bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient and Inpatient Single-level Cervical Total Disc Replacement
Authors: Segal Dale N. , Wilson Jacob M. , Staley Christopher , Yoon S. Tim 
Published: June 2018

Study Design.
A retrospective cohort study.

Objective.
The aim of this study was to compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement (TDR) surgery.

Summary of Background Data.
Cervical TDR is a motion-sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce health care costs are driving spine surgery to be performed in the outpatient setting. As cervical TDR surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated.

Methods.
The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006 and 2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data were compared between the inpatient and outpatient cohort using univariate analysis.

Results.
There were 531 (34.2%) patients treated as outpatients and 1022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts.

Conclusion.
There was no difference between 30-day complications, readmission, and reoperation rates between inpatients and outpatients who underwent a single-level cervical TDR. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting.

Level of Evidence: 3
US Pediatricians' Attitudes, Beliefs, and Perceived Injunctive Norms About Spanking
Authors: Taylor Catherine A. , Fleckman Julia M. , Scholer Seth J. , Branco Nelson 
Published: June 2018

ABSTRACT:

Objective:
To assess United States pediatricians' attitudes, beliefs, and perceived professional injunctive norms regarding spanking.

Method:
A self-administered questionnaire was mailed to a nationwide random sample of 1500 pediatricians in the US, drawn from a database maintained by IMS Health. Four survey mailings were conducted and cash incentives of up to $20 were provided. The response rate was 53% (N = 787).

Results:
Most respondents were members of the American Academy of Pediatrics (85%), had been practicing physicians for 15 years or more (66%), and were white (69%) and female (59%). All US regions were represented. About 3-quarters of pediatricians did not support the use of spanking, and most perceived that their colleagues did not support its use either. Pediatricians who were male, black, and/or sometimes spanked as children had more positive attitudes toward spanking and expected more positive outcomes from spanking than their counterparts. Nearly 80% of pediatricians never or seldom expected positive outcomes from spanking, and a majority (64%) expected negative outcomes some of the time.

Conclusion:
The majority of pediatricians in the US do not support the use of spanking with children and are aware of the empirical evidence linking spanking with increased risk of poor health outcomes for children. Pediatricians are a key, trusted professional source in advising parents about child discipline. These findings suggest that most pediatricians will discourage the use of spanking with children, which over time could reduce its use and associated harms in the population. This is of clinical relevance because, despite strong and consistent evidence of the harms that spanking raises for children, spanking is still broadly accepted and practiced in the US
Concentrated Growth Factor Enhanced Fat Graft Survival: A Comparative Study
Authors: Hu Yun , Jiang Yichen , Wang Muyao , Tian Weidong , Wang Hang 
Published: June 2018

BACKGROUND
Concentrated growth factors (CGFs) belong to a new generation biomaterials that concentrate large number of growth factors and CD34+ stem cells in small volume of plasma.

OBJECTIVE
The purpose of this study was to evaluate the impact of the new technique, CGF, on fat graft survival, which compared with platelet-rich plasma (PRP) and platelet-rich fibrin (PRF).

MATERIALS AND METHODS
Nude mice received fat graft were divided into PRP group, PRF group, CGF group, and saline. The grafts were volumetrically and histologically evaluated at 4, 8, and 12 weeks after fat grafting. In vitro growth factor levels in PRP, PRF, and CGF were compared using enzyme-linked immunoassay method. Cell count and real-time polymerase chain reaction were used to evaluate the impact of CGF in medium on human adipose-derived stem cell (hADSC) proliferation and vascular differentiation, respectively.

RESULTS
Fat graft weight was significantly higher in the CGF group than those in the other groups, and histologic evaluation revealed greater vascularity, fewer cysts, and less fibrosis. Adding CGF to the medium maximally promoted hADSC proliferation and expressing vascular endothelial growth factor and PECAM-1.

