bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gross and Histologic Anatomy of the Pelvic Ureter
Authors: Jackson Lindsey A. , Ramirez Denise M. O. , Carrick Kelley S. , Pedersen Rebecca , Spirtos Alexandra , Corton Marlene M. 
Published: April 2019

OBJECTIVE:
To further evaluate relationships of the pelvic ureter to clinically relevant structures and to characterize the anatomy, histology, and nerve density of the distal ureter.

METHODS:
In this observational cadaveric study, 35 female cadavers were examined, 30 by gross dissections and five microscopically. Ureter length and segments of pelvic ureter were measured. Closest distances between the ureter and clinically relevant points were recorded. The distal pelvic ureter and surrounding parametrium were evaluated microscopically. Nerve density was analyzed using automated quantification of peripheral nerve immunostaining. Average measurements of nerve density in the anterior and posterior quadrants surrounding the ureter were statistically compared using a two-tailed t test. Descriptive statistics were used for analyses with distances reported as mean±SD (range).

RESULTS:
Gross dissections revealed ureter length of 26.3±1.4 (range 24–29) cm (right), 27.6±1.6 (25–30.5) cm (left). Lengths of ureter from pelvic brim to uterine artery crossover were 8.2±1.9 (4.4–11.5) cm (right), 8.5±1.5 (4.5–11.5) cm (left) and from crossover to bladder wall 3.3±0.7 (2.4–5.8) cm (right), 3.2±0.4 (2.6–4.1) cm (left). Intramural ureter length was 1.5±0.3 (1–2.2) cm (right) and 1.7±1.2 (0.8–2.5) cm (left). Distances from the ureter to uterine isthmus: median 1.7 (range 1–3.0) cm (right) and 1.7 (1.0–2.9) cm (left); lateral anterior vaginal fornix 1.5 (1.0–3.1) cm (right) and 1.7 (0.8–3.2) cm (left); lateral vaginal apex 1.3 (1.0–2.6) cm (right) and 1.2 (1.1–2.2) cm (left) were recorded. Microscopy demonstrated denser fibrovascularity posteromedial to the ureter. Peripheral nerve immunostaining revealed greater nerve density posterior to the distal ureter.

CONCLUSION:
Proximity of the ureter to the uterine isthmus and lateral anterior vagina mandates careful surgical technique and identification. The intricacy of tissue surrounding the distal ureter within the parametrium and the increased nerve density along the posterior distal ureter emphasizes the importance of avoiding extensive ureterolysis in this region.
Addressing Obstetrics and Gynecology Trainee Burnout Using a Yoga-Based Wellness Initiative During Dedicated Education Time
Authors: Babbar Shilpa , Renner Kathryn , Williams Karen 
Published: April 2019

OBJECTIVE:
To estimate the feasibility of implementing a yoga-based wellness program during training and its influence on burnout, depression, anxiety, stress, and mindfulness among obstetrics and gynecology trainees.

METHODS:
We conducted a departmental quality improvement initiative consisting of weekly 1-hour yoga classes conducted during protected education time and nutrition and physical challenges for 24 obstetrics and gynecology residents and five maternal–fetal medicine fellows. Participants received a free wrist-worn fitness tracker device to record their activity. Preprogram and postprogram data collection included results from validated scales on burnout, mindfulness, depression and anxiety, blood pressure, heart rate, and weight. Wilcoxon signed rank tests were used for analysis. A P-value <.05 was considered significant.

RESULTS:
Over an 8-week period, 90% (n=26) of participants attended at least one yoga class and 68% attended at least 50% of the classes. No participant completed all sessions. Eighty percent (n=20) engaged in at least one nutrition challenge and 60% (n=15) in at least one physical challenge. After the program, a significant reduction in the depersonalization component of burnout (P=.04), anxiety (P=.02), and systolic (preprogram: 122, postprogram: 116 mm Hg; P=.01) and diastolic blood pressure (preprogram: 82, postprogram: 76 mm Hg; P=.01) occurred. Those participants who attended more than 50% of yoga classes demonstrated a significant reduction in systolic and diastolic blood pressure compared with less-frequent attendees (P=.02 and .04, respectively). A postprogram survey revealed feelings of increased camaraderie, appreciation, motivation, and overall training experience.

