bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inter/Intraobserver Reliability of T1 Pelvic Angle (TPA), a Novel Radiographic Measure for Global Sagittal Deformity
Authors: Plachta Stephen M. , Israel Heidi , Brechbuhler Jennifer , Hayes Ann , Huebner Stephen , Place Howard M. 
Published: April 2018

Study Design.
Reliability analysis.

Objective.
To assess intra- and interobserver agreement of the T1 pelvic angle (T1PA), a novel radiographic measure of spinal sagittal alignment. Orthopedic surgeons of various levels of experience measured the T1PA in a series of healthy adult volunteers. The relationship of the TIPA to pelvic position was also assessed.

Summary of Background Data.
Recent literature suggests that the T1PA is a more reliable measure of global sagittal alignment than traditional measurements (i.e., sagittal vertical axis). Previous research focuses on postoperative patients with known spinal deformity. No published research exists evaluating the use of T1PA on healthy subjects without spinal deformity. The purpose of this study is: (1) to assess the reliability of measurements of the T1PA, (2) to examine its relationship to pelvic position.

Methods.
Seven evaluators of varying orthopedic experience measured the T1PA in 50 healthy adult volunteers. Subjects were radiographed in each of three pelvic positions: resting, maximal anterior pelvic rotation, and maximal posterior pelvic rotation. After a washout period, the measurement was repeated. Using intraclass correlation coefficients, the intra- and inter-rater agreement for the T1PA was measured. The collected data was also used to determine the accuracy of this measurement and its relationship to pelvic position.

Results.
A very high level of agreement was found in measurements of the T1PA (intraclass correlation coefficients r = 0.98). At each pelvic position, all examiners had excellent intrarater reliability, > 0.85. The inter-rater reliability, compared with a gold standard, consistently measured the T1PA within ± 2°. The data also shows that the T1PA changes with pelvic rotation.

Conclusion.
T1PA is a reproducible and reliable measure of global sagittal alignment regardless of the level of training. The T1PA varies based on pelvic rotation; this variation must be taken into account when assigning an absolute target for correction.

Level of Evidence: 4
Measurement Properties of the Functional Rating Index
Authors: Bai Zhongfei , Shu Tian , Lu Jiani , Niu Wenxin 
Published: April 2018

Study Design.
A systematic review and meta-analysis.

Objective.
To assess the measurement properties of the Functional Rating Index (FRI) and determine whether its measurement properties are comparable with other region-specific questionnaires.

Summary of Background Data.
In addition to low back pain (LBP) and neck pain (NP), multiregion spinal pain (SP) is a common problem with a considerable prevalence in the general population. The FRI was built to assess physical functioning in patients with SP. However, a systematic review assessing evidence of its measurement properties in separated populations and a comparison with other questionnaires regarding each measurement property is lacking.

Methods.
Articles concerning the FRI's measurement properties or head-to-head comparison with other questionnaires on measurement properties were obtained from MEDLINE, Embase, CINAHL, and PsycINFO. Two reviewers independently reviewed the articles, extracted data, and conducted the methodological quality assessment. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of the included studies.

Results.
A total of 18 studies evaluating the FRI's measurement properties, including seven that carried out head-to-head comparisons in at least one measurement property with other questionnaires, were included in the current review. Our findings show strong positive evidence for structural validity and internal consistency in patients with SP and LBP. Evidence for most of the FRI's measurement properties is limited, conflicting, or even unknown. The current evidence shows that the FRI is comparable with both the Oswestry Disability Index and the Neck Disability Index in responsiveness. However, relevant information about the majority of the other measurement properties is lacking.

Conclusion.
Our finding suggests that clinicians and researchers should use the FRI with caution until there are more studies with high methodological quality that support the view that it is positive in all measurement properties, especially in regard to patients with multiregion SP.

Level of Evidence: 1
Simplified Chinese Version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire
Authors: Yao Min , Yang Long , Zhu Bin , Xu Bao-ping , Chen Ni , Wang Xiao-tao , Cheng Shao-dan , Wang Yong-jun , Cui Xue-jun 
Published: April 2018

Study Design.
Psychometric test of the cross-cultural adaptation the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in low back pain (LBP) patients.

Objective.
To investigate the agreement, responsiveness, and minimal important change (MIC) of the simplified Chinese version of the JOABPEQ in LBP patients.

Summary of Background Data.
The factor structure, internal consistency, test–retest reliability, validity, floor and ceiling effect of simplified Chinese JOABPEQ have been tested, while the agreement, responsiveness, and MIC were required.