CONCLUSION
In this preliminary study, CGF treatment improved the survival and quality of fat grafts.
Durability, Behavior, and Tolerability of 5 Hyaluronidase Products
Authors: Casabona Gabriela , Marchese Paula Barreto , Montes José Raúl , Hornfeldt Carl S. 
Published: June 2018

BACKGROUND
Hyaluronic acid (HA) dermal fillers are commonly used in cosmetic dermatology. Due to differences in their physical characteristics, HA fillers demonstrate different sensitivity to degradation by hyaluronidase (Hase) because of HA concentration and differences in cross-linking. Similarly, there are differences in the activity of Hase products depending on source and concentration.

OBJECTIVE
The primary objective was to demonstrate the differences in potency and activity of 5 Hase products when used to degrade 5 different HA products using a human in vivo model.

MATERIALS AND METHODS
The study subject was a healthy, consenting adult woman scheduled to undergo abdominoplasty. Skin to be excised was injected with 0.1 to 0.2 mL of each filler (10 injections each) leaving a visible lump. Immediately afterward, the HA lumps were injected with 4 IU of each Hase product every 2 minutes until the HA lumps were no longer visible or palpable. This procedure was repeated after 30 days. Injected tissues were excised after abdominoplasty for histological analysis.

RESULTS
The 5 Hase products displayed a wide range of doses and times required to completely degrade the 5 HA products ranging from <2 to >16 minutes.

CONCLUSION
Cosmetic practitioners should familiarize themselves with differences in HA and Hase products.
Treatment of Cosmetic Tattoos: A Review and Case Analysis
Authors: McIlwee Bridget E. , Alster Tina S. 
Published: June 2018

BACKGROUND
Cosmetic tattoos such as eyeliner, brow liner, and lip liner have become increasingly popular in the United States and throughout the world. For a variety of reasons, patients frequently regret their tattoos and request their removal; however, removal is often complicated by the aesthetically sensitive location of these specialized tattoos and the fact that they often contain white metallic compounds that darken on pigment-specific laser irradiation.

OBJECTIVE
To review the clinical use, effectiveness, and safety of an ablative laser technique for cosmetic tattoos.

MATERIALS AND METHODS
A thorough literature review pertaining to laser treatment of cosmetic tattoos and a discussion of illustrative patient cases showcasing the successful use of ablative carbon dioxide (CO2) laser to treat cosmetic tattoos is presented.

RESULTS
Cosmetic eyeliner and lip liner tattoos were significantly improved after CO2 laser vaporization. Side effects were limited to erythema, edema, and serosanguinous drainage. No infection, scarring, nor tattoo ink darkening was observed.

CONCLUSION
Because ablative lasers do not target specific tattoo inks, they do not pose a risk of paradoxical tattoo ink darkening and, thus, can be applied successfully in the treatment of iron oxide– or titanium dioxide–containing cosmetic tattoos.
Ruxolitinib for the Treatment of Essential Thrombocythemia
Authors: Gunawan Arief , Harrington Patrick , Garcia‐Curto Natalia , McLornan Donal , Radia Deepti , Harrison Claire 
Published: June 2018

AbstractDeregulated Janus Kinase 2 (JAK2) activation is central to the pathogenesis of most myeloproliferative neoplasms (MPNs), of which essential thrombocythemia (ET) is the most common entity. Patients with ET are risk‐stratified according to their risk of thrombo‐hemorrhagic complications. High‐risk patients are offered treatments to reduce their platelet count using cytoreductive therapy. The disease course is often long and therapy intolerance is not infrequent. Ruxolitinib, a Janus Kinase (JAK) 1/JAK2 inhibitor, has demonstrated efficacy in patients with both myelofibrosis (MF) and polycythemia vera and is well tolerated. Side effects include predictable cytopenias and an augmented risk of infections. Ruxolitinib has been investigated in a small group of ET patients who were refractory/intolerant to hydroxycarbamide (HC) and demonstrated improvements in both symptoms and splenomegaly. Of note, a proportion of treated patients (13.2%) also had a significant reduction in platelet counts. However, these results require further validation in comparison with conventional therapy. Recently, a randomized‐controlled phase 2 study (MAJIC‐ET) assessed the role of Ruxolitinib in patients refractory or intolerant to HC. This study revealed that Ruxolitinib demonstrated some clinical efficacy but was only superior in terms of symptom control. In clinical practice, some individuals with ET do exhaust all potential treatment options and there may well be a role for Ruxolitinib in such patients or those with a significant symptom burden. However, in the wider context the goal of therapy with the use of JAK inhibitor therapy in ET needs to be defined carefully and we explore this within this timely review article.
Corneal Subbasal Nerve Density and Sensitivity After Pars Plana Vitrectomy Using Contact or Noncontact Wide-Angle Viewing Systems
Authors: Tosi Gian Marco , Bacci Tommaso , Tarantello Antonio , Martone Gianluca , Traversi Claudio , Marigliani Davide , Cevenini Gabriele , Virgili Gianni 
Published: June 2018