DISCUSSION:
Implementing a wellness program consisting of weekly yoga classes is feasible and may be beneficial. A wellness initiative that emphasizes active participation during education time with the autonomy to implement daily wellness activities may reduce burnout and improve well-being.
Second Uterine Curettage and the Number of Chemotherapy Courses in Postmolar Gestational Trophoblastic Neoplasia
Authors: Hemida Reda , Vos Elvira L. , El-Deek Basem , Arafa Mohammad , Toson Eman , Burger Curt W. , van Doorn Helena C. 
Published: April 2019

OBJECTIVE:
To investigate the effect of second uterine curettage on the number of chemotherapy courses and relapse rate in low-risk postmolar gestational trophoblastic neoplasia.

METHODS:
In a phase III trial, patients with low risk gestational trophoblastic neoplasia were randomised (1:1) to a second curettage or no curettage group before methotrexate treatment. Eligibility criteria were serum human chorionic gonadotropin (hCG) level 5,000 international units/L or less and fit for treatment with methotrexate. Exclusion criteria were previous uterine perforation and life-threatening bleeding. With a two-sided 5% significance level and a power of 99%, a sample size of 44 patients per group was necessary to detect a mean reduction in 2.3 chemotherapy courses. The primary outcome was the number of chemotherapy courses required for hCG normalization. Secondary outcomes were needed for second-line treatment, toxicity, relapse rates, and variables associated with number of chemotherapy courses.

RESULTS:
From October 2011 through February 2016, 89 patients entered the study at the Mansoura Trophoblastic Clinic; in each group, 43 patients were included in the intention‐to‐treat analyses. Surgical complications did not occur. The mean number of chemotherapy courses required to reach hCG normalization was 4.4±2.2 SD in the control group vs 3.8±2.3 SD in the intervention group (P=.14). Groups were comparable in terms of second-line treatment needed to reach hCG normalization, and relapse within the first year. Only hCG levels related to the number of chemotherapy cycles required for hCG normalization.

CONCLUSION:
Second uterine curettage did not reduce the number of chemotherapy courses required or affect relapse rate in patients with low-risk postmolar gestational trophoblastic neoplasia.

CLINICAL TRIALS REGISTRATION:
Dutch Trial Registry, NTR3390.
Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty
Authors: Jiang Da David , Gallagher Sandra , Burchill Laura , Berli Jens , Dugi Daniel 
Published: April 2019

OBJECTIVE:
To describe the incidence of pelvic floor dysfunction in transgender women undergoing gender-affirming vaginoplasty and outcomes in a program providing pelvic floor physical therapy (PT).

METHODS:
We conducted a retrospective, single-institution study on vaginoplasty patients between May 1, 2016, and February 28, 2018; all were referred for pelvic floor PT. We reviewed medical records for baseline demographics, medical comorbidities, prior surgeries, insurance data, attendance at pelvic floor PT, and dilation success at 3 and 12 months.

RESULTS:
Seventy-two of 77 patients (94%) attended pelvic floor PT at least once. Preoperative pelvic floor PT identified a high incidence of potential problems: 42% had pelvic floor dysfunction, 37% had bowel dysfunction. Of those patients found to have dysfunction preoperatively, the rate of resolution by the first postoperative visit of pelvic floor and bowel dysfunction were 69% and 73%, respectively. There were significantly lower rates of pelvic floor dysfunction postoperatively for those patients who attended pelvic floor PT both preoperatively and postoperatively compared with only postoperatively (28% vs 86%, P=.006). Patients reporting a history of abuse had a significantly higher rate of preoperative pelvic floor muscle dysfunction (91% vs 31%, P<.001). Successful dilation at 3 months in all patients was 89%.

CONCLUSION:
Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for pelvic floor PT for patients undergoing gender-affirming vaginoplasty.
Prediction of the Peripheral Rim Instability of the Discoid Lateral Meniscus in Children by Using Preoperative Clinicoradiological Factors
Authors: Kang Michael Seungcheol , Kim Jong-Min , Park Soo-Sung , Bin Seong-Il 
Published: April 2019

Background:
The discoid lateral meniscus (DLM) in children often presents peripheral rim instability (PRI) and is susceptible to tear or subluxation, which manifests symptoms and leads to a poor prognosis. We aimed to investigate the association between preoperative clinical and MRI findings and the intraoperative findings of PRI.

Methods:
Children and adolescents aged younger than 16 years who underwent surgical treatment for DLM were retrospectively reviewed. Cases of bucket-handle tear were not included because they would confound the stability of the peripheral rim. Total 60 knees from 47 children were included. PRI was additionally subdivided based on the location, such as anterior, middle, and posterior, during the investigation.

