bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Risk Factors of Low Back Pain in Female High School Students
Authors: Noormohammadpour Pardis , Borghei Alireza , Mirzaei Shadi , Mansournia Mohammad Ali , Ghayour-Najafabadi Mahboubeh , Kordi Mahla , Kordi Ramin 
Published: August 2018

Study Design.
A prospective cross-sectional study.

Objective.
The aim of this study was to evaluate the prevalence and associated factors with low back pain (LBP) in female adolescents of high school age.

Summary of Background Data.
The prevalence of LBP in Tehran is high, and the majority of previous studies on LBP in adolescent and its risk factors have been performed in the developed countries. Therefore, identification of risk factors and planning appropriate protocols for prevention of LBP in adolescents may substantially decrease the prevalence of LBP and its burden in developing countries in future.

Methods.
In a prospective cross-sectional study, demographic characteristics, including age, body mass index (BMI), weight and mode of using backpack, family history of LBP in first degree relatives, and passive smoking status of the participants along with a history of LBP were recorded. Joint hypermobility was assessed using Beighton scale. Also, anthropometric measurements, spinal flexion, and hip joint range of motion were measured for each participant.

Results.
In total, 372 students participated in the study. The mean (SD) age of the participants was 15.8 (0.9) years. The lifetime, more than 3 months, and last month history of LBP was 46.2%, 11.6%, and 31.2%, respectively. Positive history of LBP in the first-degree relatives was significantly associated with LBP in the participants (P < 0.01). The prevalence of passive smoking was significantly higher in the participants with last month history of LBP (P = 0.03). The prevalence of joint hypermobility was 15.9% and was significantly higher in those with the lifetime and last month history of LBP (P < 0.01).

Conclusion.
LBP is a common complaint among adolescent and high school girl students. The results of this study identified the prevalence and associated factors with LBP in high school students and will help develop strategies for prevention and treatment of LBP in the adolescent population.

Level of Evidence: 3
The Impact of Vancomycin and Cefazolin as Standard Preoperative Antibiotic Prophylaxis on Surgical Site Infections Following Instrumented Spinal Fusion
Authors: Lopez Wylie Y. , Rider Sean M. , Nwosu Kenneth , Kazarian Erick R. , Blucher Justin A. , Schoenfeld Erin M. , Simpson Andrew K. , Kang James D. , Schoenfeld Andrew J. 
Published: August 2018

Study Design.Retrospective cohort study.Objective.To assess whether administration of prophylactic vancomycin, in addition to cefazolin decreased revision surgeries for postoperative infection (SSI) as well as the need for revisions overall.Summary of Background Data.In 2010 our institution implemented an antibiotic prophylaxis regimen consisting of intravenous vancomycin and cefazolin that applied to all patients receiving surgical implants. The impact of this change in prophylactic antibiotic regimen on SSIs following instrumented spinal fusions remains unknown.Methods.We conducted a prepost analysis evaluating the effect of the change in antibiotic prophylaxis on SSIs following instrumented spinal fusions. We collected data on all eligible patients over the course of 2005 to 2009 and 2011 to 2015. We used logistic regression techniques to evaluate unadjusted results for the prophylactic antibiotic protocol on all revision surgeries, as well as those for SSI, followed by sequential adjustments for sociodemographic factors and surgical characteristics.Results.Revision surgeries performed for a diagnosis of infection were reduced from a rate of 4% (n = 57) in the period 2005 to 2009 to 2% (n = 44) over 2011 to 2015 (P < 0.001). At the same time, the incidence of revision surgeries for any cause was also reduced (14% in 2005–2009vs. 9% in 2011–2015;P < 0.001). In adjusted analysis, the odds of a revision procedure for SSI were reduced by 50% following introduction of the protocol (OR 0.50; 95% CI 0.33, 0.76). No significant difference in the organisms responsible for SSI was identified between 2005 and 2009 and 2011 and 2015 (P = 0.22).Conclusion.This natural experiment has shown some utility for a preoperative prophylactic antibiotic regimen of vancomycin and cefazolin, including meaningful reductions in revision procedures performed for SSI. This is the first effort we are aware of to consider a uniform institutional protocol that employs the use of intravenous vancomycin and cefazolin as prophylactic agents.Level of Evidence:2
Can Elective Spine Surgery Be Performed Safely Among Nonagenarians?
Authors: Oichi Takeshi , Oshima Yasushi , Matsui Hiroki , Fushimi Kiyohide , Tanaka Sakae , Yasunaga Hideo 
Published: August 2018

Study Design.
Retrospective cohort study.

