bluuebunny/crossref_metadata_2025_split huggingface dataset:
VESSEL DENSITY OF SUPERFICIAL, INTERMEDIATE, AND DEEP CAPILLARY PLEXUSES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Lavia Carlo , Bonnin Sophie , Maule Milena , Erginay Ali , Tadayoni Ramin , Gaudric Alain 
Published: December 2018

Purpose:
To provide values of retinal vessel density (VD) in the three retinal capillary plexuses, foveal avascular zone (FAZ) area, and retinal layer thickness in a cohort of healthy subjects.

Methods:
The optical coherence tomography angiography maps of 148 eyes of 84 healthy subjects, aged 22 to 76 years, were analyzed for measuring VD of the retinal capillary plexuses, using the Optovue device comprising a projection artifact removal algorithm. Foveal avascular zone metrics were measured, and the relationship between optical coherence tomography angiography findings and age, sex, and image quality was studied.

Results:
The deep capillary plexus showed the lowest VD (31.6% ± 4.4%) in all macular areas and age groups compared with the superficial vascular plexus (47.8% ± 2.8%) and intermediate capillary plexus (45.4% ± 4.2%). The mean VD decreased by 0.06%, 0.06%, and 0.08% per year, respectively, in the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus. Mean FAZ area, FAZ acircularity index, and capillary density in a 300-µm area around the FAZ were 0.25 ± 0.1 mm2, 1.1 ± 0.05, and 50.8 ± 3.4%, respectively. The yearly increase in FAZ area was 0.003 mm2 (P < 0.001).

Conclusion:
The deep capillary plexus, a single monoplanar capillary plexus located in the outer plexiform layer, has the lowest VD, a significant finding that might be used to evaluate retinal vascular diseases. Vascular density decreased with age in the three capillary plexuses.
DRUSEN SUBTYPES AND CHOROIDAL CHARACTERISTICS IN ASIAN EYES WITH TYPICAL NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Lee Junwon , Kim Min , Lee Christopher Seungkyu , Kim Sung Soo , Koh Hyoung Jun , Lee Sung Chul , Byeon Suk Ho 
Published: December 2018

Purpose:
To investigate the prevalence of pachydrusen, soft drusen, and subretinal drusenoid deposits in eyes with different neovascular age-related macular degeneration (nAMD) subtypes, determine the relationship between each drusen type and the choroidal thickness, and analyze the distinct features of each nAMD subtype according to the drusen type.

Methods:
Medical records involving 454 eyes from 454 patients with nAMD were retrospectively reviewed. The prevalence of each drusen type and the choroidal thickness and choroidal characteristics were evaluated according to the nAMD subtype.

Results:
Pachydrusen were prevalent in the typical nAMD (40.4%) and polypoidal choroidal vasculopathy (47.8%) groups and were not detected in the retinal angiomatous proliferation group. No significant drusen were detected in 24.3% of typical nAMD, 43.3% of polypoidal choroidal vasculopathy, and 0% of retinal angiomatous proliferation groups. Regardless of the nAMD subtype, pachydrusen, soft drusen, and subretinal drusenoid deposits were associated with a thick, moderately thick, and thin choroid, respectively. For eyes with typical nAMD, the prevalence of choroidal vascular hyperpermeability and extrafoveal neovascularization was significantly higher in the pachydrusen group than in the other groups. By contrast, the prevalence of Type 2 neovascularization was significantly lower in the pachydrusen group than in the subretinal drusenoid deposit group (P < 0.001 for all).

Conclusion:
The prevalence of various drusen differed according to the nAMD subtypes, and each drusen type was strongly associated with the choroidal thickness. Typical nAMD showed distinct features according to the accompanying drusen type.
A Prospective Comparative Study Between Subcuticular and Sutureless Technique of Skin Closure Following External Dacryocystorhinostomy
Authors: Rizvi Syed Ali Raza , Sabah Mehnaz , Saquib Mohammmed , Mahmood Faizan , Alam Md Shahid 
Published: December 2018

Purpose:
To compare the cosmetic outcome of the surgical scar of external dacryocystorhinostomy by the subcuticular versus sutureless technique.