Methods.
The agreement, responsiveness, and MIC of the simplified Chinese version were assessed by completing the Chinese JOABPEQ twice. Agreement was tested with Bland–Altman plot. Responsiveness was operationalized using receiver operating characteristic analyses. The anchor-based method was used to calculate MIC.

Results.
One hundred sixty-two of 184 patients returned to finish the booklet twice were available for analysis (response rate: 88.0%). While the responsiveness, the area under the curves of each subscale were ranged from 0.746 to 0.875, which meant a good responsiveness. While the MIC (MIC%) of simplified Chinese JOABPEQ was 19.28 (44.98%) for Q1 Low back pain, 15.20 (24.13%) for Q2 Lumbar function, 15.79 (22.76%) for Q3 Walking ability, 9.58 (19.86%) for Q4 Social life function, 7.33 (17.28%) for Q5 Mental health. While compared with the MIC, only the Q3 Walking ability had a positive rating for agreement in the Bland–Altman plot.

Conclusion.
The simplified Chinese JOABPEQ has positive agreement of Q3 Walk ability and acceptable to excellent responsiveness of all the subscales. The MICs for subscales of the simplified Chinese JOABPEQ ranged from 7.33 to 19.28 points.

Level of Evidence: 3
Vasopressors During Cardiopulmonary Resuscitation. A Network Meta-Analysis of Randomized Trials
Authors: Belletti Alessandro , Benedetto Umberto , Putzu Alessandro , Martino Enrico A. , Biondi-Zoccai Giuseppe , Angelini Gianni D. , Zangrillo Alberto , Landoni Giovanni 
Published: April 2018

Objectives:Several randomized controlled trials have compared adrenaline (epinephrine) with alternative therapies in patients with cardiac arrest with conflicting results. Recent observational studies suggest that adrenaline might increase return of spontaneous circulation but worsen neurologic outcome. We systematically compared all the vasopressors tested in randomized controlled trials in adult cardiac arrest patients in order to identify the treatment associated with the highest rate of return of spontaneous circulation, survival, and good neurologic outcome.Design:Network meta-analysis.Patients:Adult patients undergoing cardiopulmonary resuscitation.Interventions:PubMed, Embase, BioMed Central, and the Cochrane Central register were searched (up to April 1, 2017). We included all the randomized controlled trials comparing a vasopressor with any other therapy. A network meta-analysis with a frequentist approach was performed to identify the treatment associated with the highest likelihood of survival.Measurements and Main Results:Twenty-eight studies randomizing 14,848 patients in 12 treatment groups were included. Only a combined treatment with adrenaline, vasopressin, and methylprednisolone was associated with increased likelihood of return of spontaneous circulation and survival with a good neurologic outcome compared with several other comparators, including adrenaline. Adrenaline alone was not associated with any significant difference in mortality and good neurologic outcome compared with any other comparator.Conclusions:In randomized controlled trials assessing vasopressors in adults with cardiac arrest, only a combination of adrenaline, vasopressin, and methylprednisolone was associated with improved survival with a good neurologic outcome compared with any other drug or placebo, particularly in in-hospital cardiac arrest. There was no significant randomized evidence to support neither discourage the use of adrenaline during cardiac arrest.
Dermatologic Surgery and Reconstruction Photograph Booklet as a Tool to Improve Informed Consent Before Skin Surgery
Authors: Arujuna Nisha Rishi , Brendling Lisa , DeGiovanni Claudia 
Published: April 2018

BACKGROUND
Skin surgery is a high-risk area of litigation and tools to improve consent are welcomed.

OBJECTIVE
This project aimed to strengthen the consenting process for dermatological surgery by introducing a photograph booklet.

MATERIALS AND METHODS
The authors designed a booklet containing skin surgery images. Patients attending surgery completed an anonymous questionnaire immediately after their procedures before the booklet introduction (Group 1). The questionnaire was then repeated (Group 2) with the introduction of the photograph booklet during consent. The authors looked for changes in the following: understanding of procedure, scar, and postoperative care as well as addressing of patients' concerns using a subjective scale of 1 to 5 (1 = poor, 2 = fair, 3 = okay, 4 = good, and 5 = great).

RESULTS
Results indicated greater patient satisfaction among patients in Group 2 who had been shown relevant surgical images compared with Group 1, with improvements from ratings of 3 and 4 on the scale to 5. The difference in the 2 groups for the highest ratings of 5/5 was significant (p < .05) for understanding of procedure and resulting scars.