Objective.
To compare morbidity and mortality between nonagenarians and other older adult patients who underwent elective spine surgery.

Summary of Background Data.
There is a lack of information of the perioperative risks of nonagenarians undergoing spine surgery.

Methods.
Data of patients aged ≥65 years who underwent elective spine surgery from July 2010 to March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan. Clinical outcomes included mortality, occurrence of major complications (cardiac events, respiratory complications, pulmonary embolism, stroke, and acute renal failure), urinary tract infection, and postoperative delirium. These clinical outcomes in nonagenarians were compared with those in patients aged 65 to 79 years and octogenarians. A multivariate logistic regression model fitted with a generalized estimation equation was used to evaluate the influence of advanced age on 90-day mortality and postoperative major complications.

Results.
Of 88,370 patients identified in the database, 418 were nonagenarians. Compared with patients aged 65 to 79 years and octogenarians, nonagenarians had the highest rates of 90-day mortality (0.2%, 0.3%, and 1.7%, respectively; P < 0.001) and at least one major complication (3.7%, 5.0%, and 7.4%, respectively; P < 0.001). Nonagenarians had the highest proportions of cardiac events, respiratory complications, urinary tract infections, and delirium. The multivariable logistic regression analyses revealed that nonagenarians had increased risks of both 90-day mortality (odds ratio, 8.65; 95% confidence interval, 3.62–20.6) and postoperative major complications (odds ratio, 2.32; 95% confidence interval, 1.61–3.36) compared with patients aged 65 to 79 years.

Conclusion.
Nonagenarians had increased morbidity and mortality following elective spine surgery compared with other older adult patients. Among the complications, cardiac events, respiratory complications, urinary tract infection, and delirium were more likely to occur in nonagenarians.

Level of Evidence: 3
The Impact of Closed Incision Negative Pressure Therapy on Postoperative Breast Reconstruction Outcomes
Authors: Gabriel Allen , Sigalove Steven , Sigalove Noemi , Storm-Dickerson Toni , Rice Jami , Maxwell Patrick , Griffin Leah 
Published: August 2018

Background:
Studies report that incision management with closed incision negative pressure therapy (ciNPT) may provide clinical benefits, including protecting surgical incisions, for postsurgical closed incisions (eg, orthopedic, sternotomy, and colorectal). This retrospective analysis compared postoperative outcomes in patients who received ciNPT versus standard of care (SOC) for incision management after breast reconstruction postmastectomy.

Methods:
Patient demographics, chemotherapy exposure, surgical technique, ciNPT use, number of drains, time to drain removal, and 90-day postoperative complication rates were analyzed from records of 356 patients (ciNPT = 177, SOC = 179) with 665 closed breast incisions (ciNPT = 331, SOC = 334).

Results:
Overall complication rate was 8.5% (28/331) in ciNPT group compared with 15.9% (53/334) in SOC group (P = 0.0092). Compared with the SOC group, the ciNPT group had significantly lower infection rates [7/331 (2.1%) versus 15/334 (4.5%), respectively; P = 0.0225], dehiscence rates [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0178], necrosis rates [17/331 (5.1%) versus 31/334 (9.3%), respectively; P = 0.0070], and seroma rates [6/331 (1.8%) versus 19/334 (5.7%), respectively; P = 0.0106]. The ciNPT group required significantly fewer returns to operating room compared with the SOC group [8/331 (2.4%) versus 18/334 (5.4%), respectively; P = 0.0496]. Time to complete drain removal per breast for ciNPT versus SOC groups was 9.9 versus 13.1 days (P < 0.0001), respectively.

Conclusions:
Patients who received ciNPT over closed incisions following postmastectomy breast reconstruction experienced a shorter time to drain removal and significantly lower rates of infection, dehiscence, necrosis, and seromas, compared with the SOC group. Randomized controlled studies are needed to corroborate the findings in our study.
Lipoaugmentation following Implant Removal Preferred by Plastic Surgeons and the General Public
Authors: Mess Sarah A. 
Published: August 2018

Background:
Breast implant removal followed by fat transfer to the breast (lipoaugmentation) is a newer procedure and as such there is a need for empirical aesthetic comparisons between breast augmentation with implants versus fat transfer. Fat transfer to the breast is becoming an important option for women seeking reoperation of breast augmentation.

