bluuebunny/crossref_metadata_2025_split huggingface dataset:
5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease
Authors: Searle Tamara , Al-Niaimi Firas , Ali Faisal R. 
Published: February 2021

BACKGROUND
5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported.

OBJECTIVE
We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease.

METHODS
We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance.

RESULTS
We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas).

CONCLUSION
In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.
Identification and Validation of Anaphylaxis Using Electronic Health Data in a Population-based Setting
Authors: Bann Maralyssa A. , Carrell David S. , Gruber Susan , Shinde Mayura , Ball Robert , Nelson Jennifer C. , Floyd James S. 
Published: February 2021

Background:
Anaphylaxis is a life-threatening allergic reaction that is difficult to identify accurately with administrative data. We conducted a population-based validation study to assess the accuracy of ICD-10 diagnosis codes for anaphylaxis in outpatient, emergency department, and inpatient settings.

Methods:
In an integrated healthcare system in Washington State, we obtained medical records from healthcare encounters with anaphylaxis diagnosis codes (potential events) from October 2015 to December 2018. To capture events missed by anaphylaxis diagnosis codes, we also obtained records on a sample of serious allergic and drug reactions. Two physicians determined whether potential events met established clinical criteria for anaphylaxis (validated events).

Results:
Out of 239 potential events with anaphylaxis diagnosis codes, the overall positive predictive value (PPV) for validated events was 64% (95% CI = 58 to 70). The PPV decreased with increasing age. Common precipitants for anaphylaxis were food (39%), medications (35%), and insect bite or sting (12%). The sensitivity of emergency department and inpatient anaphylaxis diagnosis codes for all validated events was 58% (95% CI = 51 to 65), but sensitivity increased to 95% (95% CI = 74 to 99) when outpatient diagnosis codes were included. Using information from all validated events and sampling weights, the incidence rate for anaphylaxis was 3.6 events per 10,000 person-years (95% CI = 3.1 to 4.0).

Conclusions:
In this population-based setting, ICD-10 diagnosis codes for anaphylaxis from emergency department and inpatient settings had moderate PPV and sensitivity for validated events. These findings have implications for epidemiologic studies that seek to estimate risks of anaphylaxis using electronic health data.
Acute pain after serratus anterior plane or thoracic paravertebral blocks for video-assisted thoracoscopic surgery
Authors: Qiu Yuwei , Wu Jingxiang , Huang Qi , Lu Yungang , Xu Meiying , Mascha Edward J. , Yang Dongsheng , Ince Ilker , Sessler Daniel I. 
Published: February 2021

BACKGROUND
Serratus anterior plane blocks (SAPBs) and thoracic paravertebral blocks (TPVBs) can both be used for video-assisted thoracic surgery. However, it remains unknown whether the analgesic efficacy of a SAPB is comparable to that of a TPVB.

OBJECTIVE
We tested the primary hypothesis that SAPBs provide noninferior analgesia compared with TPVBs for video-assisted thoracic surgery.

DESIGN
A noninferiority randomised trial.

SETTING
Shanghai Chest Hospital, between August 2018 and November 2018.

PATIENTS
Ninety patients scheduled for video-assisted thoracic lobectomy or segmentectomy were randomised. Patients were excluded if they were unable to perform the visual analogue pain scale, or surgery was converted to thoracotomy.

INTERVENTIONS
Blocks were performed after induction of general anaesthesia. The three groups were paravertebral blocks (n = 30); serratus anterior plane blocks (n = 29); and general anaesthesia alone (n = 30).

PRIMARY OUTCOME MEASURES
Visual analogue pain scores (0 to 10 cm) at rest and while coughing, and Prince-Henry pain scores (0 to 4 points) were used to assess postoperative analgesia at 2, 24 and 48 h after surgery. We assessed the noninferiority of SAPBs with TPVBs on all three primary pain outcomes using a delta of 1 cm or one point as appropriate.

RESULTS
The mean difference (95% confidence intervals) in visual analogue scores between the SAPBs and TPVBs was −0.04 (−0.10 to 0.03) cm at rest, −0.22 (−0.43 to −0.01) cm during coughing and −0.10 (−0.25 to 0.05) for Prince-Henry pain scores. As the upper limit of the confidence intervals were less than 1 (all P < 0.001), noninferiority was claimed for all three primary outcomes. Compared with general anaesthesia alone, the VAS scores at rest and while coughing, and the Prince-Henry pain scores for the two blocks were significantly lower during the initial 2 h after surgery.