Methods:
This was a prospective interventional randomized control study conducted at tertiary level hospital. Fifty patients of primary-acquired nasolacrimal duct obstruction were included in this study. The control group patients underwent the technique of wound closure in 2 layers, subcutaneous interrupted suture with 6-0 vicryl and superficial skin with 6-0 prolene continuous subcuticular sutures. In the case group, interrupted subcutaneous sutures with 6-0 vicryl with Steristrip for skin apposition was used. The surgical scars were assessed and graded by still photographs on a computer screen by 2 independent observers unaware of the surgical technique used at 2, 6 and 12 weeks postoperatively.

Results:
The mean scar assessment score by the 2 observers were 2.60 (0.57), 2.04 (0.64), and 1.16 (0.89) in control group and 2.02 (0.65), 1.44 (0.70), and 0.44 (0.61) in case group at 2, 6, and 12 weeks, respectively. Scar grades were analyzed using chi-square test between the 2 group and Wilcoxon signed rank test within the group. The difference between the 2 groups were found to be statistically significant at 2, 6, and 12 weeks (P < 0.05). Thus, the technique of wound closure with steristrip lead to comparatively less scarring as compared with subcuticular technique.

Conclusion:
The authors recommend the sutureless technique of wound closure using steristrip in Ext DCR as it has superior cosmetic results as compared with subcuticular technique of external dacryocystorhinostomy.
Provider Perspective in the Health Care Economics of Lower-Limb Prosthetic Rehabilitation
Authors: Kaluf Brian 
Published: December 2018

ABSTRACT
Health care economic science holds great potential for improving the quality of lower-limb prosthetic care. To realize this potential, health care providers need to adopt an outlook that economic analysis is not strictly limited to the scrutiny of cost, but includes a better understanding of the value generated in the provision of lower-limb prostheses. Health care providers in the United States currently have a negative perception of cost containment efforts implemented by regulators to rein in health care spending. The United States currently spends more on health care than any other developed country (17.9% of GDP; National Health Expenditure Projections 2017–2026. Centers for Medicare and Medicaid Services; 2017), whereas other countries have reduced cost and increased quality of care through health care economic science.
The clinical outcome of restoring mobility and independence to a person with lower-limb amputation has an appreciable impact on quality of life. By measuring the quality improvement and comparing costs associated with available lower-limb prosthetic alternatives, health care economic science can improve decision making regarding the best use of resources and improve the overall value of care. Although limited economic evidence exists concerning lower-limb prostheses, a better understanding of the purpose of health care economic science can lead health care providers to contribute to the economic research that is needed.
Economic Evaluations of Interventions for Transtibial Amputees: A Scoping Review of Comparative Studies
Authors: Highsmith M. Jason , Kahle Jason T. , Lewandowski Amanda , Klenow Tyler D. , Orriola John J. , Miro Rebecca M. , Hill LTC. Owen T. , Raschke Sylvia Ursula , Orendurff Michael S. , Highsmith James T. , Sutton Bryce S. 
Published: December 2018

ABSTRACT
Transtibial amputation (TTA) is life-altering emotionally, functionally, and economically. The economic impact to all stakeholders is largely unknown, as is the cost-effectiveness of prosthetic intervention. This scoping report’s purpose was to determine if there is sufficient evidence to conduct a formal systematic review or meta-analysis in any particular prosthetic intervention area and to determine if any evidence statements could be synthesized relative to economic evaluation of interventions provided to patients with TTA. The scoping review revealed six articles representing three topical areas of transtibial care: Care Models, Prosthetic Treatment, and Prosthetic Sockets. All six articles were cost-identification or cost-consequence design and included a total of 704 subjects. Presently, it can be concluded with moderate confidence that specific weight bearing and total contact sockets for transtibial amputees are functionally and economically equivalent in the short term when costs, delivery time, and all stakeholder perspectives are considered. Long-term socket outcomes are relatively unexplored. Further primary research is needed beyond this to determine cost-effectiveness for other areas of transtibial prosthetic care although clinical outcomes are somewhat established through systematic review and meta-analysis in other areas of care. Conversely, evaluation of narrative economic reports relative to transtibial care may be sufficient to warrant further analysis. Guidance from the profession may also be useful in devising a strategy for how to assure economic analyses are a routine element of future prosthetic science.
The Jar of Truthiness: A Novel Class Activity to Develop Leaders With Integrity
Authors: Brown Nathaniel A. , Luna Sarah E. , LaLonde Amanda N. 
Published: December 2018

Background and Purpose.
Truthiness is a gut feeling of being true rather than being based on logic or factual evidence. This educational case report describes a novel class activity called the “Jar of Truthiness” (JoT) that aims to teach the important issues of academic and professional integrity within the affective domain.

