bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thoracic Lordosis, Especially in Males, Increases Blood Loss in Adolescent Idiopathic Scoliosis
Authors: Abousamra Oussama , Sponseller Paul D. , Lonner Baron S. , Shah Suken A. , Marks Michelle C. , Cahill Patrick J. , Pahys Joshua M. , Newton Peter O. 
Published: September 2018

Background:
Intraoperative blood loss during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) has been reportedly associated with multiple factors. This study aims to investigate the effect of thoracic kyphosis on blood loss in AIS spinal fusion.

Methods:
Patients with AIS who underwent posterior-only procedures for Lenke I and II type curves were identified. All included patients had intraoperative tranexamic acid. Difference in estimated blood loss per blood volume (EBL/BV) was identified between hypokyphotic curves (−), normal curves (N), and hyperkyphotic curves (+) classified based on Lenke sagittal modifier. Regression analysis was then performed with EBL/BV as dependent variable. Independent variables included radiographically measured T5-T12 kyphosis and calculated 3D T5-T12 kyphosis in addition to sex, body mass index (BMI), operative time, number of fused vertebrae, number of Ponte osteotomy levels, and main thoracic coronal curve.

Results:
In total, 837 patients were included. For female patients: EBL/BV was significantly higher for (−) (18%) compared with (N) (16%) and (+) (14%). A total of 29 female patients had T5-T12≤0 (−15 to 0 degree). EBL/BV was not significantly higher than patients with T5-T12>0 degree (18%±9% vs. 16%±11%; P=0.212). For male patients: EBL/BV was significantly higher in (−) (23%) compared with (+) (16%). In total, 14 male patients had T5-T12≤0 (−13 to 0) degree. EBL/BV was significantly higher than patients with T5-T12>0 degree (32%±18% vs. 18%±13%; P=0.015). Significant factors in predicting EBL/BV were sex, BMI, number of fused levels, and both 2D and 3D T5-T12 kyphosis. Male sex as well as every fused-level predicted an increase in EBL/BV~2%. Every 10-unit decrease in BMI predicted an increase in EBL/BV of 7%. Every 10-degree decrease in 2D or 3D T5-T12 kyphosis predicted an increase in EBL/BV~1%. The impact of the number of Ponte osteotomy levels was not significant.

Conclusions:
This study supports the role of sagittal thoracic alignment in affecting EBL/BV in AIS surgery. Male patients with severe thoracic lordosis (T5-T12≤0 degree) are the highest risk group for intraoperative bleeding. These findings are helpful in predicting the intraoperative blood loss for patients with AIS undergoing posterior spinal fusion. In addition to sex and number of fused levels, decreased thoracic kyphosis is associated with increased blood loss.

Level of Evidence:
Level III—prognostic study.
Electrophysiological Function of the Lumbar Multifidus and Erector Spinae Muscles in Elderly Patients With Chronic Low Back Pain
Authors: Sakai Yoshihito , Matsui Hiroki , Ito Sadayuki , Hida Tetsuro , Ito Kenyu , Koshimizu Hiroyuki , Harada Atsushi 
Published: September 2018

Study Design:
This was a cross-sectional electrophysiological study.

Objective:
The main objective of this study was to evaluate electrophysiological activation of lumbar multifidus (LM) and erector spinae (ES) in elderly patients with chronic low back pain (CLBP) classified by LBP developmental mechanisms.

Summary of Background Data:
Local and global muscles that function independently for stabilization and moment production, respectively, are crucial for stability and mobility of the lumbar spine. There is little research conducted on the electrophysiological functions of the LM as a local muscle and the ES as a global muscle in the lumbar spine, and their interrelation in patients with CLBP.

Materials and Methods:
Elderly patients aged 65 years and above, with CLBP were assigned into motion-induced LBP (49 patients) or walking-induced LBP cohorts (57 patients), and compared with a control group (53 patients without LBP). Electrophysiological activation of the LM and ES was performed using surface electromyography (EMG) and mechanomyography (MMG) during lumbar extension and flexion. Electromechanical coupling efficiency (EMCE) was calculated using the ratio of MMG to EMG.

