bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efforts to Strengthen the Clearing and Settlement Framework of the Capital Markets Union
Authors: Zebregs Bas , de Serière Victor 
Published: July 2018

Abstract
This chapter discusses the EU's efforts to strengthen the European clearing and settlement framework for securities and derivatives transactions. That exercise is pa should promote access and therefore competitrt of the EU's plans to establish an integrated European Capital Markets Union. Important steps have already been undertaken, and more legislation is now under construction, designed to lead to a comprehensive robust market infrastructure in the EU. These include the EU Commission's proposals to update the segregation provisions in the European Market Infrastructure Regulation and the proposed regulation dealing with the recovery and resolution of central counterparties. The chapter shows that although the advances made are significant, there is quite a long way to go before a fully integrated and risk-averse environment for clearing and settlement is achieved.
Alopecia due to high androgen index contraceptives
Authors: Graves Katelyn Y. , Smith Benjamin J. , Nuccio Brigitta C. 
Published: July 2018

ABSTRACT
Adverse reactions to hormonal contraceptives are a common patient concern. Alopecia, an adverse reaction to androgen activity caused by the progestin component of hormonal contraceptives, can cause considerable psychosocial distress for women. This article discusses how to identify the level of androgen activity in certain progestins, how increased androgen activity can lead to hair loss, and alternatives for patients experiencing androgenic alopecia due to high androgen index contraceptives.
Development and Preliminary Findings of the Dizziness Symptom Profile
Authors: Jacobson Gary P. , Piker Erin G. , Hatton Kelsey , Watford Kenneth E. , Trone Timothy , McCaslin Devin L. , Bennett Marc L. , Rivas Alejandro , Haynes David S. , Roberts Richard A. 
Published: July 2018

Objectives:
Dizziness, vertigo, and unsteadiness are common complaints of patients who present to primary care providers. These patients often are referred to otology for assessment and management. Unfortunately, there are a small number of specialists to manage these patients. However, there are several dizziness disorders that can be successfully managed by primary care providers if the disorder is properly identified. To assist in the identification of several of the most common dizziness disorders, we developed the dizziness symptom profile (DSP). The DSP is a self-report questionnaire designed to generate one or more differential diagnoses that can be combined with the patient’s case history and physical examination.

Design:
This report describes three investigations. Investigations 1 and 2 (i.e., exploratory and confirmatory investigations, N = 514) describe the development of the DSP. Investigation 3 (N = 195) is a validation study that describes the level of agreement between the DSP completed by the patient, and, the differential diagnosis of the otologist.

Results:
The final version of the DSP consists of 31 items. Preliminary findings suggest that the DSP is in agreement with the differential diagnoses of ear specialists for Meniere’s disease (100% agreement), vestibular migraine (95% agreement), and benign paroxysmal positional vertigo (82% agreement).

Conclusions:
Early results suggest that DSP may be useful in the creation of differential diagnoses for dizzy patients that can be evaluated and managed locally. This has the potential to reduce the burden on primary care providers and reduce delays in the diagnosis of common dizziness and vertigo disorders.
The Fragility of Statistically Significant Results in Pediatric Orthopaedic Randomized Controlled Trials as Quantified by the Fragility Index: A Systematic Review
Authors: Khormaee Sariah , Choe Judy , Ruzbarsky Joseph J. , Agarwal Kunal N. , Blanco John S. , Doyle Shevaun M. , Dodwell Emily R. 
Published: July 2018

Background:
The randomized controlled trial (RCT) is the gold standard study design allowing critical comparison of clinical outcomes while minimizing bias. Traditionally clinical trials are evaluated through statistical significance, expressed by P-values and confidence intervals. However, until recently, the robustness of a study’s conclusions has been given little attention. A new metric, the fragility index, quantifies the number of patients theoretically required to switch outcomes in order to reverse the study conclusions. The primary aim of our work was to determine the fragility index of RCTs in the pediatric orthopaedic literature. The secondary aim was to determine study factors associated with lower fragility index.

Methods:
Pubmed and Embase were systematically searched for pediatric orthopaedic RCTs published September 1, 2006 to September 1, 2016. Two independent reviewers screened titles, abstracts, and manuscripts to identify studies published in English involving 2 treatment arms. Trials without dichotomous primary or secondary outcomes or with patients >18 years were excluded. Data were extracted from each eligible article in duplicate and the fragility index was determined using Fisher exact test, with previously published methods. Univariate analysis was used to determine factors associated with lower fragility index.