Case Description.
The activity was completed in 3 different ways in physical therapist education programs at 2 institutions. Students were asked to report their incidence of cheating during a specific quiz, or overall during their time in physical therapy school, by placing anonymous responses in a jar (the JoT). Two of the activities were completed during the first year of the program, the other activity was completed during the second year of the program.

Outcomes.
Most students who participated in the activity reported they had cheated, and some students even reported they lied about whether they cheated. When the activity was repeated over time, the number of students admitting to cheating decreased significantly.

Discussion and Conclusion.
Students responded positively and were able to link academic integrity to professional integrity when the JoT activity was centered around one specific quiz and completed early in the Doctor of Physical Therapy curriculum. Students experienced negative emotions when the activity was held during the second year and when they were asked broadly about sharing information on any assessment in the program. The JoT activity facilitated class discussions about professional development and stimulated learning within the affective domain. Also, the activity appears to work best during the students' early professional formation so that it can help to frame a culture of integrity within their class cohort.
Diagnostic Value of the Magnetic Resonance Imaging With Intratympanic Gadolinium Administration (IT-Gd MRI) Versus Audio-Vestibular Tests in Menière's Disease: IT-Gd MRI Makes the Difference
Authors: Wesseler Antje , Óvári Attila , Javorkova Andrea , Kwiatkowski André , Meyer Jens E. , Kivelitz Dietmar E. 
Published: December 2018

Objective:
Our aim was to evaluate the validity and reliability of clinically relevant tests in the diagnosis of Menière's disease (MD) according to the criteria formulated during 2015 as well as their efficacy in detecting endolymphatic hydrops (EH). The focus was on: three-dimensional fluid-attenuated inversion recovery—SPectral Attenuated Inversion Recovery (3D-FLAIR-SPAIR) sequences using 3 Tesla magnetic resonance imaging (3T MRI) performed 24 hours after intratympanic Gadolinium injection (IT-Gd) in comparison with the functional tests pure tone audiometry (PTA), caloric test, video head impulse test (vHIT), and cervical-vestibular-evoked-myogenic-potentials (cVEMP).

Study Design:
Retrospective study.

Setting:
Tertiary care center.

Patients:
Primary eligibility criteria were given clinical suspicion of MD and the performance of an IT-Gd MRI leading to a group of 31 patients and 52 ears to be analyzed separately.

Main Outcome Measure (s):
Reanalysis of the raw diagnostic data leading to comparability of IT-Gd MRI, PTA, caloric test, vHIT, and cVEMP concerning their valency for clinically diagnosed MD and quantifiability of EH.

Results:
Considering sensitivity, specificity, and the likelihood-ratio only the IT-Gd MRI displayed results qualifying it as a viable device for MD-diagnostics in regards to the criteria of 2015 (p = 0.01), it even provides direct imaging evidence for the underlying pathology of the disease. Furthermore, the comparison between MRI images and test results of caloric test, vHIT and cVEMP revealed that neither of these diagnostic functional tests serves as a reliable indicator for EH.

Conclusions:
It appears that the diagnosing process of MD would benefit from turning IT-Gd MRI into a standard diagnostic procedure in cases of suspected MD, displaying better results than caloric test, vHIT, and cVEMP.
Direct comparison of choline PET/CT and MRI in the diagnosis of lymph node metastases in patients with prostate cancer
Authors: Huang Shi-ming , Yin Liang , Yue Jian-lan , Li Yan-feng , Yang Yang , Lin Zhi-chun 
Published: December 2018

Abstract

Background:
Lymph node detection in prostate cancer is challenging and critical to determine treatment policy. Choline PET/CT (positron emission tomography/computed tomography) and magnetic resonance imaging (MRI) have been used for the evaluation of lymph node metastasis in patients with prostate cancer for the past decade. However, only limited patients underwent direct comparison studies.

Purpose:
To evaluate the diagnostic performance of choline PET/CT compared with MRI imaging for detecting lymph node metastases in prostate cancer patients.