Results:
In multivariate analyses, both central (inward) (P=0.004) and external (outward) (P=0.029) displacement of lateral meniscal margin, and peripheral tear of the anterior body (P=0.022) were significant predictors of PRI, regardless of the location. The predictive factors for PRI based on each location were female gender (P=0.004), subjective symptom of clicking sound (P=0.023), and central displacement of the anterior meniscal margin (P=0.034) for anterior PRI; flexion contracture >10 degrees (P=0.017) and peripheral tear of the middle body (P<0.001) for middle PRI; and central displacement of the posterior meniscal margin (P=0.036) and peripheral tears of the anterior (P=0.029) and middle bodies (P=0.047) for posterior PRI.

Conclusions:
We evaluated the preoperative clinical and MRI findings that predict PRI of pediatric DLM. Displacements of the DLM, not only centrally (inward) but also externally (outward), seem to be significant predictive factors for PRI. Furthermore, some clinical findings were associated with PRI, even predicting the locations. Although the actual surgical procedure should be determined by meticulous probing during arthroscopy, preoperative prediction of the presence and location of PRI would help decrease the risk of oversight during surgery.

Level of Evidence:
Level III—Diagnostic Study.
Brace Yourselves: Outcomes of Ponseti Casting and Foot Abduction Orthosis Bracing in Idiopathic Congenital Talipes Equinovarus
Authors: Kuzma Alexander L. , Talwalkar Vishwas R. , Muchow Ryan D. , Iwinski Henry J. , Milbrandt Todd A. , Jacobs Cale A. , Walker Janet L. 
Published: April 2019

Background:
Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients.

Methods:
After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor. Dimeglio score and family demographic information were collected. Initial treatment was by the Ponseti method, with or without Achilles tenotomy. Following correction, patients had three months of full-time FAO bracing during which parents kept a log of compliance. Patients were followed until recurrence (need for further treatment) or age 5.

Results:
In total, 42 patients with 64 affected feet met the above criteria and were included in the final analysis. Twenty-six feet (40%) went on to develop recurrence requiring further treatment, including casting, bracing, or surgery. Because of poor tolerance of the original FAO, 20 feet were transitioned to an alternative FAO, and 14 of these (70%) went on to recur (P<0.01). The casting duration (P=0.02) had a statistically significant relationship to recurrence. Patients who were casted for 9 weeks or more had a higher rate of recurrence (57.1% vs. 27.8%; P=0.02). Age at treatment start, Dimeglio score, demographic factors, and compliance during full-time bracing, whether by report or sensor, did not show a significant relationship with recurrence.

Conclusions:
The study showed a statistically significant relationship between the difficulty of CTEV correction and the risk of recurrent deformity requiring treatment. This relationship could be used to provide prognostic information for patients’ families. Caregiver-reported compliance was not significantly related to recurrence.

Level of Evidence:
Level III—Prognostic Retrospective Cohort Study.
Vascular Supply to the Femoral Head in Patients With Healed Slipped Capital Femoral Epiphysis
Authors: Shore Benjamin J. , Mardam-Bey Sami W. , Kim Young-Jo , Matheney Travis , Novais Eduardo N. , Millis Michael B. , Yen Yi-Meng 
Published: April 2019

Background:
Slipped capital femoral epiphysis (SCFE) is one of the most common hip disorders. The vascularity of the lateral epiphyseal vessels supplying the femoral head in patients with healed SCFE has not been well defined. The purpose of this study was to characterize the location and number of lateral epiphyseal vessels in young adults with healed SCFE.

Methods:
This was a retrospective study of 17 patients (18 hips) with a diagnosis of SCFE and a matched control group of 17 patients (17 hips) with developmental dysplasia of the hip. All patients underwent high-resolution contrast-enhanced magnetic resonance imaging to visualize the path of the medial femoral circumflex artery and the lateral epiphyseal arterial branches supplying the femoral head.

Results:
There were 5 unstable SCFEs and 13 stable SCFEs with an average slip angle of 31 degrees. (All patients had been treated with in situ pinning and screw removal). Average age at time of magnetic resonance imaging was 24.5 years (range, 15 to 34 y). The lateral epiphyseal vessels reliably inserted on the posterior-superior aspect of the femoral neck from the superior-anterior to the superior-posterior position in both the SCFE and control groups. An average of 2 (±0.8) retinacular vessels were identified in the SCFE group compared with 5.2 (±0.7) retinacular vessels in the control group (P<0.001).