Results:
Seventeen trials were eligible for inclusion. The median treatment arm size was 58 and overall sample size was 116 patients. The median fragility index was 3 (range, 0 to 18). A fragility index of 3 means that just 3 patients would need to switch treatment outcomes in order for the trial results to become statistically nonsignificant. In 1 study, the number of patients lost to follow-up exceeded the fragility index, such that the study conclusions could be completely reversed purely depending on the outcomes of the patients lost to follow-up. Lower fragility index was associated with smaller patient sample sizes and greater P-values.

Conclusions:
The fragility index is a useful adjunct metric to the P-value and confidence intervals, allowing analysis of the robustness of study conclusions. RCTs in pediatric orthopaedics often have small sample sizes, many with low fragility indices. Future efforts could focus on encouraging institutional collaboration and patient recruitment with the ultimate goal of improving RCT sample sizes, and potentially improving the robustness of RCT results.

Level of Evidence:
Level I.
What’s New in Pediatric Orthopaedic Trauma: The Lower Extremity
Authors: Rickert Kathleen D. , Hosseinzadeh Pooya , Edmonds Eric W. 
Published: July 2018

Background:
Skeletal trauma is a primary tenet of pediatric orthopaedics. Many high-quality studies have been published over the last few years with substantial relevance to the clinical practice of pediatric orthopaedic trauma. Because of the volume of literature on the subject, this review excludes upper extremity trauma and focuses on the publications affecting the lower extremity.

Methods:
An electronic search of the PubMed database was performed utilizing keywords for pediatric lower extremity trauma: pelvic injuries, femur fractures, tibial shaft fractures, femur fractures, ankle fractures, and foot fractures. All 835 papers related to the treatment of pediatric orthopaedic trauma of the lower extremity published from January 1, 2012 to July 31, 2017 were reviewed, yielding 25 papers that were believed to contribute significant findings to the profession.

Results:
Of the 25 papers selected for presentation within this review, 8 related to tibial shaft injuries, 6 involved the pelvis, 5 involved femur fractures, 4 related to ankle injuries, 2 involved foot injuries, and 1 regarding trauma and venous thromoembolism. The level of evidence for these studies were either level III or IV.

Conclusions:
Higher-grade pediatric pelvic fractures do not correlate with increased severity of splenic or hepatic injuries. Successful union of femur fractures in older children can be obtained by surgeon preferred method of surgical management. Pediatric tibia shaft fractures should be managed conservatively in most cases; however, fractures with >20% of displacement and associated fibula fractures have a 40% risk of requiring delayed surgical stabilization. Vigilance remains the sin qua non regarding identification and appropriate management of compartment syndrome and venous thromboemobolism in children. Many Salter-Harris I distal fibula fractures are now believed to be ligamentous injury and can be treated as such. Calcaneous fractures remain uncommon in pediatrics, but minimally invasive approaches of surgical reduction and fixation may reduce complications in management.

Level of Evidence:
Level IV.
The Association of Variations in Hip and Pelvic Geometry With Pregnancy-Related Sacroiliac Joint Pain Based on a Longitudinal Analysis
Authors: Ji Xiang , Morino Saori , Iijima Hirotaka , Ishihara Mika , Kawagoe Mirei , Umezaki Fumiko , Hatanaka Yoko , Yamashita Mamoru , Tsuboyama Tadao , Aoyama Tomoki 
Published: July 2018

Study Design.
Cross-sectional study using radiological measurements and longitudinal data analysis.

Objective.
We aim to explore hip/pelvic geometry on anteroposterior radiographs and examine if such parameters are associated with clinical symptoms.

Summary of Background Data.
Pregnancy-related sacroiliac joint pain is a common disease and is responsible to the disability of daily activities. The etiology is likely to be correlated with the biomechanical factors which are determined by trunk load and hip/pelvic geometry. Previous studies have already found the association between symptoms and weight increase during pregnancy. However, the relationship between bony anatomy and pregnancy-related sacroiliac joint pain remains unknown.