CONCLUSION
The use of photograph booklets containing simple and relevant images to support the consent process for dermatologic surgery improves patients' understanding, expectations, and experience of skin surgery.
The Safety and Efficacy of Treatment With a 1,927-nm Diode Laser With and Without Topical Hydroquinone for Facial Hyperpigmentation and Melasma in Darker Skin Types
Authors: Vanaman Wilson Monique J. , Jones Isabela T. , Bolton Joanna , Larsen Lisa , Fabi Sabrina Guillen 
Published: April 2018

BACKGROUND
The nonablative, fractional, 1,927-nm diode laser is theoretically a safe and effective treatment for hyperpigmentation and melasma in darker skin and may potentiate topical cosmeceutical delivery.

OBJECTIVE
To evaluate the use of a nonablative, fractional, 1,927-nm diode laser with and without topical 2% hydroquinone (HQ) cream for moderate-to-severe facial hyperpigmentation in Fitzpatrick skin Types III–V.

METHODS
Forty adults underwent 4 laser treatments at 2-week intervals and were randomized to daily application of 2% HQ cream or moisturizer. Follow-ups were conducted 4 and 12 weeks after the final laser treatment.

RESULTS
Hydroquinone and moisturizer groups demonstrated Mottled Pigmentation Area and Severity Index improvements of approximately 50% at post-treatment Weeks 4 and 12. Blinded investigator–assessed hyperpigmentation and photodamage improved significantly for both the groups at post-treatment Weeks 4 and 12. Subject satisfaction improved significantly in both the groups by post-treatment Week 4. Although investigator-rated Global Aesthetic Improvement Scale scores were significantly better in the HQ group at post-treatment Week 12, satisfaction was higher among those using moisturizer. No adverse events were noted.

CONCLUSION
The nonablative, fractional, 1,927-nm diode laser produced significant improvement in hyperpigmentation in Fitzpatrick skin Types III–V by 4 weeks, with maintenance of results at 12 weeks after treatment even without HQ.
Prospective Cohort Study Investigating Changes in Body Image, Quality of Life, and Self-Esteem Following Minimally Invasive Cosmetic Procedures
Authors: Sobanko Joseph F. , Dai Julia , Gelfand Joel M. , Sarwer David B. , Percec Ivona 
Published: April 2018

BACKGROUND
Minimally invasive cosmetic injectable procedures are increasingly common. However, a few studies have investigated changes in psychosocial functioning following these treatments.

OBJECTIVE
To assess changes in body image, quality of life, and self-esteem following cosmetic injectable treatment with soft tissue fillers and neuromodulators.

METHODS
Open, prospective study of 75 patients undergoing cosmetic injectable procedures for facial aging to evaluate changes in psychosocial functioning within 6 weeks of treatment. Outcome measures included the Derriford appearance scale (DAS-24), body image quality of life inventory (BIQLI), and the Rosenberg self-esteem scale.

RESULTS
Body image dissatisfaction, as assessed by the DAS-24, improved significantly 6 weeks after the treatment. Body image quality of life, as assessed by the BIQLI, improved, but the change did not reach statistical significance. Self-esteem was unchanged after the treatment.

CONCLUSION
Minimally invasive cosmetic injectable procedures were associated with reductions in body image dissatisfaction. Future research, using recently developed cosmetic surgery-specific instruments, may provide further insight into the psychosocial benefits of minimally invasive procedures.
In Vivo Degradation of Crosslinked Hyaluronic Acid Fillers by Exogenous Hyaluronidases
Authors: Shumate Garrett T. , Chopra Rajesh , Jones Derek , Messina Darin J. , Hee Christopher K. 
Published: April 2018

BACKGROUND
An advantage of hyaluronic acid (HA)-based fillers is reversibility.

OBJECTIVE
To evaluate the ability of 2 hyaluronidases to degrade 3 HA-based fillers using a novel in vivo model.

MATERIALS AND METHODS
Rats were injected with 3 HA fillers (HYC-24L+, VYC-20L, and RES-L) to create a projecting bolus. After 4 days, recombinant human hyaluronidase (HX) or ovine hyaluronidase (VIT) was administered at (1) varying doses (5 U, 10 U, or 30 U per 0.1 mL filler) or (2) different dilutions (10 U diluted 3-fold). The impact of tissue integration was assessed by administering 10 U/0.1 mL filler 4 weeks after filler injection. Three-dimensional images quantified projection loss over 72 hours.

RESULTS
Complete loss of projection was achieved for all fillers with the highest HX and VIT doses; lower doses achieved less degradation. No difference in degradation was observed between HYC-24L+ and VYC-20L using HX or VIT. RES-L was slightly more degraded with 10 U VIT but not with 10 U HX. Enzyme dilution resulted in less degradation. Tissue integration did not impact the degree of degradation.