Conclusions:
In healed SCFE, the lateral epiphyseal vessels reliably insert in the same anatomic region as patients with hip dysplasia; however, the overall number of vessels is significantly lower.
Patient Satisfaction and Press Ganey Scores for Spine Versus Nonspine Neurosurgery Clinics
Authors: Chen Yi-Ren , Johnson Eli , Montalvo Carlos , Stratford Shelley , Veeravagu Anand , Tharin Suzanne , Desai Atman , Ratliff John , Shuer Lawrence , Park Jon 
Published: April 2019

Study Design:
Retrospective survey review.

Objective:
We seek to evaluate satisfaction scores in patients seen in neurosurgical spine versus neurosurgical nonspine clinics.

Summary of Background Data:
The Press Ganey survey is a well-established metric for measuring hospital performance and patient satisfaction. These measures have important implications in setting hospital policy and guiding interventions to improve patient perceptions of care.

Methods:
Retrospective Press Ganey survey review was performed to identify patient demographics and patient visit characteristics from January 1st, 2012 to October 10th, 2017 at Stanford Medical Center. A total of 40 questions from the Press Ganey survey were investigated and grouped in categories addressing physician and nursing care, personal concerns, admission, room, meal, operating room, treatment and discharge conditions, visitor accommodations and overall clinic assessment. Raw ordinal scores were converted to continuous scores of 100 for unpaired student t test analysis. We identified 578 neurosurgical spine clinic patients and 1048 neurosurgical nonspine clinic patients.

Results:
Spine clinic patients reported lower satisfaction scores in aggregate (88.2 vs. 90.1; P=0.0014), physician (89.5 vs. 92.6; P=0.0002) and nurse care (91.3 vs. 93.4; P=0.0038), personal concerns (88.2 vs. 90.9; P=0.0009), room (81.0 vs. 83.1; P=0.0164), admission (90.8 vs. 92.6; P=0.0154) and visitor conditions (87.0 vs. 89.2; P=0.0148), and overall clinic assessment (92.9 vs. 95.5; P=0.005).

Conclusions:
This study is the first to evaluate the relationship between neurosurgical spine versus nonspine clinic with regards to patient satisfaction. The spine clinic cohort reported less satisfaction than the nonspine cohort in all significant questions on the Press Ganey survey. Our findings suggest that efforts should be made to further study and improve patient satisfaction in spine clinics.

Level of Evidence:
Level III.
Adoption and Use of Mobile Learning in Continuing Professional Development by Health and Human Services Professionals
Authors: Curran Vernon , Fleet Lisa , Simmons Karla , Lannon Heather , Gustafson Diana L. , Wang Chenfang , Garmsiri Mahyar , Wetsch Lyle 
Published: April 2019

Introduction:
Health and human services professionals are increasingly using mobile devices to support clinical decision-making and evidence-based practice. However, research on self-directed learning in an era of growing digital technology utilization is underdeveloped. This study explored the adoption and use of mobile learning as a continuing professional development (CPD) activity.

Methods:
A mixed-methods case study using semistructured interviews and a web-based questionnaire was conducted with health and human services professionals in Newfoundland and Labrador, Canada.

Results:
Respondents reported using a smartphone (53.8%), tablets (50.4%), YouTube (43.0%), and mobile apps (35.8%) for CPD. The highest-rated benefits of mobile learning included improved access to information (M = 3.51); potential for enhanced knowledge acquisition (M = 3.45); staying up to date (M = 3.44); and verifying information (M = 3.40). The greatest barriers included cost of some apps and resources (M = 3.07); websites/programs not functional on mobile devices (M = 2.84); workplace barriers preventing access to digital resources (M = 2.82); and social media use linked to negative perceptions of professionalism (M = 2.65). Interview respondents described the flexibility and convenience of mobile learning, the level of autonomy it offered, and the advantages of learning on their own time. Technical issues, particularly for rural and remote practitioners, and digital professionalism also emerged as potential barriers.