Methods.
In total, 72 women were included in the final analysis. In pregnant women with self-reported sacroiliac joint pain, pain scores at 12, 24, 30, and 36 weeks of pregnancy were recorded and included in a mixed-effect linear regression model as dependent variables. The radiological measurements were included as independent variables. Furthermore, to investigate the relationship between hip/pelvic geometry and the activity-specific nociceptive phenomenon, the radiological measurements between patients with and without activity-induced pain were compared using a binominal logistic regression model.

Results.
The relative bilateral is chial tuberosity distance (betta coefficient: 0.078; P = 0.015) and the relative bilateral femoral head length (betta coefficient: 0.011; P = 0.028) showed significant interactions with the slope of pain scores. Moreover, women whose pain exacerbate during prolonged walking had a higher odds in hip/pelvic geometry of the bilateral ischial tuberosity distance (odds ratio [OR]: 1.12; P = 0.050) and the bilateral femoral head length (OR: 1.16; P = 0.076) with approximately significant P-value.

Conclusion.
These data indicate hip/pelvic anatomical variations are associated with the degree of pain increasing and the activity-specific pain during pregnancy, which may help to have further understanding on the biomechanical factor in developing pregnancy-related sacroiliac joint pain.

Level of Evidence: 3
A Novel Posterior Trench Approach Involving Percutaneous Endoscopic Cervical Discectomy for Central Cervical Intervertebral Disc Herniation
Authors: Yu Ke-Xiao , Chu Lei , Chen Liang , Shi Lei , Deng Zhong-Liang 
Published: July 2018

Objective:
This report describes a novel posterior trench approach involving percutaneous endoscopic cervical discectomy (PECD) for central cervical intervertebral disc herniation (CIVDH) and an evaluation of the feasibility, safety, and short-term clinical effect of this approach.

Background Context:
Central CIVDH is considered the contraindication for posterior PECD.

Materials and Methods:
A single-center retrospective observational study was performed with 30 patients managed with posterior PECD using the trench approach for symptomatic single-level central CIVDH. Primary outcomes included the measures of bodily pain and physical function based on the SF-36 and modified MacNab criteria. Radiographical follow-up included the static and dynamic cervical plain radiographs, computed tomographic scans, and magnetic resonance images.

Results:
A positive clinical response for symptom relief was achieved in all patients. The postoperative MRI showed total removal of the herniated disc.

Conclusions:
As a supplement to the described surgical techniques of PECD, this trench approach provides novel access for the treatment of CIVDH, especially for the central type. The advantages of this technique include the provision of access to decompress the ventral region of the thecal sac and the ability to avoid damage to the facet joint. The steep learning curve might be a major disadvantage, and the sample volume is a limitation of the study; the effectiveness and reliability of the trench approach should be further verified in a comparative cohort study with a large volume of patients.
Variation in Sedation and Neuromuscular Blockade Regimens on Outcome After Cardiac Arrest*
Authors: May Teresa L. , Riker Richard R. , Fraser Gilles L. , Hirsch Karen G. , Agarwal Sachin , Duarte Christine , Friberg Hans , Søreide Eldar , McPherson John , Hand Robert , Kent David , Nielsen Niklas , Seder David B. 
Published: July 2018

Objectives:
Sedation and neuromuscular blockade protocols in patients undergoing targeted temperature management after cardiac arrest address patient discomfort and manage shivering. These protocols vary widely between centers and may affect outcomes.

Design:
Consecutive patients admitted to 20 centers after resuscitation from cardiac arrest were prospectively entered into the International Cardiac Arrest Registry between 2006 and 2016. Additional data about each center’s sedation and shivering management practice were obtained via survey. Sedation and shivering practices were categorized as escalating doses of sedation and minimal or no neuromuscular blockade (sedation and shivering practice 1), sedation with continuous or scheduled neuromuscular blockade (sedation and shivering practice 2), or sedation with as-needed neuromuscular blockade (sedation and shivering practice 3). Good outcome was defined as Cerebral Performance Category score of 1 or 2. A logistic regression hierarchical model was created with two levels (patient-level data with standard confounders at level 1 and hospitals at level 2) and sedation and shivering practices as a fixed effect at the hospital level. The primary outcome was dichotomized Cerebral Performance Category at 6 months.

Setting:
Cardiac arrest receiving centers in Europe and the United states from 2006 to 2016

Patients:
Four-thousand two-hundred sixty-seven cardiac arrest patients 18 years old or older enrolled in the International Cardiac Arrest Registry.