CONCLUSIONS
Serratus anterior plane blocks are quicker and easier to perform than paravertebral blocks and provide comparable analgesia in patients having video-assisted thoracic surgery. Both blocks provided analgesia that was superior to general anaesthesia alone during the initial 2 h after surgery.

TRIAL REGISTRATION
Chinese Clinical Trial Registry, identifier: ChiCTR1800017671.
Detailed Case Reports of Surgical Treatment for Intraneural Ganglion Cysts
Authors: Ruiz Samuel , McCoy James , Pulikkottil Benson , Cheng Jonathan 
Published: February 2021

Background:
Intraneural ganglion cysts are nonneoplastic mucinous cysts that form by the accumulation of thick mucinous fluid in the epineurium of peripheral nerves. Symptoms arise from mechanical compression of adjacent nerve fascicles from the intraneural ganglion cyst, and include local or radiating pain, paresthesias, weakness, and muscle atrophy.

Methods:
Retrospective review of three cases of symptomatic intraneural ganglion cysts affecting the upper and lower extremity.

Results:
In our cases, the intraneural ganglion cysts were completely decompressed with resection of the articular branches, leading to improvement in the patient’s symptoms.

Conclusions:
Treatment of intraneural ganglion cysts requires an understanding of the underlying anatomy and pathophysiology; accurate early diagnosis is important and can lead to timely treatment and better outcomes.
Adenoid Cystic Carcinoma Developed from the Parotid Gland to the Ear Lobe of a Young Woman
Authors: Nojiri Gaku , Kamimori Tomoki , Uchiyama Mizuki , Tomyo Rei , Suga Yasushi , Takamori Kenji , Higo Ryuzaburo , Hayashi Ayato 
Published: February 2021

Summary:
Adenoid cystic carcinoma (ACC) is a relatively rare malignant tumor. It is more common in women than in men and typically develops in the lacrimal, salivary, and breast glands. ACC of the external auditory canal (EAC) is exceedingly rare, and its invasion into the ear lobe is even more unusual. In this report, we present a case of ACC that presented as a mass on the surface of the ear lobe in a 28-year-old woman and was initially diagnosed as infected atheroma. For wide resection of the tumor, half of the entire auricula was resected and superficial parotidectomy was performed. After confirming no tumor cells on the surface of the facial nerve, the defect was reconstructed by the combination of platysma muscle flap to prevent Frey syndrome and free forearm flap for the ear lobe form. There was no recurrence or metastasis of the tumor, and Frey syndrome did not occur at 2 years and 8 months after surgery. The patient was satisfied with the result, oncologically and cosmetically. Even in young patients, comprehensive treatments (including diagnosis, resection, and reconstruction) are important in painful ear lobe masses.
Long-term Improvements of Neuroplasty and Scalene Muscle Resection in LTN-injured Winged Scapula Patients
Authors: Nath Rahul K. , Somasundaram Chandra 
Published: February 2021

Background:
Injuries to the long thoracic nerve, which directly branches off of the C6, C7, and C8 brachial plexus nerve roots, can cause scapular winging and affect shoulder movements. Long thoracic nerve injuries resulting from accidents, violence, or overuse can be severe lesions requiring challenging surgeries. We evaluated the long-term functional outcomes of neuroplasty and the scalene muscle resection procedures in patients with long thoracic nerve injury and winging scapula.

Methods:
All 15 patients who underwent scalene muscle resection with decompression and neurolysis of the long thoracic nerve in a single institution to treat winged scapula and limited shoulder movements between March 2007 and May 2020 with follow-up over 2 years were included in the study.

Results:
Shoulder abduction and arm flexion improved significantly to 158 ± 52 degrees and 165 ± 53 degrees from a mean of 108 ± 54 degrees and 104 ± 52 degrees (P < 0.02) over 2 years after surgery (mean 3.4 years). Overall, there was a significant reduction in the scapular winging, as assessed by estimating the decrease in the angle between the scapular plane and the posterior chest wall. The extent of the score greatly improved post-surgically from a mean of 1.2 ± 0.4 to 3.5 ± 0.9 (range 1–4; 1—severe, 2—moderate, 3—mild, and 4—minimal) (P < 0.01).