Discussion:
A systems model organizes the factors influencing the adoption and use of mobile devices and resources to support “just-in-time” learning. Addressing policies, practices, and regulations that enable or inhibit adoption of mobile learning for CPD may foster enhanced use to support better clinical decision-making, improved accuracy, and greater patient safety.
Multimodal Imaging Report of Crystalline Keratopathy in Relapsing Polychondritis
Authors: Wang Kaidi , Gonzales John , Pawar Varun , Cheewaruangroj Nontawat , Seitzman Gerami D. 
Published: April 2019

Purpose:To describe a case of bilateral multifocal stromal crystalline keratopathy in the setting of relapsing polychondritis (RP).Methods:Case report.Results:We describe a 31-year-old woman who presented with ocular inflammation, bilateral auricular chondritis, and nasal chondritis, meeting the clinical criteria of RP. We illustrate her auricular cartilaginous abnormalities, saddle nose deformity, scleritis, and discrete mid-stromal opacities in both corneas that extend through the central cornea. Uniquely, her opacities feature a marked crystalline component as demonstrated on photography, anterior segment optical coherence tomography, and confocal microscopy.Conclusion:A central keratopathy is not typically reported in patients with RP. In this case report, we describe a unique diffuse bilateral nummular mid-stromal crystalline keratitis that extends into the central cornea and further define it using multimodal imaging.
Evidence for a GPR18 Role in Chemotaxis, Proliferation, and the Course of Wound Closure in the Cornea
Authors: Murataeva Natalia , Daily Laura , Taylor Xavier , Dhopeshwarkar Amey , Hu Sherry Shu-Jung , Miller Sally , McHugh Douglas , Oehler Olivia , Li Shimin , Bonanno Joseph A. , Mackie Ken , Straiker Alex 
Published: April 2019

Purpose:
We previously showed that cannabinoid-related GPR18 receptors are present in the murine corneal epithelium, but their function remains unknown. The related CB1 receptors regulate corneal healing, possibly via chemotaxis. We therefore examined a potential role for GPR18 in corneal epithelial chemotaxis and wound healing.

Methods:
We examined GPR18 messenger RNA (mRNA) and protein expression in the cornea. We additionally examined GPR18 action in cultured bovine corneal epithelial cells (bCECs) using Boyden and tracking assays, as well as proliferation and signaling. Finally, we examined wound closure in murine corneal explants.

Results:
GPR18 mRNA was upregulated with injury in the mouse cornea. GPR18 protein was present in basal epithelial cells of the mouse and cow and redistributed to the wound site upon injury. GPR18 ligand N-arachidonoylglycine induced bCEC chemotaxis. The endocannabinoid arachidonoylethanolamine also induced chemotaxis via fatty acid amide hydrolase–mediated metabolism to N-arachidonoylglycine. GPR18 receptor activation additionally induced bCEC proliferation. In an explant model, the GPR18 antagonist O-1918 slowed corneal epithelial cell migration and the rate of corneal wound closure.

Conclusions:
Corneal GPR18 activation induced both chemotaxis and proliferation in corneal epithelial cells in vitro and impacted wound healing. GPR18 may contribute to the maintenance of corneal integrity.
Corneal Evaluation in Patients With Parkinsonism on Long-Term Amantadine Therapy
Authors: Daggumilli Satyasudha , Vanathi Murugesan , Ganger Anita , Goyal Vinay , Tandon Radhika 
Published: April 2019

Purpose:
To evaluate the progression of corneal endothelial changes in patients with Parkinson disease (PD) on long-term oral amantadine therapy.

Methods:
A prospective comparative longitudinal observational study of 90 patients (180 eyes) with PD on more than 6 months of oral amantadine therapy, 30 amantadine naive patients with PD, and 30 healthy controls (age and gender matched). Corneal endothelial cell parameters (endothelial cell density, percentage hexagonality of the cells, and coefficient of variation) and corneal subbasal nerve fiber layer changes were studied over a follow-up period of 1 year.

Results:
The amantadine patients with PD group had a statistically significant decrease in endothelial cell density (1.51% vs. 0.94% vs. 0.55%) (P = 0.04), decrease of percentage hexagonality of the cells (4.98% vs. 3.56% vs. 2.31%) (P = 0.01), and increase of coefficient of variation (6.12% vs. 4.80% vs. 3.30%) (P = 0.03) compared with amantadine naive patients with PD and controls, respectively. Analysis of changes in the patients with PD based on the daily dosage of amantadine showed greater change in endothelial parameters in patients who were on 400 mg amantadine.

Conclusions:
Long-term amantadine therapy seems to effect changes on corneal endothelium.