Methods:
A survey was created using standardized before and after photographs of 12 patients who underwent implant removal and lipoaugmentation. Four photographs of breasts that had no surgery were used as controls, with identical before/after photographs. The survey was administered to 96 respondents from the general population and 10 plastic surgeons. Respondents were asked to rate the breasts using a 5-point Likert scale without procedural knowledge. The responses were evaluated using parametric statistical t tests to compare responses to implants versus fat transfer in terms of their respective attractiveness, naturalness, size, symmetry, and femininity.

Results:
Fat transfer was significantly preferred to implants on all 5 measures; attractiveness, naturalness, size, symmetry, and femininity. Fat transfer was significantly preferred to implants by a margin of +0.36 average on 1–5 scale, which is approximately 1/3 of a Likert interval on all measures. Plastic surgeons took significantly longer than the general population to complete the survey and preferred fat transfer over implants to a higher degree.

Conclusions:
Lipoaugmentation can provide a favorable aesthetic outcome in women seeking implant removal. The general public can be conveniently surveyed via crowd sourcing, and their aesthetic judgments largely mirror those of trained and experienced plastic surgeons. Patients weighing breast implant removal or breast implant revision could consider this study in their decision making.
An Algorithm Using Botox Injections for Facial Scar Improvement in Fitzpatrick Type IV–VI Skin
Authors: Shome Debraj , Khare Stuti , Kapoor Rinky 
Published: August 2018

Background:Wounds of the face are known to heal poorly with conspicuous scarring. Hence, it is crucial to address the distracting effect of muscle pull on immature collagen, which often leads to worsening of scars.Study Design:Prospective clinical study.Methods:One hundred patients with a minimum of 6 months follow-up were recruited. All patients with depressed scars underwent surgery for scar revision. Two weeks before surgical intervention, intramuscular Botulinum toxin was injected around the scar, to prevent movement of the facial muscles. From the second week postsurgery, Cicatrix (Formulation containing activated Centella Asiatica & Pinus Sylvestris, Catalysis, Spain) was routinely used, 3 times a day, for 6 months post the scar revision surgery. Six weeks postsurgery, Fractional C02laser treatment was started and performed every 4 weeks.Results:Using the Objective Assessment Score and the Subjective Assessment Score, the mean of the scores were taken. All patients had satisfactory results, as measured by a patient satisfaction survey and objectively by the physician assessment.Discussion:Botulinum toxin injected before scar revision surgery resulted in the wound being stabilized, better wound healing, and prevention of wound widening during healing.Conclusion:In view of the results of this study, it is considered worthwhile to offer patients with facial scars, Botulinum toxin injections before scar revision surgery, followed by Fractional C02laser, along with the routine use of Cicatrix Cream.
BREAST-Q Measurement of the Patient Perspective in Oncoplastic Breast Surgery: A Systematic Review
Authors: Liu Liang Q. , Branford Olivier A. , Mehigan Sinead 
Published: August 2018

Background:
Since BREAST-Q was developed in 2009, it has been widely used by clinicians and researchers to capture information regarding health-related quality of life (HRQoL) and patient satisfaction related to breast surgery. Yet clinical guidelines regarding the use of BREAST-Q for assessment of success of surgery in women with breast cancer remain limited. To maximize the benefits of using BREAST-Q to inform clinical decision making, this systematic review aimed to identify and appraise current evidence on patient-reported outcomes (PROs) assessed by BREAST-Q associated with breast oncoplastic surgery.

Methods:
A detailed search strategy was implemented and electronic databases searched include PubMed, MEDLINE, CINAHL, and PsycINFO. Review was limited to peer-reviewed studies published in English from 2009 to January 2018. Any interventional and observational studies that used BREAST-Q to assess PROs in the assessment of breast oncoplastic surgery were included.

Results:
Fifty-four peer-reviewed articles met inclusion criteria. Fifty-three studies were observational, 1 study was interventional. Current comparative studies using BREAST-Q indicated that abdominal flap, buttock flap, or thigh flap reconstruction offered highest satisfaction with breast; contralateral prophylactic mastectomy with immediate reconstruction offered higher levels of satisfaction with breast, but poor postsurgical physical well-being. Silicone implant and no radiation therapy offered higher level satisfaction and HRQoL.