Purpose:
To assess corneal subbasal nerve density (SBND) and corneal sensitivity (CS) after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) without intraoperative 360-degree laser treatment using contact or noncontact panoramic viewing systems.

Methods:
This is a prospective study of 34 eyes affected by RRD, which underwent PPV using contact (18 eyes) and noncontact (16 eyes) panoramic viewing systems; 12 eyes which underwent scleral buckling, and 17 eyes which underwent cataract surgery. SBND and CS were assessed before surgery and 3 and 6 months postoperatively by in vivo confocal microscopy and Cochet–Bonnet esthesiometry.

Results:
Compared with baseline values, at 6 months, SBND and CS decreased in both contact PPV (SBND preoperative value: 19.1 ± 3.7 mm/mm2; SBND postoperative value: 3.5 ± 1.3 mm/mm2; CS preoperative value: 5.1 ± 0.5 cm; CS postoperative value: 1.5 ± 0.4 cm) and in noncontact PPV groups (SBND preoperative value: 19.5 ± 3.8 mm/mm2; SBND postoperative value: 8.7 ± 2.3 mm/mm2; CS preoperative value: 5.3 ± 0.5 cm; CS postoperative value: 2.5 ± 0.7 cm) (P < 0.001 for all comparisons). SBND reduction was greater in the contact PPV group than in the noncontact PPV group (P < 0.001). By contrast, the scleral buckling and cataract surgery group values were unchanged (P > 0.1 for all comparisons). In multivariate analysis, no significant effect was found for cataract surgery associated with PPV, pseudophakia, surgical time, intraocular pressure, or for laser in horizontal sectors for PPV groups. SBND was highly correlated with CS (r = 0.93).

Conclusions:
A contact viewing system reduces SBND after PPV more than a noncontact system does.
Uncertainty of Acute Stroke Patients: A Cross-sectional Descriptive and Correlational Study
Authors: Ni Chunping , Peng Jing , Wei Yuanyuan , Hua Yan , Ren Xiaoran , Su Xiangni , Shi Ruijie 
Published: June 2018

ABSTRACT

Background: Uncertainty is a chronic and pervasive source of psychological distress for patients and plays an important role in the rehabilitation of stroke survivors. Little is known about the level and correlates of uncertainty among patients in the acute phase of stroke. Purpose: The purposes of this study were to describe the uncertainty of patients in the acute phase of stroke and to explore characteristics of patients associated with that uncertainty. Methods: A cross-sectional descriptive and correlational study was conducted with a convenience sample of 451 consecutive hospitalized acute stroke patients recruited from the neurology department of 2 general hospitals of China. Uncertainty was measured using Chinese versions of Mishel Uncertainty in Illness Scale for Adults on the fourth day of patients’ admission. Results: The patients had moderately high Mishel Uncertainty in Illness Scale for Adults scores (mean [SD], 74.37 [9.22]) in the acute phase of stroke. A total of 95.2% and 2.9% of patients were in moderate and high levels of uncertainty, respectively. The mean (SD) score of ambiguity (3.05 [0.39]) was higher than that of complexity (2.88 [0.52]). Each of the following characteristics was independently associated with greater uncertainty: functional status (P = .000), suffering from other chronic diseases (P = .000), time since the first-ever stroke (P = .000), self-evaluated economic pressure (P = .000), family monthly income (P = .001), educational level (P = .006), and self-evaluated severity of disease (P = .000). Conclusion: Patients experienced persistently, moderately high uncertainty in the acute phase of stroke. Ameliorating uncertainty should be an integral part of the rehabilitation program. Better understanding of uncertainty and its associated characteristics may help nurses identify patients at the highest risk who may benefit from targeted interventions.
Sampling Utility of the Convex Probe Endobronchial Ultrasound Visible Intrapulmonary Lesion
Authors: Almeida Francisco A. , Salam Shameen , Mehta Atul C. , Yuhico Luke , Sarda Yash , Choi Humberto , Cicenia Joseph C. , Gildea Thomas , Machuzak Michael , Mazzone Peter , Oliveira Eduardo , Sethi Sonali , Wang Xiao-Feng , Reynolds Jordan P. 
Published: June 2018

