bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Race for a COVID-19 Vaccine: Current Trials, Novel Technologies, and Future Directions
Authors: Brown Stav , Brown Tal , Cederna Paul S. , Rohrich Rod J. 
Published: April 2021

Summary:The Coronavirus Disease 2019 (COVID-19) pandemic has presented a major threat to public health worldwide alongside unprecedented global economic and social implications. In the absence of a “gold standard” treatment, the rapid development of a safe and effective vaccine is considered the most promising way to control the pandemic. In recent years, traditional vaccine technologies have seemed insufficient to provide global protection against the rapid spread of emerging pandemics. Therefore, the establishment of novel approaches that are independent of whole pathogen cultivation, cost-effective, and able to be rapidly developed and produced on a large scale are of paramount importance for global health. This article summarizes the current efforts to develop a COVID-19 vaccine, including the ongoing and future anticipated clinical trials. We also provide plastic and reconstructive surgeons with insight into the novel technologies currently utilized for COVID-19 vaccine development, focusing on the very promising viral-vector-based and gene-based vaccine technologies. Each platform has its own advantages and disadvantages related to its efficacy and ability to induce certain immune responses, manufacturing capacity, and safety for human use. Once the fundamental key challenges have been addressed for viral-vector-based and gene-based vaccines, these novel technologies may become helpful in winning the fight against COVID-19 and transforming the future of health care.
Assessing State Variation in Plastic Surgeons’ Risk of Hepatitis C Exposure: Revisit in Methodology
Authors: Hardy Kristen M. , Mullens Cody L. , Mason Aaron C. 
Published: April 2021

Background:
As the national opioid epidemic escalates, rates of the Hepatitis C (HCV) infection have similarly risen. Surgeons exposed intraoperatively secondary to sharp instrument or needle-sticks are affected both socioeconomically and physically. Current treatment strategies involve antiretroviral agents that have not been universally available. This study evaluates the current risk of surgeon exposure to HCV.

Methods:
CDC data regarding state-by-state HCV diagnosis reporting were combined with the plastic surgery workforce data from the ASPS. Proxy variables for exposure risk to HCV were generated for each state and compared.

Results:
West Virginia plastic surgeons were found to have a significantly elevated risk of exposure (60.0 versus 18.7, P < 0.0001). Their exposure risk is a notable outlier compared with the rest of the country (Risk >3 × IQR + 75th percentile). Similarly, states within the Ohio Valley were found to be at increased risk (34.8 versus 16.0, P = 0.05). States most heavily burdened by the opioid crisis were found to be at an increased risk for HCV exposure (40.8 versus 13.6, P = 0.0003).

Conclusions:
Plastic surgeons employed in states within the Ohio Valley were found to be at an increased risk of exposure to HCV. Plastic surgeons operating in states severely impacted by the opioid crisis were found to be at an increased risk of exposure. These findings underscore the importance of reducing the risk in the operating room and the need for better data collection to better understand this association and mitigate the risk to the operating surgeon.
Peters Anomaly in Nail-Patella Syndrome: A Case Report and Clinico-Genetic Correlation
Authors: Ramappa Muralidhar , Gandhi Uppal , Chaurasia Sunita , Kabra Meha , Kaur Inderjeet , Mittal Ruchi , Mishra Dilip Kumar , Chakrabarti Subhabrata , Edward Deepak P. 
Published: April 2021

Purpose:
The purpose of this study was to report the clinicopathological features of Peters anomaly in a child with nail-patella syndrome.

Methods:
Nail-patella syndrome (NPS) is a rare autosomal dominant connective tissue disorder characterized by several anomalies of the extremities, joints and nails, glomerulopathy, and rarely ocular involvement. NPS is caused by heterozygous loss-of-functional mutations in the LMX1B gene that encodes the LIM homeodomain proteins.

Results:
This case reports a new association of Peters anomaly in a child with NPS that also had classic skeletal/nail anomalies and protein losing nephropathy. Furthermore, DNA sequence analysis identified a novel missense heterozygous mutation in the LMX1B gene (Transcript ID: NM_001174146) resulting in the replacement of tryptophan by serine in codon 266, suggesting that the mutation (p.Trp.266Ser) affects LMX1B function by disturbing its interactions with other proteins. To the best of our knowledge, this association of Peters anomaly is novel and has not been reported earlier in the ophthalmic and systemic literature on NPS.