Material and Methods:
Relevant English-language articles published before February 2018 were searched in PubMed database, Embase database, and Cochrane Library databases search using the keywords: (Prostate Neoplasm OR Prostate Cancer OR prostate carcinoma) and (Lymph Node) and (PET/CT OR positron emission tomography/computed tomography) and (choline or 2-hydroxy-N,N,N-trimethylethanaminium) and (magnetic resonance imaging OR MRI). Articles were included that directly compare the diagnostic performance and clinical utility of choline PET/CT and MRI for detecting lymph node metastases in prostate cancer patients. Study quality was assessed with QUADAS criteria. Analyses were performed on a per patient and a per node basis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (LR+), and negative likelihood ratio (LR−) were calculated using Meta-Disc 1.4 software. Summary receiver-operating characteristic (SROC) curves constructed.

Results:
A total of 362 patients from 8 studies involving fulfilled the inclusion criteria. On patient-based analysis, the pooled sensitivity, specificity, and DOR with a 95% confidence interval (CI) for choline PET/CT imaging were 0.59 (95%CI, 0.50–0.67), 0.92 (95%CI, 0.87–0.96), 17.37 (95%CI, 4.42–68.33), and for MRI imaging, they were 0.52 (95%CI, 0.44–0.61), 0.87 (95%CI, 0.81–0.92), 6.05 (95%CI, 3.09–11.85), respectively. On node-based, the corresponding values for choline PET/CT imaging were 0.51 (95%CI, 0.46–0.57), 0.99 (95%CI, 0.98–0.99), 65.55 (95%CI, 23.55–182.45), and for MRI imaging, they were 0.39 (95%CI, 0.34–0.44), 0.97 (95%CI, 0.96–0.97), 15.86 (95%CI, 8.96–28.05), respectively.

Conclusion:
Choline PET/CT performed better than MRI imaging in evaluating the lymph nodes metastasis of prostate cancer patients and had the potential to be broadly applied in clinical practice.
Effectiveness of acupuncture for recovery of flatulence after cesarean section
Authors: Sun Weipeng , Li Minying , Lin Tong , Sun Zhizhong , Zhuang Zhenjie , Wen Junmao , Ji Shuliang , Xie Yizi , Lu Jingjing , Luo Chuanjin , Wu Wei , Wang Lin , Zheng Liang , Xu Danghan 
Published: December 2018

Abstract

Rationale:
Postoperative ileus with flatulence is a common symptom in patients who have undergone cesarean section, and it can lead to peritonitis and intestinal perforation. However, few previous reports described therapeutic effects of acupuncture in women with flatulence after cesarean delivery. We reported a case of 29-year-old woman with abdominal flatulence after cesarean section.

Patient concerns:
The patient developed right abdominal pain and distention with no discharging bowel movement or passage of gas through the anus after cesarean section.

Diagnosis:
The computed tomography revealed bowel loops filled with gas. She was diagnosed with postoperative ileus.

Interventions:
From the second day after cesarean section, acupuncture was administered at the bilateral Zusanli (ST36), Shangjuxu (ST37), Yinlingquan (SP9), Sanyinjiao (SP6), Zhigou (TE6), and Hegu (LI4) acupoints.

Outcomes:
The patient exhibited the successful passage of gas through the anus 30 minutes after acupuncture needles were removed. The time to first defecation with a normal total stool weight and moderate hardness was 3 hours after acupuncture treatment.

Lessons:
Acupuncture can be an effective alternative treatment in patients with flatulence after cesarean section.
Clinicopathological features and differential diagnosis of hepatocellular carcinoma in extrahepatic metastases
Authors: Chen Dingbao , Li Zhao , Song Qiujing , Qian Lihua , Xie Batubaiyin , Zhu Jiye 
Published: December 2018