Background:The value of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer has been well established. However, data regarding its utility in the diagnosis of intrapulmonary lesions has been sparse. This study assesses the sampling utility of convex probe EBUS-visible intrapulmonary lesions not visualized by the white-light bronchoscopy.Methods:A retrospective analysis of EBUS-TBNA of EBUS-visible intrapulmonary lesions was performed between January 2010 and March 2015. Patients with visible endobronchial lesions by white-light bronchoscopy were excluded from analysis.Results:Among 108 procedures, the diagnostic yield of EBUS-TBNA for EBUS-visible intrapulmonary lesions was 87%. Following diagnoses were established: lung cancer (73/67.6%), lung metastases (10/9.2%), infection (5/4.6%), lymphoma (1/<1%), sarcoma/spindle cell sarcoma or neoplasm (3/2.8%), unspecified malignancy (1<1%), and hamartoma (1/<1%). EBUS-TBNA was nondiagnostic in 14 (13%); among these, 9 turned out to have benign disease based on additional bronchoscopy samples or other testing and/or follow-up imaging. Five were ultimately diagnosed with a malignant condition: lymphoma (1), epithelioid hemangioendothelioma (1), and non–small cell lung cancer (3). The sensitivity and the negative predicted value of EBUS-TBNA for differentiating malignancy from benign disease was 94.7% and 75%, respectively, while the accuracy for diagnosing the neoplastic disease was 95.3%. There was one major bleeding requiring bronchial artery embolization and 1 pneumothorax requiring chest tube drainage.Conclusion:EBUS-TBNA is safe and effective in the diagnosis of EBUS-visible intrapulmonary lesions. It should be considered as the diagnostic test of choice in patients with these lesions undergoing EBUS-TBNA for the staging of suspected lung cancer.
The Direct Oblique Method
Authors: Miyake Kotaro , Morimura Osamu , Inoue Takako , Yoshida Kenya , Nagatomo Izumi , Kijima Takashi , Kumanogoh Atsushi 
Published: June 2018

Background:
The purpose of this study was to identify bronchi on computed tomographic (CT) images, manual analysis is more accurate than automatic methods. Nonetheless, manual bronchoscopic navigation is not preferred as it involves mentally reconstructing a route to a bronchial target by interpreting 2-dimensional CT images. Here, we established the direct oblique method (DOM), a form of manual bronchoscopic navigation that does not necessitate mental reconstruction, and compared it with automatic virtual bronchoscopic navigation (VBN).

Methods:
Routes were calculated to 47 identical targets using 2 automatic VBNs (LungPoint and VINCENT-BFsim) and the DOM, using 3 general application CT viewers (Aquarius, Synapse Vincent, and OsiriX). Results of all analyses were compared.

Results:
The DOM drew routes to more targets than the VBNs [94% (the DOM on any viewer) vs. 49% (LungPoint) vs. 62% (VINCENT-BFsim), P<0.0001]. For the 44 targets with the CT-bronchus or CT-artery signs, 100% of the DOM routes led to targets. In the bronchoscopic simulation phase, the DOM covered 100% of the bifurcations identified on CT, whereas some bifurcations were skipped and some bronchial walls appeared partially transparent in the VBNs. Manual analysis identified more bronchi near the targets than the VBNs [32.1±3.4 (manual analysis) vs.18.9±2.1 (LungPoint) vs. 22.9±2.7 (VINCENT-BFsim), mean±SEM, P<0.0001]. The DOM took around 5 minutes on average.