Conclusion:
The corneal findings in our case with NPS are similar to those seen in congenital corneal opacification because of Peters anomaly. This novel association of Peters anomaly with NPS may be related to the effects of the LMX1B mutation on corneal development.
Corneal Neurotization: A Novel Surgical Procedure for Neurotrophic Keratopathy
Authors: Giannaccare Giuseppe , Bolognesi Federico , Pellegrini Marco , Spena Rossella , Allevi Fabiana , Marchetti Claudio , Scorcia Vincenzo , Biglioli Federico 
Published: April 2021

Purpose:
The aim of this study is to describe techniques, results, and open issues of corneal neurotization (CN) for the treatment of neurotrophic keratopathy (NK).

Methods:
An overview of the most important studies of CN is provided. The 2 main surgical approaches (namely, direct CN and indirect CN) with specific advantages and disadvantages are described. The results regarding changes of corneal sensitivity and clarity, visual acuity, and in vivo confocal microscopy metrics are summarized. Ex vivo studies with histopathology of the neurotized cornea are reported. Intraoperative and early and late postoperative complications are described along with current open issues to be further clarified.

Results:
Corneal sensitivity improves after both direct and indirect CN. Corneal reinnervation allows the healing of NK in almost the totality of the operated eyes, determining a corresponding improvement of corneal clarity and visual acuity. Regeneration of corneal nerve fibers is confirmed by means of either in vivo confocal microscopy or ex vivo histopathology. Few self-limiting complications are reported during the postoperative course. Current open issues concern the identification of the technique of choice, the use of autograft or allograft, and the timing of CN either when performed alone or when combined with other surgeries.

Conclusions:
CN represents a game-changing surgical procedure for NK, which has the potential to restore corneal sensitivity in all stages of the disease regardless of the mechanism of denervation. Further long-term results are needed to confirm its efficacy over time. The design of randomized clinical trials comparing CN with noninterventional therapies could further validate the adoption of this technique.
Effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials
Authors: Buzasi Eva , Kurakata Hiroshi , Gandhi Akash , Birch Helen L. , Zarnegar Roxaneh , Best Lawrence 
Published: April 2021

Abstract
Our objective was to investigate the effectiveness of booster sessions after self-management interventions as a means of maintaining self-management behaviours in the treatment of chronic musculoskeletal pain. We searched MEDLINE, EMBASE, Science Citation Index, Cochrane Central Register of Controlled Trials, and PsychINFO. Two authors independently identified eligible trials and collected data. We calculated the odds ratio for the analyses of dichotomous data and standardised mean differences (SMDs) with 95% confidence interval (CI) for continuous variables. Our search identified 14 studies with a total of 1695 patients. All studies were at high risk of bias and provided very low quality evidence. For the primary outcomes, booster sessions had no evidence of an effect on improving patient-reported outcomes on physical function (SMD −0.13, 95% CI −0.32 to −0.06; P = 0.18), pain-related disability (SMD −0.16, 95% CI −0.36 to 0.03; P = 0.11), and pain self-efficacy (SMD 0.15, 95% CI −0.07 to 0.36; P = 0.18). For the secondary outcomes, booster sessions caused a significant reduction in patient-reported pain catastrophising (SMD −0.42, 95% CI −0.64 to −0.19; P = 0.0004) and no evidence of an effect on patient-reported pain intensity, depression, coping, or treatment adherence. There is currently little evidence that booster sessions are an effective way to prolong positive treatment effects or improve symptoms of long-term musculoskeletal conditions after self-management interventions. However, the studies were few with high heterogeneity, high risk of bias, and overall low quality of evidence. Our review argues against including booster sessions routinely to self-management interventions for the purpose of behaviour maintenance.
Medical Diagnoses in a University Athlete Training Room Clinic
Authors: McMurray Nathan , Reinke Emily , Riboh Jonathan , Pyles Courtney , Bytomski Jeffrey 
Published: April 2021

Introduction:
Approximately 560 000 student–athletes participate in university athletic programs every year. These athletes develop a variety of medical injuries and illnesses during their time at the university. There is currently a paucity of data with regarding medical encounters in a dedicated university athlete training room clinic.