Results:
EMG and MMG amplitudes in the LM tended to be lower in patients with LBP than in the control group. EMG and MMG amplitudes in the ES tended to be higher in patients with LBP than in the control group. EMCE was significantly higher in both the LM and ES during lumbar extension and flexion in the motion-induced LBP cohort than in the walking-induced LBP cohort; however, ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio.

Conclusions:
ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio. Subgrouping of patients according to the induction of LBP seems to be important for CLBP treatment, and the electrophysiological assessment for the deep and superficial back muscles may be beneficial to elderly patients.
Microendoscopic Decompression for Lumbar Spinal Stenosis With Degenerative Spondylolisthesis
Authors: Minamide Akihito , Simpson Andrew K. , Okada Motohiro , Enyo Yoshio , Nakagawa Yukihiro , Iwasaki Hiroshi , Tsutsui Shunji , Takami Masanari , Nagata Keiji , Hashizume Hiroshi , Yukawa Yasutsugu , Yamada Hiroshi , Yoshida Munehito 
Published: September 2018

Study Design:
This study was a retrospective subgroup analysis of prospective cohort data.

Objective:
The main objectives of this study were to develop a classification of degenerative spondylolisthesis (DS) and concurrent lumbar spinal stenosis (LSS) based on pathologic stage, and to determine how these subtypes of DS affect outcomes for minimally invasive (MIS) decompression

Summary of Background Data:
DS with LSS is a common clinical scenario, yet there is no consensus on optimal treatment. Natural history of DS is described as early degenerative damage, followed by instability, and eventual restabilization via spondylotic changes. MIS decompression surgery has become increasingly popular, but the effect of DS subtypes on clinical outcomes after MIS decompression is unknown.

Patients and Methods:
From 2008 to 2013, all patients who underwent microendoscopic laminotomy for single-level LSS with DS were included. In total, 218 patients (91 male, 127 female individuals) were reviewed. DS pathologic staging was defined as early, advanced, or end stage, based on percent slippage (10% slippage), degree of dynamic instability (3 mm), and disc height. The following variables were evaluated preoperatively and >2 years postoperatively and compared among groups: Japanese Orthopaedic Association (JOA) score, JOA recovery rate, and Visual Analog Scale low back pain.

Results:
In total, 173 patients were included in final analysis. Final follow-up period was 2.3 years. Average JOA recovery rate was 63.8%. There were no significant differences in JOA recovery and Visual Analog Scale among 3 DS stages (P>0.05). In total, 9.8% of patients required additional spine surgery, with 5% requiring subsequent fusion. All patients who required subsequent fusion were in the advanced stage DS group.

Conclusions:
Microendoscopic decompression is an effective treatment for patients with DS and concurrent LSS, with only 5% of patients requiring subsequent fusion at over 2-year follow-up, and another 5% requiring revision or adjacent segment decompression. The advanced stage DS group, indicating a >10% anterolisthesis and/or >3 mm of dynamic instability, was more likely to require additional surgery.
Langerhans Cell Histiocytoma: A Benign Histiocytic Neoplasm of Diverse Lines of Terminal Differentiation
Authors: Dupeux Margot , Boccara Olivia , Frassati-Biaggi Annonciade , Hélias-Rodzewicz Zofia , Leclerc-Mercier Stéphanie , Bodemer Christine , Molina Thierry Jo , Emile Jean-François , Fraitag Sylvie 
Published: September 2018

