisfied and five patients were completely satisfied) with the results of the classical Chong-Chet technique. Seven patients were neither satisfied nor dissatisfied, while 17 patients were dissatisfied (11 patients were completely dissatisfied and 6 patients were mostly dissatisfied). As for the modified method, on average, nine out of 10 patients (73 or 90.1%) were satisfied, of which 49 patients (60.5%) were completely satisfied and 24 patients (29.6%) were mostly satisfied.
The statistical significance was P < .05.
Research results point to the modified Chong-Chet technique being a significant improvement to the classical method.

Conclusion:
Modified Chong-Chet technique increases the number of positive long-term results and significantly improves the standard method.
Variant rs6749447 (T > G) in the serine threonine kinase gene is associated with cardiovascular complications, the Tampere adult population cardiovascular risk study
Authors: Kunnas Tarja , Määttä Kirsi , Nikkari Seppo T. 
Published: October 2021

Abstract
We have previously shown an association of STK39 (serine threonine kinase) rs6749447 (T > G) with hypertension in the Tampere adult population cardiovascular risk study in 50-year-old subjects. These 1196 subjects were followed up to the age of 65 years to determine whether rs6749447 is also associated with coronary artery disease (CAD), transient ischemic attack (TIA), or early cardiovascular death.
DNA samples were collected by buccal swabs and genotypes were determined by PCR. Hypertension, TIA, and CAD were determined by questionnaire and the National Hospital Discharge Registry. Outcomes for death were collected from the National Statistics Centre. Linkage disequilibrium analysis and gene expression correlations for rs6749447 were done in silico.
After following the subjects up to the age of 60 years the rs6749447 G-allele still associated with hypertension (P = .009). The variation did not associate with CAD (P = .959). The risk for TIA was 5.2-fold among G-allele carriers compared to TT genotype even after adjusting for body mass index (P = .036, 95% CI 1.11-24.59). After follow-up of the subjects to the age of 65 years, adjusting for body mass index, the G-allele was associated with 3.2-fold risk of premature cardiovascular death (P = .049, 95% CI 1.00-10.01).
In conclusion, the STK39 genetic variant rs6749447 was significantly associated with TIA and premature cardiovascular death in a Finnish cohort. The in silico results of linkage disequilibrium and gene expression analyses also showed associations that were distinct from the retention of salt effect on kidneys proposed earlier for this intronic variation.
Application of nanofat grafting to rescue a severe ischaemic hand with thromboangiitis obliterans
Authors: Ng Kwan Lok Benjamin , Hsieh Meng-Chien Willie , Lin Yun-Nan , Chen Rong-Fu , Lin Tsai-Ming , Lin Sin-Daw , Kuo Yur-Ren 
Published: October 2021

Abstract

Rationale:
Currently, there is no consensus regarding the best treatment for patients with thromboangiitis obliterans (TAO). Regenerative medicine, such as bone marrow stem cells or adipose-derived stem cell (ASC) transplantation, have proven efficacy in improving tissue perfusion and wound healing in clinical trials. In this case, we used nanofat grafting to treat severe conditions in a patient with TAO, with promising outcomes.

Patient concerns:
This is a case of a 48-year-old smoker who presented with cyanosis in both hands and the right foot, with gangrenous changes. Investigative angiography showed severe vasospasm in the radial and ulnar arteries of the patient's left hand. Progressive cyanosis of the patient's left hand was noted which may eventually require amputation if left untreated.

Diagnoses:
He was diagnosed with TAO under the Shionoya diagnostic criteria.

Interventions:
Fasciotomy and necrotic tissue debridement were performed, followed by centrifuged nanofat grafting. The nanofat graft was prepared using Pallua method and deployed with a MAFT-GUN (Dermato Plastica Beauty Co., Ltd., Kaohsiung, Taiwan).

Outcomes:
Three months later, computed tomography angiography revealed a radial artery patency. The patient's wrist function was preserved with uneventful wound healing.

Lessons:
The regenerative ability of centrifuged nanofat grafts not only helps wound healing but also helps reverse vasospasm and preserve remnant tissue perfusion.
Case Series: West African Crystalline Maculopathy
Authors: Morettin Christina E. , Ittner Erica A. 
Published: October 2021

SIGNIFICANCE
West African crystalline maculopathy is a rare crystalline maculopathy without a clear etiology. Although the crystals do not appear to be visually significant, there may be a role in the breakdown of the blood-retina barrier within the pathogenesis of this disorder.

PURPOSE
The purpose of this case series is to describe two cases of West African crystalline maculopathy. These crystals do not affect vision, nor visual function. Because there are only 39 other documented cases in the literature, it is imperative to understand the differences and similarities in this rare maculopathy.

CASE SERIES
Case 1 was a 65-year-old Black woman with a history of proliferative diabetic retinopathy after panretinal photocoagulation was seen for routine examination. She recently emigrated from Tema, Ghana. Examination revealed asymmetric macular crystals consistent with West African crystalline maculopathy and quiescent proliferative diabetic retinopathy. Case 2 was a 60-year-old Black woman that presented for routine examination. She recently emigrated from Nigeria. Examination revealed macular crystals consistent with West African crystalline maculopathy with evidence of stage 1 hypertensive retinopathy and extramacular drusen.