Abstract
Extrahepatic metastasis of hepatocellular carcinoma (HCC) may cause a diagnostic problem. All 195 cases of histologic and immunostained sections were reviewed retrospectively in one center. The expression of arginase-1 (Arg-1), hepatocyte paraffin-1 (HepPar-1), glypican-3 (GPC-3), and α-Fetoprotein (AFP) was evaluated. Eighty cases of metastatic tumors of the liver were also collected to verify their effectiveness. Totally 151 cases had previous history of HCC, in whom 49 had history of liver transplantation. Forty-four cases were diagnosed as metastatic HCC at initial presentation. The most common extrahepatic metastatic sites were bone (57%), followed by lung, lymph node, etc. Around 19 cases were positive for 1 marker, 22 were positive for 2 markers, 95 were positive for 3 markers, and 59 were positive for 4 markers. With the number of antibody increased in the panel, the negative cases decreased. The sensitivity of ARG, GPC-3, HepPar-1, and AFP was 82.6%, 89.2%, 83.6% and 53.8%, and the specificity was 98.3%, 94.8%, 96.2% and 100%, respectively. These data suggest that the panel of ARG-1, GPC-3, HepPar-1 and AFP has a high sensitivity and specificity to differentiate HCC from non-HCC. This study indicated that HCC should be considered when diagnosing metastasis of unclear origin. It is recommended to use the panel of ARG-1, GPC-3, HepPar-1 and AFP to differentiate HCC from non-HCC in extrahepatic metastasis, because of their sensitivity and specificity, especially in poorly differentiated lesions.
PET/CT-negative malignant spine tumor with pathologic fracture
Authors: Kim Kang-Un , Choi Joon Hyuk , Lee Gun Woo 
Published: December 2018

Abstract

Rationale:
We report on a patient with a positron emission tomography/computed tomography scans (PET/CT)-negative malignant spine tumor, which had even caused a pathologic fracture, and was eventually confirmed on surgical biopsy.

Patient concerns:
A 67-year-old man visited our emergency department with sudden onset of lower extremities paraplegia after slip down. On examination, gradually increasing paralysis was observed in both lower limbs.

Diagnoses:
Plain radiograph and CT showed an acute burst fracture at T12 with an osteolytic mass lesion within the vertebral body and pedicle, causing severe encroachment of the spinal canal. Magnetic resonance imaging (MRI) revealed a bulging posterior cortex of the T12 vertebral body, which suspected a pathologic fracture due to malignancy. However, PET/CT showed a benign burst fracture, which was confirmed by a senior radiologist.

Intervention:
We planned surgery for emergent decompression of the spinal cord, temporary stabilization, and tissue biopsy. The histologic evaluation confirmed the lesion to be a malignant solitary bone plasmacytoma (SBP). Seven days later, definite surgery in the form of pedicle screw fixation and posterolateral bone graft from T8 to L2 was performed. Four weeks after the definite surgery, the patient underwent radiation therapy for 2 months.

Outcomes:
Three weeks postoperatively, lower extremity motor function fully recovered, and ambulation with support was possible. One year postoperatively, spine MRI showed no evidence of local recurrence, and complete decompression of the spinal cord was achieved.

Lessons:
Spine surgeons should bear in mind that malignant spine tumors could be misinterpreted as benign on PET/CT.
Comparison of the clinical outcomes of revision of failed UKAs to TKAs with primary TKAs
Authors: Zuo Wei , Ma Jinhui , Guo Wanshou , Zhang Qidong , Wang Weiguo , Liu Zhaohui 
Published: December 2018

AbstractUnicompartmental knee arthroplasty (UKA) is one of the effective surgical methods for the treatment of unicompartmental knee arthritis. When UKA fails, a revised surgery to total knee arthroplasty (TKA) is often necessary. The purpose of this study was to compare the clinical outcomes of revision of failed UKAs to TKAs with primary TKAs. The hypothesis was that the TKAs revised from UKAs had inferior clinical outcomes compared with primary TKAs.This meta-analysis was conducted in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Newcastle-Ottawa Scale (NOS) proposed by the Cochrane Collaboration was used for evaluating the methodological quality of the studies. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies that compared the revision of UKA to TKA with primary TKA. Primary outcomes included Range of motion (ROM); Knee society score (KSS); (re-)revision rate and complications. Secondary outcomes were blood loss and length of hospital stay.A total of 8 eligible retrospective comparative studies were identified from a keyword search. Results revealed that the primary TKAs group has a better ROM (MD = −7.29, 95% CI:−14.03–0.56,P < .05), higher Knee Society Knee scores (MD = −0.54, 95% CI:−1.12–0.04,P < .05), higher Knee Society function score (MD = −0.65,95% CI:−1.25–0.06,P < .05), lower (re-)revision rate (MD = 4.15, 95% CI:2.37–7.25,P < .05) than rUKAs. There was no significant difference in postoperative complications, blood loss and length of stay between the 2 groups.Our meta-analysis revealed that compared with primary TKAs, TKAs revised from UKAs had inferior clinical outcomes.