Conclusion:
The improvement in shoulder movements and reduced scapular winging was significant and stable over 2 years of surgery in 81% of our study patients.
Acromioclavicular Joint Cyst Treated with Excision and Anterolateral Thigh Flap Reconstruction
Authors: Hattori Yoshitsugu , Imai Shoichi , Nakamura Hara Runa , Niu Atsushi 
Published: February 2021

Summary:Acromioclavicular joint (ACJ) cysts are a rare clinical entity that can impair patients’ cosmetic appearance as well as activities of daily living. Both nonsurgical and surgical treatments are available, but nonsurgical treatments are often associated with a high recurrence rate. Surgical excision can provide resolution of patients’ symptoms, but excision of the cyst as monotherapy is also associated with recurrence. Therefore, various surgical techniques to prevent recurrence have been described, but there is no general consensus regarding the appropriate surgical methods. We describe the case of an 81-year-old man with a recurrent ACJ cyst. The cyst had been excised twice, but it recurred shortly after the excisions. We performed surgical resection and anterolateral thigh (ALT) flap reconstruction. The deteriorated ACJ capsule was repaired with durable fascia lata and the defect after tumor excision was obliterated with an ALT flap harvested from the same donor site as fascia lata. On the 12-month follow-up, the patient had no recurrence of the ACJ cyst. Our case suggests that excision of ACJ cysts as monotherapy is likely to fail, and fascia lata patch for durable ACJ capsule reconstruction can be a viable alternative preventing cyst recurrence.
Reconstruction of E. coli Osteomyelitis of Costa: A Case Report
Authors: Yamashita Teruyo , Arata Jun , Kumakiri Masanori , Kaito Shuko , Yoon Yong 
Published: February 2021

Summary:
We report a case of E. coli osteomyelitis of the ribs in an immunocompetent 66-year-old man. After radical surgical debridement, bone and soft-tissue defects were covered with a rectus abdominis muscle flap. The postoperative course was uneventful, and there was no recurrence of chest symptoms. Among the various types of osteomyelitis, Gram-negative bacteria such as E. coli osteomyelitis is a relatively rare disease. Osteomyelitis is known to supervene in trauma or postoperative infection and to frequently begin with cellulitis, vascular access, endocarditis, or urinary tract infection, which spreads through the blood to the bone. To add to the difficulty of making a correct diagnosis, the early symptoms of osteomyelitis are often non-specific. We should never forget osteomyelitis in the differential diagnosis of these antecedent infections.
The Impact of Progestin-only Contraception on Adolescents with Macromastia
Authors: Nuzzi Laura C. , Pramanick Tannishtha , Massey Gabrielle G. , Walsh Landis R. , McNamara Catherine T. , Firriolo Joseph M. , DiVasta Amy D. , Labow Brian I. 
Published: February 2021

Background:
Progestin-only contraception has become increasingly popular among adolescents. However, patients, parents, and providers share concerns regarding the potential impact that progestin-only contraception may have on breast growth. We sought to explore the impact of progestin-only contraception on breast hypertrophy and symptomatology in adolescents with macromastia.

Methods:
Patients between the ages of 12 and 21 years undergoing reduction mammaplasty were prospectively assessed for baseline and postoperative breast symptomatology and medication use. The medical records of female controls within the same age range were retrospectively reviewed.

Results:
A total of 378 participants with macromastia and 378 controls were included in analyses. A higher proportion of controls used progestin-only methods compared with participants with macromastia (28.0% versus 5.3%, P < 0.001). The most commonly prescribed methods were the depot medroxyprogesterone acetate injection (31.0%), levonorgestrel-containing intrauterine device (31.0%), and subdermal implant (26.2%). Patients with macromastia who used progestin-only contraception had a greater amount of breast tissue resected during reduction mammaplasty (P = 0.04), reported greater musculoskeletal pain (P = 0.008), and were roughly 500% more likely to experience breast pain (odds ratio, 4.94; 95% confidence interval, 1.58–15.47; P = 0.005) than those with macromastia who never used hormonal contraception.