Conclusion:
On the basis of precise manual CT analysis using general application CT viewers, the DOM drew routes leading to more targets and provided better bronchoscopic simulation than the automatic route calculation of the VBNs.
Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease
Authors: Cho Roy , Zamora Felix , Gibson Heidi , Dincer H. Erhan 
Published: June 2018

Background:
Surgical lung biopsy (SLB) is the gold standard to aid diagnosis of interstitial lung disease (ILD). Complication rates are restrictive as routine approach for all patients with ILD. Transbronchial lung cryobiopsy (TBLC) is presumed to be a safe, less invasive alternative to assist multidisciplinary discussions regarding the diagnosis of ILD. Varying practice patterns and lack of consistent guidelines prohibit wide support of this technique. The purpose of this study was to evaluate safety and diagnostic yield of TBLC, with highlight of distinct technical features, in ILD.

Methods:
Retrospective study of patients with ILD on the basis of high-resolution chest computed tomography who underwent TBLC.

Results:
Of 121 TBLC, 40 patients (mean age, 57.2±13 y; 28 men) with ILD were referred for biopsy. Procedures were performed in endoscopy suite (60%) or operating room by using 1.9-mm cryoprobe. Biopsies were performed in 2 lobes with at least 3 to 5 specimens >5 mm in diameter. The average diameter and area of specimens were 5.7±2 mm and 40±2 mm2, respectively. The most common diagnosis was nonspecific interstitial pneumonitis; usual interstitial pneumonia was diagnosed in 1 patient. Of 6 nondiagnostic specimens, 2 underwent SLB with subsequent diagnoses. Final histopathologic diagnostic rate was 85%. Bleeding was the most frequent complication.

Conclusion:
We provided a detailed description of our TLBC technique and highlighted areas of similarity and differences among comparative studies and attest that TBLC is a safe alternative to SLB in the diagnosis of ILD. Our data also indicated the tendency for moderate-to-severe bleeding occurred more in the endoscopy suite.
Are Transbronchial Cryobiopsies Ready for Prime Time?
Authors: Sethi Jaskaran , Ali Muhammad S. , Mohananey Divyanshu , Nanchal Rahul , Maldonado Fabien , Musani Ali 
Published: June 2018

Background:
There is a lack of consensus regarding the yield and safety of transbronchial cryobiopsies for diagnosing diffuse parenchymal lung diseases (DPLD). The purpose of this study was to perform a systematic review and meta-analysis assessing the diagnostic yield and safety profile of transbronchial cryobiopsies in DPLD.

Methods:
A literature search of MEDLINE, EMBASE databases, and Google Scholar was performed in August 2017. The quality of included studies was assessed using Quality Assessment, Data Abstraction and Synthesis-2 tool. Meta-analysis was performed using MedCalc (version 17.2). Inverse variance weighting was used to aggregate diagnostic yield proportions across studies, with the number of subjects in each study representing its weight. Random effects model was used when significant heterogeneity was observed (I
2>40%).

Results:
A total of 31 studies were included in the review. Of these, 27 studies with 1443 patients reported data on the performance of cryobiopsies for diagnosing DPLD. The diagnostic yield was 72.9% [95% confidence interval (CI), 67.9%-77.7%]. The pooled mean specimen size obtained by cryobiopsies was 23.4 mm2 (95% CI, 9.6-37.3 mm2). The overall complication rate was 23.1% with bleeding and pneumothoraces being the most commonly reported complications. The incidence of significant bleeding was 14.2% (95% CI, 7.9%-21.9%), whereas pneumothorax was seen in 9.4% (95% CI, 6.7%-12.5%) of patients. Overall reported mortality was 0.3%.

Conclusion:
Our meta-analysis shows that cryobiopsies have a good diagnostic yield but a significant risk for complications. Cryobiopsy outcomes vary markedly among different centers. Further research is needed to standardize the procedure and improve its safety profile.