Abstract:
Langerhans cell (LC) histiocytoma is a neonatal tumor that often consists of a single, ulcerated nodule. Systemic involvement is rare, and LC histiocytoma is considered to be a variant of congenital, self-healing LC histiocytosis (also referred to as Hashimoto–Pritzker disease). In view of its low prevalence, LC histiocytoma is not always diagnosed in a clinical examination and requires histological confirmation. Furthermore, the histological and molecular features of LC histiocytoma have not been well characterized. Here, we report on 6 cases of this rare disease and review the corresponding literature. LC histiocytoma differs from classical self-healing LC histiocytosis with regard to the pathological features; we found that LC histiocytoma was associated with massive infiltration by histiocytes of various sizes and shapes (although often large) throughout the dermis and the superficial subcutis. Epidermotropism was rare, mitotic figures were not inconspicuous, and necrotic or calcified areas were often present. Immunohistochemical assessment revealed a mixture of different types of histiocytes (with CD1a+ CD207+, CD1a+ CD207−, and CD1a− CD207− CD163+ cells). Genetic testing was performed in 5 cases; it revealed a BRAF mutation (p.V600E and p.485_490delinsF) in 2 cases, a HRAS mutation (p.T58I) in 1 case, a combination of 2 PTEN mutations in another case (p.I224M and p. R234W), and no mutations in the fifth case. All the lesions regressed spontaneously, and none recurred during follow-up.
Utility of TERT Promoter Mutations for Cutaneous Primary Melanoma Diagnosis
Authors: Thomas Nancy E. , Edmiston Sharon N. , Tsai Yihsuan S. , Parker Joel S. , Googe Paul B. , Busam Klaus J. , Scott Glynis A. , Zedek Daniel C. , Parrish Eloise A. , Hao Honglin , Slater Nathaniel A. , Pearlstein Michelle V. , Frank Jill S. , Kuan Pei Fen , Ollila David W. , Conway Kathleen 
Published: September 2018

Abstract:
Telomerase reverse transcriptase (TERT) promoter mutations are commonly found in malignant melanomas but rare in melanocytic nevi. To assess its potential diagnostic utility for the distinction of melanoma from nevus, we determined the TERT promoter mutation status of 86 primary melanomas, 72 melanocytic nevi, and 40 diagnostically problematic melanocytic proliferations. Of the 86 melanomas, 67 (77.9%) were TERT-positive, defined as harboring a hotspot TERT promoter mutation at positions -124C>T, -124_125CC>TT, -138_139CC>TT, or -146C>T. Of the 72 nevi, only 1 (1.4%) was TERT-positive. Of the 40 diagnostically uncertain melanocytic proliferations, 2 (5.0%) were TERT-positive. TERT positivity as a test for melanoma versus nevus had an accuracy of 87.3% [95% confidence interval (CI), 81.1–92.1], a sensitivity of 77.9% (95% CI, 68.9–85.4), a specificity of 98.6% (95% CI, 95.8–100), a positive predictive value of 98.5% (95% CI, 95.6–100), and a negative predictive value of 78.9% (95% CI, 72.6–85.4). Our results indicate that hotspot TERT promoter mutation status may be a useful ancillary parameter for the diagnosis of melanoma. In particular, the high specificity of these mutations for melanoma indicates the presence of a TERT promoter mutation in a melanocytic neoplasm associated with diagnostic controversy, or uncertainty should increase concern for a melanoma.
Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients
Authors: Smith Harvey , Borchard Kate , Cherian Paul , Tai Yee , Vinciullo Carl 
Published: September 2018

BACKGROUND
Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus).

OBJECTIVE
The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus.

METHODS AND MATERIALS
The authors performed a randomized controlled trial of S. aureus nasal swab–negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention.

RESULTS
In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29).

CONCLUSION
Topical decolonization reduces SSI in nasal swab–negative Mohs surgery patients.
Nuclear and Radiological Source Security Culture Assessment of Radioactive Material Users at a University
Authors: Rane Shraddha , Harris Jason T. , Foss Eric K. , Sheffield Courtney 
Published: September 2018

Abstract
Securing radioactive sources has become increasingly important given the rising threat of radiological terrorism. While radiation safety has long been established in most applicable industries, the importance of nuclear and radiological source security has lagged behind in nonnuclear material specific industries, such as academic institutions and medical facilities. To evaluate the attitudes and behaviors regarding nuclear security culture, an assessment of nuclear and radiological material practices was developed and conducted on 73 radioactive material users at a university. The survey portion of the assessment was comprised of a series of questions segregated into four categories: policy, enforcement, leadership, and behavior. Nuclear security awareness questions formed a subset of the questionnaire. Users were classified by their radioactive material experience and work classification: student, faculty, or other staff. Of the users surveyed, 9% were also interviewed face-to-face to further expand on their views of nuclear security culture. Results of the assessment showed that students from the work classification group as well as the cohort of radioactive material users with 2–5 y of experience possessed a greater degree of awareness towards nuclear security compared to faculty and other more experienced radioactive material users. Relative to students and faculty, other staff from the work classification group faced some difficulty judging the enforcement of policies, adequacy of inspection, and job performance review related to nuclear security. The response from all three groups emphasized the need to enhance threat-response preparedness and greater communication among stakeholders.
The Impact of Military Women in Health Physics
Authors: VanHorne-Sealy Jama 
Published: September 2018