Conclusions:
Adolescents with macromastia who use progestin-only contraception may have greater breast hypertrophy and worse breast and musculoskeletal pain. When appropriate, providers may wish to consider other contraception methods for patients who are at-risk for breast hypertrophy or those who suffer from macromastia-related symptoms.
Intrastromal Allogeneic Inclusions for the Management of Keratoconus: A Review of Current Literature
Authors: García de Oteyza Gonzalo , Benedetti Sandner Mónica , Velazco Casapía Jorge , Triviño Carmen , Salvador-Culla Borja , García-Albisua Ana Mercedes 
Published: February 2021

Abstract:A new therapeutic alternative has been developed in the past 6 years to treat severe keratoconus in young patients. Those patients had only corneal transplantation as an option, but now a variety of surgical alternatives in the form of allogeneic corneal inclusions have bloomed and are becoming more popular. Although Bowman layer transplantation is the most studied technique, recent studies have described different options with very promising preliminary results. Mostly all the techniques described improve corneal curvature, visual acuity, pachymetry, contact lens tolerance, and foremost, manage to avoid or postpone corneal transplantation. Very few complications have been described so far, which makes these techniques not only feasible but also safe. Herein, we focus on reviewing recently published studies describing these techniques and their first results.
Supra-Descemetic Venting Incision in the Management of Spontaneous Descemet Membrane Detachment in an Old Penetrating Keratoplasty Graft
Authors: Ramakrishnan Seema , Devarajan Sathish , Srinivasan Muthiah , Karunakaran Vanishree 
Published: February 2021

Purpose:
To report a case of late spontaneous detachment of Descemet membrane (DM) in a donor penetrating keratoplasty (PKP) graft and its successful management using a supra-Descemetic venting incision combined with gas descemetopexy.

Methods:
Case report with review of literature.

Results:
A 56-year-old man who had undergone PKP after acute hydrops in pellucid marginal degeneration 27 years before presentation experienced sudden onset vision loss. Clinical features mimicked acute graft rejection but detailed evaluation and anterior segment optical coherence tomography showed a DM detachment (DMD) of the graft. Ten weeks after the onset of DMD, he underwent descemetopexy with a supra-Descemetic stromal venting incision and sulfur hexafluoride gas tamponade. DM reattached with complete resolution of graft edema.

Conclusions:
Late spontaneous DMD of the graft after PKP is very uncommon and must be differentiated from acute graft rejection. Anterior segment optical coherence tomography may help to diagnose this entity that can be managed successfully despite late intervention. The addition of a venting incision that drains fluid from the supra-Descemetic space can increase the chance of success of descemetopexy when compared with descemetopexy with air or gas alone.
Associated Neurotrophic Keratopathy in Complex Regional Pain Syndrome
Authors: Soifer Matias , Gomez-Caraballo Maria , Venkateswaran Nandini , Jay Gary W. , Perez Victor L. 
Published: February 2021

Purpose:
To report a case of neurotrophic keratopathy (NK) in a patient with complex regional pain syndrome (CRPS) with ipsilateral facial involvement.

Methods:
Case report.

Results:
An 18-year old woman with a 5-year history of CRPS type I, a systemic disorder with a neuropathic component with associated limb and right facial involvement, presented with an insidious onset of blurred vision and pain in the right eye. Ocular examination revealed decreased corneal sensation, as measured by Cochet–Bonnet testing, associated with recurrent epithelial defects and whorl-like superficial corneal epitheliopathy. NK was suspected and confirmed by in vivo confocal microscopy (IVCM), which revealed rarefaction of the subbasal nerve plexus in the affected eye. To enhance corneal nerve health, plasma rich in growth factors drops were used. Persistence of NK prompted a superficial keratectomy with placement of an amniotic membrane graft and a course of cenegermin 0.002% (Oxervate; Dompé Farmaceutici SpA, Italy) in the postoperative period. This combination therapy resulted in successful epithelial closure and vision improvement after 8 weeks of therapy with no recurrence of disease for 11 months. Importantly, at that final visit, IVCM demonstrated growth of corneal nerves for the first time in this patient.

Conclusions:
This is the first case report of NK occurring in the context of CRPS, a neuropathy with ipsilateral facial pain involvement. IVCM was important in the diagnosis of NK, which responded successfully to ocular surface treatments focused on nerve health stimulation that ultimately resulted in corneal nerve growth.
Standalone iStent Trabecular Micro-bypass Glaucoma Surgery: A Systematic Review and Meta-Analysis
Authors: Healey Paul R. , Clement Colin I. , Kerr Nathan M. , Tilden Dominic , Aghajanian Lara 
Published: February 2021

Precis:
Standalone trabecular micro-bypass glaucoma surgery with the iStent devices is associated with clinically relevant reductions in intraocular pressure (IOP) sustained over a reasonably long-term while simultaneously reducing medication burden and a relatively favorable safety profile.