Objective:
This study aims to provide data regarding medical diagnoses from a university athlete training room clinic.

Study design:
Descriptive epidemiology study.

Setting:
University athlete training room clinic.

Patients:
University athletes.

Methods:
The electronic medical record for a year-round, athlete-only training room clinic at a private US university was reviewed. Athlete age, sex, sport, date of medical encounter, and encounter diagnoses across 5 calendar years were recorded; medical diagnoses were then manually stratified into diagnostic categories and subgroups.

Results:
A total of 1258 university athletes were evaluated during 5303 medical encounters. Approximately two-thirds of athletes were evaluated one or more times per year. Average number of encounters per athlete per year was 2.2 (0.6-3.8, 95% confidence interval). The football team accounted for the greatest number of encounters (15.2% of total encounters). The most common medical diagnosis category was otorhinolaryngology (30.6% of total diagnoses). The most common diagnosis subgroup was upper respiratory infection (14.8% of total diagnoses).

Conclusions:
Approximately two-thirds of athletes were evaluated annually with an average of 2 encounters per athlete per year. Upper respiratory infection represented the most common individual diagnosis. The results reported in this study may be useful in directing future care and research of university athletes.
Assessment of Saccades and Gaze Stability in the Diagnosis of Pediatric Concussion
Authors: Storey Eileen P. , Corwin Daniel J. , McDonald Catherine C. , Arbogast Kristy B. , Metzger Kristina B. , Pfeiffer Melissa R. , Margulies Susan S. , Grady Matthew F. , Master Christina L. 
Published: April 2021

Objective:
To evaluate the discriminatory ability of different repetition increments of saccades and gaze stability testing for diagnosing concussion in adolescents.

Design:
Cross-sectional.

Setting:
Suburban high school and academic pediatric tertiary care center.

Participants:
Sixty-nine adolescent athletes within 28 days of a sports- or recreation-related concussion and 69 adolescent athletes without recent concussion.

Assessment of Independent Variables:
Symptom provocation with horizontal and vertical saccades and gaze stability testing performed up to 30 repetitions.

Main Outcome Measures:
Sensitivity and specificity at 10-repetition increments (≤10, ≤20, ≤30) and area under the receiver operating characteristic curves (AUC) of a visio-vestibular examination (VVE) subscore, scored 0 to 4 based on the number of assessments with symptom provocation, at each repetition increment.

Results:
Sensitivity improved when increasing from ≤10 to ≤20 to ≤30 repetitions for horizontal (25% to 50% to 69%) and vertical (32% to 52% to 74%) saccades and horizontal (19% to 45% to 71%) and vertical (23% to 45% to 72%) gaze stability. Specificity was comparable at ≤10 and ≤20 repetitions, but decreased at ≤30 repetitions across assessments. For a VVE subscore (0-4) based on the number of symptomatic assessments, the discriminatory ability of the test was highest at ≤20 repetitions (AUC of 0.79) with an optimal subscore of one (sensitivity 59%, specificity 96%).

Conclusions:
A VVE including a higher threshold level of repetitions for saccades and gaze stability has improved discriminatory ability for concussion, with an optimized AUC of 0.79 at ≤20 repetitions.

Clinical Relevance:
The findings in this study suggest that a higher threshold level of repetitions of 2 commonly used visio-vestibular assessments enables clinicians to more accurately diagnose youth concussion.
Risk Factors for Persistent Pain Requiring Surgical Treatment in Adult Symptomatic Accessory Navicular
Authors: Park Young Hwan , Kim Woon , Choi Jung Woo , Kim Hak Jun 
Published: April 2021

Objective:
Identifying the risk factors for persistent pain despite proper conservative treatment in adult symptomatic accessory navicular may reduce the need for surgical treatment. The aim of this study was to identify any such risk factors.

Design:
Cohort study.

Setting:
University hospital foot and ankle clinic.

Patients:
A retrospective review of 313 patients who presented with adult symptomatic accessory navicular was performed.