Abstract
Some of the finest women in the U.S. military serve with distinction in the health physics field. These talented women consistently rise above the norm and lead the way in science and in military service. There are over 200 military health or medical physicists, 35 (17%) of whom are female, supporting over one million Department of Defense personnel. They serve in the U.S. Air Force, Army, and Navy. Health physics and medical physics career fields in the military provide a unique opportunity for women to excel, and they have made monumental contributions to the medical community, to the military, and to the nation. This paper highlights just some of the impressive accomplishments of female military health and medical physicists in the service of their nation.
ANATOMICAL CHANGES BETWEEN ARGUS II RETINAL PROSTHESIS AND INNER RETINAL LAYERS DETECTED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN FIRST YEAR: A CASE REPORT
Authors: Patelli Fabio , Colombo Leonardo , Aly Mohamed Omar M. , Rossetti Luca 
Published: September 2018

Purpose:
To report and describe the anatomical changes detected by spectral domain optical coherence tomography between an Argus II retinal prosthesis and the inner retinal layers during 1-year follow-up.

Methods and Results:
A patient presented with epiretinal fibrosis 12 months after implant of an Argus II epiretinal prosthesis. One month after uneventful surgery in March 2016, an evident hyporeflective space was detected between the epiretinal prosthesis and the inner retinal surface by spectral domain optical coherence tomography. An epiretinal hyperreflective band was noticed during follow-up and 1 year after surgery. Spectral domain optical coherence tomography showed close contact of the band with the array, which greatly increased the electrical threshold of stimulation for most of the electrodes. Some electrodes were no longer functioning. No changes in visual performance were detected.

Conclusion:
Argus II epiretinal prosthesis implant may be complicated by the formation of a hyperreflective epiretinal band, detectable by spectral domain optical coherence tomography. The band may alter prosthesis function; to date, the patient did not scored any decrease in visual function.
Efficacy of Plate Expression of Meibum on Tear Function and Ocular Surface Findings in Meibomian Gland Disease
Authors: Aketa Naohiko , Shinzawa Megumi , Kawashima Motoko , Dogru Murat , Okamoto Shosei , Tsubota Kazuo , Shimazaki Jun 
Published: September 2018

Purpose:
To evaluate the clinical effectiveness of expression treatment on meibomian gland disease (MGD).

Methods:
Seventeen right eyes of 17 patients with MGD were divided into 3 groups in this randomized prospective clinical study: no expression group: routine treatment with no expression (five patients, five eyes); digital expression group: routine treatment with digital expression (five patients, five eyes); and plate expression group: routine treatment with plate expression (seven patients, seven eyes). All groups received the same routine treatment for 1 month. Tear film break-up time (TBUT), vital staining scores, meibum expressibility, and the dry eye–related quality of life score (DEQS) questionnaire results were assessed before and 1 month after treatment.

Results:
There was a statistically significant difference of posttreatment TBUT among groups as determined by one-way analysis of variance (P<0.05). A post hoc test revealed that TBUT was statistically significantly higher in plate expression group compared with digital expression group. The fluorescein staining score did not show a statistically significant difference among the groups. Meibum expressibility and the DEQS scores improved in all groups.