CONCLUSION
This model incorporates the biological system while controlling variables including filler depth and volume and location of hyaluronidase delivery. Hyaluronic acid filler degradation by exogenous hyaluronidase was not hindered by differences among fillers.
Topical Botulinum Toxin Type A Liposomal Cream for Primary Axillary Hyperhidrosis: A Double-Blind, Randomized, Split-Site, Vehicle-Controlled Study
Authors: Lueangarun Suparuj , Sermsilp Chairat , Tempark Therdpong 
Published: April 2018

BACKGROUND
Despite its effectiveness in treating primary axillary hyperhidrosis (PAH), topical botulinum toxin type A (BTX-A) is highly resistant to transdermal absorption. Topical BTX-A liposomal cream is recommended as a novel, noninvasive modality to enhance skin penetration.

OBJECTIVE
To evaluate the efficacy and safety of topical BTX-A liposomal cream in comparison with liposomal vehicle cream alone in the treatment of PAH.

MATERIALS AND METHODS
A prospective, randomized, double-blinded, split-site study was conducted in 20 subjects, aged 18 to 50 years, all of whom had symmetrical axillary sweating with Hyperhidrosis Disease Severity Scale scores between 2 to 4. All subjects were double-blinded to treatment regimens and randomly given 2 bottles, one containing topical BTX-A liposomal cream and one containing the vehicle cream without BTX-A, to be applied consistently to the same axilla nightly for 7 consecutive days. Clinical improvement and adverse reactions were evaluated at every follow-up visit.

RESULTS
Axillary skin treated with topical BTX-A demonstrated superior sweat reduction and patient satisfaction to vehicle cream–treated axillary skin, with clinical and statistical significance, at baseline, weeks 2, 4, 6, and 8 of follow-up, without adverse effects.

CONCLUSION
Topical BTX-A liposomal cream pharmaceutically enhances drug delivery, is painless, cost-effective, and overall an innovative treatment of PAH.
Liposarcoma Preoperatively Diagnosed as Lipoma: 10-Year Experience at a Single Institution
Authors: Sato Daisuke , Suga Hirotaka , Takushima Akihiko 
Published: April 2018

BACKGROUND
On rare occasions, a lesion preoperatively diagnosed as a lipoma is ultimately diagnosed as a liposarcoma. It is important to differentiate liposarcomas from lipomas preoperatively.

OBJECTIVE
To examine characteristic features of liposarcomas preoperatively diagnosed as lipomas.

METHODS
Patients (n = 637) who underwent resection of tumors preoperatively diagnosed as lipomas from January 2006 to October 2016 were retrospectively reviewed.

RESULTS
Based on pathological examination, 8 of 637 lesions were diagnosed as liposarcomas postoperatively. All the liposarcomas were well-differentiated liposarcomas. The rate of male patients was higher (87.5% vs 38.9%) and the size of tumors was larger (8.75 vs 4.64 cm) in these cases than in accurately diagnosed lipoma cases. On imaging, nonfatty septa were more frequently observed (71.4% vs 20.0%) and were thicker (2.22 vs 1.33 mm) than in true lipoma cases.

CONCLUSION
If the patient with a lipomatous tumor is male and the tumor is large, we should consider the possibility of it being a liposarcoma. A thick internal septum in the image findings is a good predictor of malignancy.
Malar Reconstruction with Anterior Bilobed Cheek Flap
Authors: Ueda Koichi , Akamatsu Jun , Sugita Naoya , Nuri Takashi , Otsuki Yuki 
Published: April 2018

Summary:
A 66-year-old man had developed a tumor on his right cheek. A biopsy revealed basal cell carcinoma. The ulcerative cancer and zygomatic bone were resected. We designed an anterior bilobed cheek flap to reconstruct the cheek skin defect. The postoperative clinical course was uneventful.
A Systematic Review of Surgical Management of Melanoma of the External Ear
Authors: Sawyer Justin D. , Wilson Morgan L. , Neumeister Michael W. 
Published: April 2018

Background:
Historically, external ear melanomas have been treated aggressively, due to early perceptions suggesting they had poor prognosis and aggressive biological behavior. More recent evidence has not supported these notions.

Methods:
We completed a complete review of the literature involving malignant melanoma of the external ear. We then completed a quantitative analysis on seventy-three cases from 8 reports that contained case-level data, assessing factors that influence recurrence, and assessing characteristics of the melanomas based on histological subtype. Baseline and outcomes data for all 20 studies were then compiled but not statistically evaluated.