Conclusions:
Current evidence showed that BREAST-Q can effectively measure patient’s satisfaction and HRQoL in relation to different type of breast oncoplastic surgeries. BREAST-Q captured meaningful and reliable information from the patients’ perspective and may be useful for clinical decision making.
Spectral Domain Anterior Segment Optical Coherence Tomography in Fungal Keratitis
Authors: Sharma Namrata , Singhal Deepali , Maharana Prafulla Kumar , Agarwal Tushar , Sinha Rajesh , Satpathy Gita , Singh Bageshwar Lalit Mohan , Titiyal Jeewan S. 
Published: August 2018

Purpose:
To evaluate the use of spectral domain anterior segment optical coherence tomography (SD-ASOCT) in fungal keratitis.

Methods:
Fifty eyes of 50 patients with fungal keratitis were recruited. Serial ASOCT was performed on days 0, 7, 14, 21, 28, 42, and 56. Corneal thickness (CT) in the infiltrate area, infiltrate thickness (IT), and infiltrate width were measured at each follow-up. The presence of any specific feature on ASOCT was evaluated.

Results:
Mean CT and IT at presentation were 650.5 ± 108 μm and 401.1 ± 91 μm, which reduced significantly at each follow-up [on days 7, 14, 28, and 42; 626.8 ± 113 μm (P < 0.001) and 367.3 ± 94 μm (P = 0.002), 601.4 ± 109 μm and 344.7 ± 94 μm (P < 0.001), 544.8 ± 103 μm and 305.1 ± 80 μm (P < 0.001), and 522.8 ± 97 μm and 291.4 ± 79 μm (P < 0.001), respectively]. The mean CT and scar depth at complete healing were 496.3 ± 101 μm and 283.2 ± 77 μm, respectively. In 10/50 (20%) eyes, the posterior border of the cornea was not clearly visible because of posterior shadowing; therefore, IT was measured along the maximum visible area of hyperreflectivity, whereas CT was measured just adjacent to the area of shadowing. The infiltrate width was measured in 35 eyes, and the mean values at days 0, 7, 14, 28, 42, and 56 were 5.5 ± 0.8 mm, 4.6 ± 0.7 mm, 4.4 ± 0.6 mm, 4.2 ± 0.6 mm, 4.1 ± 0.6 mm, and 4.1 ± 0.6 mm, respectively. A satellite lesion and endothelial plaque were seen in 30% (15/50) and 44% (22/50) eyes, respectively.

Conclusions:
ASOCT is a useful adjunct in monitoring fungal keratitis especially in cases with deep stromal involvement and endothelial plaques. In addition, it also provides insight into the activity of keratitis.
Increasing Vitamin D Serum Levels Is Associated With Reduced Pulmonary Exacerbations in Patients With Cystic Fibrosis
Authors: Abu‐Fraiha Yasmeen , Elyashar‐Earon Hila , Shoseyov David , Cohen‐Cymberknoh Malena , Armoni Shoshana , Kerem Eitan , Wilschanski Michael 
Published: August 2018

ABSTRACTContext:In 2012, The North American Cystic Fibrosis Foundation (NACFF) published new guidelines for the treatment of vitamin D deficiency in individuals with cystic fibrosis (CF).Objective:The objectives of our study were to assess the efficacy of these guidelines, and to test the effect of increasing vitamin D dosage on pulmonary function and exacerbations.Design:Pulmonary function tests and serum concentrations of 25‐hydroxyvitamin D [25(OH)D] were measured 1 year before increasing vitamin D dosage according to the guidelines and at least 1 year later. In addition, days of hospitalization and pulmonary exacerbations were counted and an average per year (average number of days of hospitalization and average number of pulmonary exacerbations [PEA], respectively) was calculated.Setting and Participants:A total of 90 patients from The Cystic Fibrosis Clinic at Hadassah Mount‐Scopus Hospital, Jerusalem, Israel.Results:The mean serum concentration of vitamin D increased significantly from 20.97 ng/mL (52.34 nmol/L) at baseline to 25.41 ng/mL (63.42 nmol/L) at the end of follow‐up (P < 0.001). The number of PEA decreased significantly from 2.79 ± 3.96 to 2.15 ± 2.91 (P = 0.007). The change in vitamin D levels was correlated with a decrease in PEA (correlation coefficient = −0.318, P = 0.002).Conclusions:The NACFF guidelines for management of vitamin D deficiency improve vitamin D levels in patients with CF but did not reach the normal values in most patients. The increase in vitamin D serum levels was, however, associated with a decrease in number of pulmonary exacerbations.
Providers' Ability to Identify Sentinel Injuries Concerning for Physical Abuse in Infants
Authors: Eismann Emily A. , Shapiro Robert A. , Thackeray Jonathan , Makoroff Kathi , Bressler Colleen J. , Kim Grace J. , Vavul-Roediger Lori , McPherson Paul , Izsak Eugene , Spencer Sandra P. 
Published: August 2018

Objectives
The objectives of this study were to assess the ability of pediatric health care providers and social workers to recognize sentinel injuries in infants under 6 months of age and to determine what factors influence their decision to evaluate for physical abuse.