Conclusion:
Plate expression when used as an adjunct to routine medical management of MGD has been found to be a comparatively effective treatment in terms of improvement of tear film stability compared with no expression or digital expression.
Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial
Authors: Dada Tanuj , Mittal Deepti , Mohanty Kuldeep , Faiq Muneeb A. , Bhat Muzaffer A. , Yadav Raj K. , Sihota Ramanjit , Sidhu Talvir , Velpandian Thirumurthy , Kalaivani Mani , Pandey Ravindra M. , Gao Ying , Sabel Bernhard A. , Dada Rima 
Published: September 2018

Background:Reducing intraocular pressure (IOP) in primary open-angle glaucoma (POAG) is currently the only approach to prevent further optic nerve head damage. However, other mechanisms such as ischemia, oxidative stress, glutamate excitotoxicity, neurotrophin loss, inflammation/glial activation, and vascular dysregulation are not addressed. Because stress is a key risk factor affecting these mechanisms, we evaluated whether mindfulness-based stress reduction can lower IOP and normalize typical stress biomarkers.Materials and Methods:In a prospective, randomized trial 90 POAG patients (180 eyes; age above 45 y) were assigned to a waitlist control or mindfulness meditation group which practiced daily for 21 days. We measured IOP (primary endpoint), quality of life (QOL), stress-related serum biomarkers [cortisol, β-endorphins, IL6, TNF-α, brain-derived neurotrophic factor (BDNF), reactive oxygen species (ROS), total antioxidant capacity (TAC)], and whole genome expression.Results:Between-group comparisons revealed significantly lowered IOP in meditators (OD: 18.8 to 12.7, OS 19.0 to 13.1 mm Hg) which correlated with significantly lowered stress-biomarker levels including cortisol (497.3 to 392.3 ng/mL), IL6 (2.8 to 1.5 ng/mL), TNF-α (57.1 to 45.4 pg/mL), ROS (1625 to 987 RLU/min/104 neutrophils), and elevated β-endorphins (38.4 to 52.7 pg/mL), BDNF (56.1 to 83.9 ng/mL), and TAC (5.9 to 9.3) (allP<0.001). These changes correlated well with gene expression profiling. Meditators improved in QOL (P<0.05).Conclusions:A short course of mindfulness-based stress reduction by meditation in POAG, reduces IOP, improves QOL, normalizes stress biomarkers, and positively modifies gene expression. Mindfulness meditation can be recommended as adjunctive therapy for POAG.
Variation in Prostaglandin Analog Prices Paid for Through Medicare Part D
Authors: Priluck Aaron Z. , Havens Shane J. 
Published: September 2018

Objective:
Determine the prices and price variation of the prostaglandin analogs (PGAs) used in the United States and examine their trends from 2013 to 2016 using Medicare Part D data.

Design:
This is a retrospective cross-sectional study.

Participants:
All ophthalmologists and optometrists in all 50 states and DC who prescribed any PGA purchased through Part D from 2013 through 2016.

Materials and Methods:
Outcome measures were calculated using Excel 2016 based off of the 2013 to 2016 Medicare Part D Prescriber Data.

Main Outcome Measures:
The 2013 to 2016 nationwide prices of 7 PGAs, the states with the 2016 minimum and maximum average prices, the SDs in PGA prices among the cities in each state, and the nationwide average of these SDs for 2013 to 2016.

Results:
The 2016 nationwide prices of 30-day supplies of bimatoprost, latanoprost, lumigan, travatan Z, travoprost, xalatan, and zioptan in 2016 were: $107.90±25.19, $10.16±1.52, $167.30±17.66, $171.36±19.44, $92.53±15.14, $153.41±15.16, and $162.75±13.22, respectively. Each drug’s SD in city prices within each state averaged nationwide for 30-day supplies in 2016 were $10.89, $1.44, $16.68, $17.23, $10.30, $10.07, and $9.48, respectively. Spending on these drugs totaled $861,180,924 in 2016. There was less price variation within each state as compared with the whole country. No substantial decreases in price variation exist for any drug from 2013 to 2016.

Conclusions:
There is substantial variation in PGA prices when purchased by Medicare Part D enrollees across the United States and within each state itself. Simultaneously, the prices and total expenditure on these medications are increasing yearly. Physicians should be cognizant of this price variation for these expensive and chronically used drugs and should educate patients to optimize their Part D supplemental plan.