Interventions:
None.

Measurements and Main Results:
The mean age was 62 ± 15 years, 36% were female, 77% out-of-hospital arrests, and mean ischemic time was 24 (± 18) minutes. Adjusted odds ratio (for age, return of spontaneous circulation, location of arrest, witnessed, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation, medical history, country, and size of hospital) was 1.13 (0.74–1.73; p = 0.56) and 1.45 (1.00–2.13; p = 0.046) for sedation and shivering practice 2 and sedation and shivering practice 3, respectively, referenced to sedation and shivering practice 1.

Conclusion:
Cardiac arrest patients treated at centers using as-needed neuromuscular blockade had increased odds of good outcomes compared with centers using escalating sedation doses and avoidance of neuromuscular blockade, after adjusting for potential confounders. These findings should be further investigated in prospective studies.
Late-Onset Facial Papular Elastorrhexis
Authors: Santonja Carlos , Salinas Silvia , Requena Luis , Kutzner Heinz , Valverde Ricardo 
Published: July 2018

Abstract:
Papular elastorrhexis, a rare defect of dermal elastic fibers of unknown origin, usually involves the trunk and extremities of children or young adults. We report the case of a 62-year-old woman with multiple soft, skin-colored facial papules with histological findings characteristic of papular elastorrhexis. Awareness of this entity may allow for its proper identification outside the usual clinical setting.
LONG-TERM VISUAL CHANGES IN INITIALLY STRONGER FELLOW EYES IN PATIENTS WITH UNILATERAL TYPE 3 NEOVASCULARIZATION
Authors: Kim Jae Hui , Chang Young Suk , Kim Jong Woo , Kim Chul Gu , Lee Dong Won , Kim Hyoung Seok 
Published: July 2018

Purpose:
To evaluate long-term visual changes in initially stronger fellow eyes in patients with unilateral Type 3 neovascularization.

Methods:
This retrospective study included 102 patients who were newly diagnosed with unilateral Type 3 neovascularization and in whom the best-corrected visual acuity (BCVA) of the fellow eye was initially better than that of the involved eye. All patients were treated with intravitreal anti–vascular endothelial growth factor injections. The BCVAs were compared at diagnosis, 12 months, 24 months, and the final visit. In patients who experienced ≥3 lines of visual deterioration in the BCVA of the fellow eye, the reason for visual deterioration was also verified.

Results:
The patients were followed for 45.9 ± 18.5 months after diagnosis. At diagnosis, the fellow-eye BCVA was better than that of the initially involved eye in all 102 patients. However, the fellow-eye visual acuity was the same or worse than that of the initially involved eye in 13 patients (12.7%) at 12 months, in 20 patients (19.6%) at 24 months, and in 24 patients (23.5%) at the final visit. At the final visit, 53 patients (51.9%) had experienced ≥3 lines of deterioration in the BCVA of the fellow eye. Fellow-eye neovascularization occurred in 42 patients, and geographic atrophy involving the fovea was noted in the remaining 11 patients.

Conclusion:
Deterioration of the visual acuity of the fellow eye is frequently noted in unilateral Type 3 neovascularization. As a result of this deterioration, the initially stronger fellow eye did not remain stronger in 23.5% of the patients, suggesting the need for long-term strict treatment of the initially involved eye even when the visual acuity of the fellow eye is good.
Refractive Stability After Deep Anterior Lamellar Keratoplasty for Keratoconus
Authors: Javadi Mohammad Ali , Feizi Sepehr , Rahmani Saeed , Khajuee-Kermani Pejman 
Published: July 2018

Purpose:
To evaluate the long-term stability of subjective refraction after deep anterior lamellar keratoplasty (DALK) performed in keratoconus-affected eyes.

Methods:
This retrospective, comparative interventional case series analyzed the data of 73 eyes in 69 patients with keratoconus who underwent DALK. Only patients with clear grafts who had all sutures removed for at least 12 months were enrolled. The corrected distance visual acuity (CDVA) and manifest refraction were measured several months after all sutures were removed. The CDVA, spherical equivalent refraction, refractive astigmatism, and vector components of refractive astigmatism (J0 and J45) were recorded and compared at different time points.