Results:
In our subanalysis, patients who had recurrence were significantly more likely to have had wedge resection versus wide-local excision, and those with no recurrence were more likely to have undergone wide local excision. Nodular tumors had significantly greater thickness. Overall, conservative excisions provided excellent outcomes.

Conclusions:
Conservative treatment for external ear melanoma produces satisfactory outcomes. There is no evidence to support the use of radical amputation and little evidence to support the removal of cartilage or perichondrium. Sentinel lymph node biopsy is warranted only with positive nodes. There is no role for elective neck dissection. The roles for chemo/radiation therapy are unclear and guidelines for other cutaneous melanomas should be followed.
Does Distal Radio-ulnar Joint Configuration Affect Postoperative Functional Results after Ulnar Shortening Osteotomy?
Authors: Gilbert Fabian , Jakubietz Rafael G. , Meffert Rainer H. , Jakubietz Michael G. 
Published: April 2018

Background:
Reverse oblique distal radio-ulnar joint (DRUJ) configuration is assumed to show inferior postoperative results in ulnar-shortening osteotomy due to osteoarthritis, as the joint force pressure in the DRUJ may be increased. An evaluation and comparison of the postoperative functional results with regard to clinical and radiographic signs of arthritis among different DRUJ configurations was carried out retrospectively.

Methods:
Sixty-two patients after ulnar shortening osteotomy were included. The minimum follow-up was 5 years. Preoperative x-rays were assessed for the DRUJ configuration according to the Tolat classification, whereas postoperative radiographs were evaluated with regard to signs of osteoarthritis using the Kallgren-Lawrence-Score. Functional results were evaluated using the disabilities of the arm, shoulder and hand (DASH) and Mayo Wrist Score and measuring range of motion and grip strength.

Results:
Significantly better functional results were found in patients with parallel configuration of the DRUJ (Tolat type 1 configuration) with regard to DASH score, grip strength, and supination compared with nonparallel configurations. In the Tolat type 1, configurated DRUJ mean DASH score was 9 compared with 18 in the Tolat type 2 and 3 groups. Apart from supination, no differences were observed in range of motion among groups.

Conclusion:
Although long-term postoperative range of motion failed to display statistically significant differences between DRUJ configurations except for supination, better results regarding grip strength and DASH scores were seen in a parallel-aligned DRUJ configuration. Although onset of osteoarthritis does not seem to become apparent within the observation period, nonparallel aligned configuration predisposes to inferior results.
PHOTODYNAMIC THERAPY AS PRIMARY TREATMENT FOR SMALL CHOROIDAL MELANOMA
Authors: Turkoglu Elif B. , Pointdujour-Lim Renelle , Mashayekhi Arman , Shields Carol L. 
Published: April 2018

Purpose:
To report outcomes of photodynamic therapy (PDT) as primary treatment for small amelanotic choroidal melanoma.

Methods:
Retrospective interventional case series of 12 patients with small choroidal melanoma treated with standard-fluence PDT (83 seconds; 50 J/cm2) using verteporfin.

Outcome measures:
Tumor regression, subretinal fluid resolution, best-corrected visual acuity, and PDT complications.

Results:
There were 12 eyes with melanoma, demonstrating amelanotic (10 [83%]) or lightly pigmented (n = 2, 17%) appearance. The mean tumor thickness was 2.7 mm (median, 2.8; range 1.8–3.7 mm). After PDT, mean follow-up was 56 months (median, 53; range, 14–91). Outcomes revealed complete tumor regression after 1 session (n = 3, 25%), 2 sessions (n = 3, 25%), and 3 sessions (n = 2, 17%) of PDT, reduced to mean thickness of 2.1 mm (median, 2.0; range 1.2–3.4 mm). Tumors that failed to regress (n = 4, 33%) were further controlled with transpupillary thermotherapy (n = 1) or plaque brachytherapy (n = 3). Subretinal fluid, present in six eyes, demonstrated resolution (n = 5) or progression (n = 1), and one tumor developed new subretinal fluid after PDT (n = 1). Visual outcome was stable (n = 11 eyes) or improved (n = 1). Photodynamic therapy complications included local retina pigment epithelium atrophy at the site of treatment in 3 (25%) eyes, with no effect on macular or optic nerve function.

Conclusion:
Primary PDT resulted in complete tumor regression of small amelanotic choroidal melanoma in 67% at mean 5 years, with no major effect on visual acuity.