CONCLUSIONS
West African crystalline maculopathy is a rare disorder that should be considered in patients who present with asymptomatic foveal crystalline deposits who are immigrants from West African countries.
Association Rule Mining to Examine Predictors for the Outcome of Gait Rehabilitation Programs in Stroke Survivors
Authors: Yen Sheng-Che , Wang Xiaofan , Wang Inga , Corkery Marie B. , Chui Kevin K. , Chou Chun-An 
Published: October 2021

Abstract
This study presents a novel application of association rule data mining to determine the predictors of the response to locomotor training and home exercise for improving gait after stroke. The study was a secondary data analysis on the Locomotor Experience Applied Post Stroke Trial dataset. The association rule analysis was applied to analyze three interventions: (1) early locomotor training, (2) late locomotor training, and (3) home exercise program. The outcome variable was whether participants poststroke had greater than median improvement in the self-selected comfortable gait speed. Three types of predictors were investigated: (1) demographics, (2) behavioral and medical history, and (3) clinical assessments at baseline. Association rules were generated when they meet two criteria determined based on the data: 10% of support and 70% of confidence. The identified rules showed that the predictors of the response were different across the three interventions, which was inconsistent with the previous report based on traditional logistic regression. However, the rules were identified with high confidence but low support, indicating that they were reliable but did not appear often in the Locomotor Experience Applied Post Stroke Trial dataset. Further investigation of these rules with a larger sample size is warranted before applying them to clinical settings.
The Impact of Medicare Coverage on Downstream Financial Outcomes for Adults Who Undergo Surgery
Authors: Neiman Pooja U. , Mouli Vibav H. , Taylor Kathryn K. , Ayanian John Z. , Dimick Justin B. , Scott John W. 
Published: October 2021

Objective:
To evaluate the effects of gaining access to Medicare on key financial outcomes for surgical patients.

Summary Background Data:
Surgical care poses a significant financial burden, especially among patients with insufficient financial risk protection. Medicare may mitigate the risk of these adverse circumstances, but the impact of Medicare eligibility on surgical patients remains poorly understood.

Methods:
Regression discontinuity analysis of national, cross-sectional survey and cost data from the 2008 to 2018 National Health Interview Survey and Medical Expenditure Panel Survey. Patients were between the ages of 57 to 72 with surgery in the past 12 months. The primary outcomes were the presence of medical debt, delay/deferment of care due to cost, total annual out-of-pocket costs, and experiencing catastrophic health expenditures.

Results:
Among 45,982,243 National Health Interview Survey patients, Medicare eligibility was associated with a 6.6 percentage-point decrease (95% confidence interval [CI]: –9.0% to –4.3) in being uninsured (>99% relative reduction), 7.6 percentage-point decrease (24% relative reduction) in having medical debt (95%CI: –14.1% to –1.1%), and 4.9 percentage-point decrease (95%CI: –9.4% to –0.4%) in deferrals/delays in medical care due to cost (28% relative reduction). Among 33,084,967 Medical Expenditure Panel Survey patients, annual out-of-pocket spending decreased by $1199 per patient (95%CI: –$1633 to –$765), a 33% relative reduction, and catastrophic health expenditures decreased by 7.3 percentage points (95%CI: –13.6% to –0.1%), a 55% relative reduction.

Conclusions:
Medicare may reduce the economic burden of healthcare spending and delays in care for older adult surgical patients. These findings have important implications for policy discussions regarding changing insurance eligibility thresholds for the older adult population.
Prevalence of Myofascial Trigger Points in the First Dorsal Interosseous Muscle in Patients With Thumb Carpometacarpal Osteoarthritis Compared to Healthy Controls
Authors: Pedersini Paolo , López-Royo María Pilar , Herrero Pablo , Cantero-Tellez Raquel , Valdes Kristin , La Touche Roy , Fernández-Carnero Josué , Villafañe Jorge Hugo 
Published: October 2021

Objective:
To investigate the prevalence of first dorsal interosseous myofascial trigger point (MTrP) in patients with thumb carpometacarpal osteoarthritis (CMC OA).

Methods:
Fifty subjects participated in the study, 25 with thumb CMC OA and 25 without thumb CMC OA. Participants were examined to identify first dorsal interosseous MTrP through palpation. Visual analog scale and Pressure Pain Threshold were the primary outcomes.

Results:
In patients with thumb CMC OA, the prevalence of MTrPs was higher when compared with the nondominant hand (88% vs 64%) and higher when compared with control group (48% vs 44%).

Conclusions:
Prevalence of MTrP showed to be higher in the dominant hand of patients with thumb CMC OA than in the dominant hand of people without thumb CMC OA.
Active, Targeted, and Measured Device-Based Therapy for Low Back Pain With the David Spine Concept
Authors: Langella Francesco , Boido Edoardo , Basso Stefano , Bassi Camilla , Biber Zeno , Vanni Daniele , Damilano Marco , Berjano Pedro 
Published: October 2021

Background:
The David Spine Concept (DSC) device–based physical therapy for low back pain involves the quantitative assessment of lumbar muscle strength and range of motion. The study aims to determine the effectiveness of the DSC device–based therapy for low back pain.

Methods:
In this retrospective observational study, clinical data of 103 patients who underwent DSC device–based physiotherapy were reviewed. Pre- and posttreatment outcome measures for pain and disability were assessed.

Results:
Our results showed statistically significant improvement in terms of disability, pain, and functional status after physiotherapy.

Conclusion:
The DSC device–based therapy effectively relieved pain, improved function, and reduced disability in patients with low back pain.