Results:
Mean age of patients was 28.3 ± 8.3 years at the time of keratoplasty. No significant changes in the CDVA were observed during the follow-up period. Spherical equivalent refraction measured at 1 month (−3.18 ± 3.41 D) and 3 months (−4.29 ± 4.26 D) after complete suture removal differed significantly from that measured at the last examination (−4.70 ± 3.75 D; P = 0.001 and 0.03, respectively). This measurement stabilized from 6 months after complete suture removal onward. Refractive astigmatism and its vector components (J0 and J45) did not change over time after complete suture removal.

Conclusions:
Refraction stabilized 6 months after complete DALK suture removal. Therefore, postponing refractive surgery until this time is advisable to manage post-DALK refractive errors.
Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes
Authors: Salinas Lauriane , Chaudhary Ankita , Berdahl John P. , Lazcano-Gomez Gabriel S. , Williamson Blake K. , Dorairaj Syril K. , Seibold Leonard K. , Smith Sanjay , Aref Ahmad A. , Darlington Jason K. , Jimenez-Roman Jesus , Mahootchi Ahad , Boucekine Mohamed , Mansouri Kaweh 
Published: July 2018

Purpose:
The purpose of the study is to describe short-term efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma.

Method:
Retrospective multicentric case series of 53 eyes with severe or refractory glaucoma as defined by ICD-10 conducted in the United States, Mexico, and Switzerland. Primary efficacy outcome was a ≥20% decrease in intraocular pressure (IOP) from baseline at 6 months. Secondary efficacy outcome measures were probability of achieving an IOP≤14 or 18 mm Hg at 6 months and the mean IOP change from baseline at 6 months. Medication use required to obtain target IOP at last follow up and adverse effects were analyzed.

Results:
The proportion of eyes achieving an IOP reduction of >20% from preoperative baseline at 6 months was 57.7% (n=30). The mean IOP decreased from 18.4±6.1 mm Hg at baseline to 13.9±3.5 mm Hg at month 6 (23.9% reduction; P<0.001). At 6 months, 63.5% and 92.3% achieved an IOP≤14 and ≤18 mm Hg, respectively, and the mean number of glaucoma medications was reduced by 1.2±1.3 (36.6%) compared with baseline (P<0.001). The most common adverse event was hyphema (n=29, 34.9%) with spontaneous resolution in all cases. No severe complications were reported. One case presented with uncontrolled IOP and required glaucoma drainage device surgery at 1 month.

Conclusions:
Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.
Lateral Canthotomy and Cantholysis in Operations Iraqi Freedom and Enduring Freedom: 2001–2011
Authors: Jaksha Alexandria F. , Justin Grant A. , Davies Brett W. , Ryan Denise S. , Weichel Eric D. , Colyer Marcus H. 
Published: July 2018

Purpose:
To describe outcomes and associated ocular injuries of lateral canthotomy and cantholysis (LCC) as performed in combat ocular trauma.

Methods:
Data from the Walter Reed Ocular Trauma Database of patients requiring LCC during Operations Iraqi Freedom and Enduring Freedom was reviewed as a retrospective cohort. Primary outcome measures included final visual acuity (VA) and Ocular Trauma Score. Secondary outcome measures were associated injuries and timing of surgery.

Results:
Thirty-six LCCs were recorded on a total of 890 eyes (4.04 %) in the Walter Reed Ocular Trauma Database. Eighteen out of 36 eyes (50.00%) had a final VA of the affected eye of 20/200 or worse vision. From the initial available VA measured either at the time of injury or at Walter Reed Army Medical Center, 13 eyes (40.63%) had no change in VA, 15 eyes (46.88%) had improvement, and 4 (12.5%) had a decrease in VA (n = 32, data unavailable for 4 eyes). Ocular Trauma score 0–65 was noted in 14 (38.9%) and 66–100 (61.1%). Retinal detachment (6, 16.67%), optic nerve injuries (7, 19.44%), orbital fractures (20, 55.56%), and retrobulbar hematoma (25, 69.44%) were commonly associated injuries. Of the 36 LCC, 18 (50.00%) were performed as the first surgery performed at the combat support hospital, 13 (36.11%) as the second, 4 (11.11%) as the third, and 1 (2.78%) as the fourth.

Conclusions:
The largest subgroup of patients had an improvement in VA associated with performance of LCC; however, half of patients remained with a final VA of equal to or worse than 20/200 due to severe ocular trauma.