Methods
A statewide collaborative focused on sentinel injuries administered a survey to pediatric health care providers and social workers in the emergency department, urgent care, and primary care. The survey contained 8 case scenarios of infants under 6 months of age with an injury, and respondents were asked if they would consider the injury to be a sentinel injury requiring a physical abuse evaluation. Respondents were then presented with several factors and asked how much each influences the decision to perform a physical abuse evaluation.

Results
A total of 565 providers completed the survey. Providers had moderate interrater reliability on their classification of the cases as sentinel injuries or not (κ = 0.57). Nearly all respondents (97%) recognized genital bruising as a sentinel injury, whereas 77% of respondents recognized intraoral injuries. Agreement was highest among social workers (κ = 0.76) and physicians with categorical pediatrics training and pediatric emergency medicine fellowship (κ = 0.63) and lowest among nurse practitioners (κ = 0.48) and residents (κ = 0.51). Concern over missing the diagnosis of abuse had the greatest influence on the decision to perform a physical abuse evaluation.

Conclusions
Sentinel injuries are not uniformly recognized as potential signs of child abuse requiring further evaluation by pediatric health care providers. Additional evidence and education are needed regarding sentinel injuries.
Craniofacial Flash: Minimizing Radiation Dose in Pediatric Craniofacial Computed Tomography
Authors: Stewart Neil M. , Hallac Rami R. , Chou Pang-Yun , Koral Korgun , Blackburn Tim , Kane Alex A. , Seaward James R. 
Published: August 2018

Background and Purpose:
The routine use of computed tomography (CT) in evaluation of pediatric craniofacial abnormalities is controversial. While there are benefits to preoperative imaging, there are risks related to ionizing radiation and sedation/anesthesia. In this study, the authors describe their experience with a new craniofacial CT protocol (Craniofacial-Flash) that provides bone detail equivalent to conventional CT, while delivering a substantially lower radiation dose and reducing the scan time to obviate the requirement of sedation/anesthesia.

Methods:
Following IRB approval, dose identification and image analysis were conducted retrospectively on all patients who underwent craniofacial CT using either the conventional protocol or Craniofacial-Flash protocol between November 2013 and September 2015. Image analysis consisted of automated segmentation of bone and soft tissue, followed by noise interpretation of each study segment.

Results:
The conventional CT group included 175 patients (mean age 6.38 years) with a median dose length product of 243.00 mGy·cm. The Craniofacial-Flash CT group included 208 patients (mean age 3.31 years) with median dose length product of 27.60 mGy·cm. Image quality was equivalent for bone, with coefficient of variation values of 0.20 for the conventional CT group and 0.21 for the Craniofacial-Flash group. Soft tissues coefficients of variation were disparate at 0.07 for conventional CT and 0.14 for Craniofacial-Flash protocol.

Conclusion:
The Craniofacial-Flash protocol reliably generates craniofacial bone images adequate for routine use in craniofacial practice, while reducing the radiation dose by 88.87% compared with a conventional craniofacial CT scan, and eliminating the need for sedation.
Physics of Transcranial Direct Current Stimulation Devices and Their History
Authors: Truong Dennis Q. , Bikson Marom 
Published: August 2018

Abstract
Transcranial direct current stimulation (tDCS) devices apply direct current through electrodes on the scalp with the intention to modulate brain function for experimental or clinical purposes. All tDCS devices include a current controlled stimulator, electrodes that include a disposable electrolyte, and headgear to position the electrodes on the scalp. Transcranial direct current stimulation dose can be defined by the size and position of electrodes and the duration and intensity of current applied across electrodes. Electrode design and preparation are important for reproducibility and tolerability. High-definition tDCS uses smaller electrodes that can be arranged in arrays to optimize brain current flow. When intended to be used at home, tDCS devices require specific device design considerations. Computational models of current flow have been validated and support optimization and hypothesis testing. Consensus on the safety and tolerability of tDCS is protocol specific, but medical-grade tDCS devices minimize risk.