Assessment of Risk Factors:
Potential risk factors were identified via medical records and foot radiographs. The possible risk factors included age, gender, body mass index, smoking status, occurrence/cause of symptoms, occupation, type of accessory navicular, and radiographic foot parameters.

Main Outcome Measures:
Predictors that relate to persistent pain requiring surgical treatment in adult accessory navicular were analyzed using logistic regression analysis.

Results:
Of the 313 patients included, 30 (9.6%) underwent surgical treatment due to failure of conservative treatment. The odds of needing surgical treatment decreased by 0.96 per year of age at symptom onset (P = 0.030), but those odds were 8.52 times higher in patients who had a type IIB accessory navicular (P = 0.001). Other variables did not reach statistical significance.

Conclusions:
Younger age at symptom onset and type IIB were the risk factors for persistent pain requiring surgical treatment in adult symptomatic accessory navicular.
Bilateral chorioretinal folds in patients with central serous chorioretinopathy
Authors: Terubayashi Yuya , Kida Teruyo , Morishita Seita , Kobayashi Takatoshi , Sato Takaki , Sato Bunpei , Ikeda Tsunehiko 
Published: April 2021

Abstract

Introduction:
Chorioretinal folds accompanied by central serous chorioretinopathy (CSC) are relatively uncommon. Here, we report CARE-compliant 2 patients with bilateral CSC chorioretinal folds and CSC that was followed-up for 2 years.

Patient concerns:
Case 1 was a 68-year-old female who complained of central visual field disturbance in her left eye. At the initial visit, her visual acuity (VA) was 20/20 in her right eye and 20/40 in her left. She had a history of systemic hypertension and an optic neuropathy in her left eye 20 years previously. Case 2 was a 63-year-old female with CSC in her right eye. Her VA at her first visit was 20/200 in her right eye and 20/20 in her left.

Diagnosis:
In case 1, an examination revealed serous retinal detachment (SRD) in the macula and optic disc atrophy in her left eye and both fundi showed chorioretinal folds. Fluorescein angiography showed a fluorescein leakage area in her left eye. In case 2, examination of fundus showed marked SRD in her right macula and both fundi had chorioretinal folds. fluorescein angiography showed a fluorescein leakage area and indocyanine green angiography showed vascular hyperpermeability, but no choroidal neovascularization.

Interventions and outcomes:
In case 1, the patient rejected the photocoagulation treatment. Her SRD resolved spontaneously and the VA improved to 20/20 in her left eye nine months after the first visit. But the chorioretinal folds in both eyes remain till date. In case 2, photodynamic therapy was planned; however, her SRD disappeared spontaneously. Photocoagulation therapy was performed at the leak point and her VA improved to 20/20, but the bilateral chorioretinal folds remain till date. There has been no recurrence of CSC in both the patients in the 2 year follow-up.

Conclusions:
The exact mechanism of CSC remains uncertain. Choroidal vascular abnormalities, such as choroidal hyperpermeability and dilated choroidal vessels associated with congested vortex veins, have been previously reported even in the unaffected eye of CSC patients. We theorize that the bilateral chorioretinal folds in CSC patients were possibly induced by the outflow congestion of the vortex vein due to the marked CSC and choroidal dysregulation. As the choroid expanded due to CSC, the overlying Bruch membrane was forced into folds. Further investigation of the pathophysiology of CSC is needed.
Septic coronary embolism treated with manual aspiration thrombectomy
Authors: Cardoso Monti Sousa Luhanda Leonora , de Carvalho Andreucci Torres Leal Tatiana , de Matos Soeiro Alexandre , Soares Paulo Rogério , Scudeler Thiago Luis 
Published: April 2021

Abstract

Rationale:
Systemic embolism is a known complication of infective endocarditis (IE), but it rarely presents as acute myocardial infarction (AMI). Aspiration thrombectomy without stenting is a possible approach in this context. The authors present a rare case of coronary embolism caused by Aggregatibacter aphrophilus IE successfully treated with manual aspiration thrombectomy.

Patient concerns:
A 19-year-old man with previous valve disease was admitted to the emergency department with fever and dyspnea. The next day, the patient presented with chest pain and hemodynamic instability.