Purpose:
While there is a relatively large body of evidence supporting the implantation of the iStent trabecular micro-bypass devices during phacoemulsification in patients with open-angle glaucoma (OAG), its efficacy as a standalone procedure has been less widely reported. The aims of this study were to systematically identify and quantitatively evaluate the efficacy of iStent devices (iStent and iStent inject) when performed independently of cataract surgery in patients with OAG.

Methods:
A systematic review of the literature was undertaken in August 2019 to identify studies of standalone trabecular micro-bypass glaucoma surgery with iStent devices in patients with OAG. All randomized trials were considered and nonrandomized studies that included at least 6 months of follow-up or more than 10 eyes. Key efficacy analyses included postoperative IOP and medication use, which were used to evaluate weighted mean differences from baseline, and the proportion of eyes free of ocular medication. Postoperative adverse events were descriptively summarized.

Results:
A total of 13 studies were identified including 4 randomized controlled trials and 9 nonrandomized or single-arm studies providing data for 778 eyes. In eyes implanted with iStent devices, a weighted mean IOP reduction of 31.1% was observed at 6 to 12 months. In studies reporting longer-term outcomes (36 to 48 mo or 60 mo), the weighted mean IOP reduction was 30.4% and 32.9%, respectively. The pooled weighted mean reduction in IOP from baseline across all studies at 6 to 12 months and 36 to 60 months poststent implantation was 7.01 mm Hg (95% confidence interval: 5.91, 8.11) and 6.59 mm Hg (95% confidence interval: 5.55, 7.63), respectively. Medication burden was reduced by ~1.0 medication at 6 to 18 months and 1.2 medications at 36 to 60 months. Adverse events reported in more than 5% of participants were progression of pre-existing cataract/cataract surgery and loss of best-corrected visual acuity but these rates were no different to those reported in comparator medical therapy study arms.

Conclusions:
The results from these studies support the independent effect of the iStent trabecular bypass devices on IOP and medication burden over a duration of follow-up of up to 5 years.
Changes in Corneal Biomechanics and Glaucomatous Visual Field Loss
Authors: Chan Eric , Yeh Kaileen , Moghimi Sasan , Proudfoot James , Liu Xiongfei , Zangwill Linda , Weinreb Robert N. 
Published: February 2021

Precis:
A lower baseline corneal hysteresis and a decrease in corneal resistance factor (CRF) over time are associated with higher risk of visual field progression in glaucomatous and glaucoma suspect eyes.

Purpose:
The aim was to investigate the longitudinal change in CRF and cornea hysteresis (CH) as risk factors for visual field progression.

Materials and Methods:
In this prospective observational cohort study, 72 eyes of 48 glaucoma or glaucoma suspect patients were followed for an average of 4.5 years. Baseline and follow-up CH and CRF measurements were performed with the Ocular Response Analyzer (Reichert Ophthalmic Instruments Inc., Depew, N.Y.). Evaluation of rates of visual field change during follow-up was performed using visual field mean deviation. Univariable and multivariable linear mixed models assessed the relationship of visual field progression with baseline CRF and CH as well as with changes in CRF and CH.

Results:
The mean baseline CH was 9.0 (95% confidence interval: 8.6-9.4)  mm Hg and the mean baseline CRF was 9.3 (95% confidence interval: 8.8-9.9) mm Hg. There was no statistically significant difference in average CH and CRF measurements over time. In multivariable modeling adjusting for age, race, and mean intraocular pressure during follow-up, each 1 mm Hg lower in baseline CH and 1 mm Hg decrease in CRF over time were associated with a 0.12 (P=0.042) and 0.14 dB/year (P=0.007) faster rate of visual field mean deviation loss, respectively. Similar findings were found in glaucoma eyes but not found in glaucoma suspect eyes.

Conclusion:
Visual field progression was associated with a lower baseline CH and a decrease in CRF over time. Assessment of corneal resistance and elasticity at baseline and during follow-up examinations should be considered to identify those eyes at highest risk of visual field progression.