Diagnosis:
Transesophageal echocardiography confirmed the presence of infectious endocarditis at the mitro-aortic junction. Blood cultures identified Aggregatibacter aphrophilus. Electrocardiogram showed significant ST segment elevation in leads V1 to V5, indicating AMI. Coronary angiography revealed total occlusion of the left anterior descending artery. The histopathological examination of the material aspirated from the coronary artery showed fibrin thrombi containing gram-negative cocci.

Interventions:
Manual aspiration thrombectomy was performed without stent implantation. No antithrombotic therapy was needed during and post-procedure. After clinical stabilization, the patient underwent cardiac surgery.

Outcomes:
Transesophageal echocardiogram before discharge showed preserved left ventricular function, with no segmental left ventricular wall motion abnormalities, and the aortic metal prosthesis without dysfunction. After discharge, a new transesophageal echocardiogram was performed with 1 month of follow-up. No evidence of recurrence of IE was found in the first postoperative review and the patient remained stable.

Lessons:
Manual aspiration thrombectomy without stenting and antithrombin therapy is feasible in patients with AMI due to IE.
High frequency spinal cord stimulation can be more effective than traditional spinal cord stimulation in treating complex regional pain syndrome
Authors: Massey Harrison R. , Massey Benjamin H. , Stitik Todd P. 
Published: April 2021

Abstract

Introduction:
This case report demonstrates the effectiveness of high frequency 10 kHz spinal cord stimulation (HF10 therapy SCS) in the treatment of Complex Regional Pain Syndrome (CRPS) when compared with other treatment modalities including traditional SCS. Traditional SCS is believed to exert its action through stimulating the dorsal columns mitigating the hyperexcitable afferent signals from the periphery. Hf10 SCS delivers more stimulation to the dorsal horns targeting specifically the wide dynamic range neurons (pain projecting neurons). This creates a greater potential to suppress the sympathetic overactivity seen in CRPS while additionally removing the paresthesia's generated with dorsal column stimulation, which many find unpleasant.

Patient concerns:
59-year-old Caucasian male presented with classic right lower limb symptoms of CRPS and longstanding low back pain with right-sided radiculopathy.

Diagnosis:
The patient developed CRPS after right leg open thrombectomy.

Interventions:
The patient received para-sagittal steroid epidural injections and lumbar sympathetic blocks with inadequate pain relief. He failed to improve using traditional SCS and was referred for evaluation using high frequency 10 kHz spinal cord stimulator, which the SENZA-RCT showed superior pain relief when compared to traditional stimulation.

Outcome:
This case is unique because the patient had no improvement with traditional SCS and reported 100% relief of CRPS pain and associated symptoms and 40% reduction in back pain while using HF10. This also is significant because back pain tends to be refractory when treated with traditional SCS.

Conclusion:
High frequency 10 kHz spinal cord stimulator might be an effective means of managing the symptoms of CRPS and reducing axial back pain.
HELLP syndrome complicated by subcapsular liver hematoma
Authors: Fan HuiKang , Zhang Ping , Yang Daji , Sun Lu , Zhao WenChao , Pan Deng , Qi Jun 
Published: April 2021

Abstract

Rationale:
Subcapsular liver hematoma (SLH) is a rare but potentially fatal complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. The SLH incidence rate is about 1% to 2% in patients with preeclampsia and HELLP syndrome.

Patient concerns:
A 28-year-old woman (gravida 3, parity 2) was admitted to the hospital at 26+1 gestation weeks because of upper abdominal discomfort of 2 weeks duration.

Diagnoses:
The patient was diagnosed with pre-eclampsia and HELLP syndrome. CT scan confirmed the presence of SLH.

Interventions:
The patient was treated with magnesium sulphate and Glucocorticoid was given for fetal lung maturation. But the blood pressure continued to rise. Cesarean section was performed, and a male infant was delivered with APGAR score 7.

Outcomes:
SLH resolved after the operation and the patient was discharged 6 days later. The newborn was discharged 1 month later from the intensive care.

Lessons:
HELLP syndrome complicated with SLH is a life-threatening condition for pregnant women and fetus. The decrease in blood volume due to bleeding can mask the underlying pre-eclampsia and delay the diagnosis and treatment.