bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Multicenter Study of a Multistep Screw Insertion Technique Using Patient-Specific Screw Guide Templates for the Cervical and Thoracic Spine
Authors: Sugawara Taku , Kaneyama Shuichi , Higashiyama Naoki , Tamura Shinya , Endo Takuro , Takabatake Masato , Sumi Masatoshi 
Published: July 2018

Study Design.
A prospective clinical study of a multistep screw insertion method using a patient-specific screw guide template system (SGTS) for the cervical and thoracic spine.

Objective.
To evaluate the efficacy of SGTS for inserting screws into the cervical and thoracic spine.

Summary of Background Data.
Posterior screw fixation is a standard procedure for spinal instrumentation; however, screw insertion carries the risk of injury to neuronal and vascular structures.

Methods.
Preoperative bone images of the computed tomography (CT) scans were analyzed using 3D/multiplanar imaging software, and the screw trajectories were planned. Plastic templates with screw-guiding structures were created for each lamina using 3D design and printing technology. Three types of templates were made for precise multistep guidance, and all the templates were specially designed to fit and lock onto the lamina during the procedure. In addition, plastic vertebra models were generated, and preoperative screw insertion simulation was performed. This patient-specific SGTS was used to perform the surgery, and CT scanning was used to postoperatively evaluate screw placement.

Results.
Enrolled to verify this procedure were 103 patients with cervical, thoracic, or cervicothoracic pathologies. The SGTS were used to place 813 screws. Preoperatively, each template was found to fit exactly and to lock onto the lamina of the vertebra models. In addition, intraoperatively, the templates fit and locked onto the patient lamina, and the screws were inserted successfully. Postoperative CT scans confirmed that 801 screws (98.5%) were accurately placed without cortical violation. There were no injuries to the vessels or nerves.

Conclusion.
The multistep, patient-specific SGTS is useful for intraoperative pedicle screw (PS) navigation in the cervical and thoracic spine. This method improves the accuracy of PS insertion and reduces the operating time and radiation exposure during spinal fixation surgery.

Level of Evidence: 3
Pityriasis Rubra Pilaris With Extensive Follicular Acantholysis Resembling Pemphigus Vulgaris: A Case Report
Authors: Lilo Mohammed T. , Yan Shaofeng , Chapman Michael Shane , Linos Konstantinos 
Published: July 2018

Abstract:
Pityriasis rubra pilaris (PRP) is a rare, chronic, heterogeneous, papulosquamous inflammatory dermatosis of unknown etiology. Although erythematous scaly patches characterize the classic presentation of PRP, a broad range of clinical presentations has been reported. Histologically, PRP is characterized by psoriasiform acanthosis with alternating orthokeratosis and parakeratosis and rarely small acantholytic foci. In this article, we report a patient who presented with diffuse erythroderma and extensive acantholysis mimicking pemphigus vulgaris histologically.
On the Use of Location and Occupancy Factors for Estimating External Exposure From Deposited Radionuclides
Authors: Tzivaki Margarita , Waller Edward 
Published: July 2018

Abstract
Providing a dose estimate for the exposed population is crucial in the case of deposition of a known radioactive material, either through an accident or during routine operations. In the absence of detailed information on each individual, knowing the demographics of the affected population concerning occupational habits and housing allows the determination and use of appropriate location and occupancy factors required for exposure and dose calculations. The previous approach in the United Nations Scientific Committee on the Effects of Atomic Radiation 2013 report, published in 2014, used time-dependent location factors and occupancy factors based on age and occupation. The newly published methodology in the United Nations Scientific Committee on the Effects of Atomic Radiation 2016 report (2017) is simplified, using a single time-independent location factor for indoor occupancy, as well as a single occupancy factor that is independent of the age and occupation of the population considered. In this work the two approaches are compared for different population groups and housing types in the case of both a short-lived and a long-lived radionuclide. It was found that the new simplified methodology, while overestimating the integrated effective dose over 100 y for 137Cs and 134Cs, also underestimates the dose on short timescales, especially for the shorter-lived 134Cs. Additionally, the dose rate is significantly underestimated for certain types of buildings with higher location factors. This was found for both radionuclides in the first year of exposure. In the case of short-lived 134Cs, the integrated effective dose after 100 y is also underestimated in certain cases. It can be concluded that, while the simplified methodology can reasonably and successfully be applied in cases where dose due to deposition (1) is not the dominant pathway and (2) is part of multistep calculations, caution must be exercised in more complex exposure situations, especially when performing dose assessment in response to an accident.
Mitigating the Psychological Harm from Actinide Intakes
Authors: Klumpp John A. , Bertelli Luiz , Hoffman Jeffrey , Poudel Deepesh , Waters Tom 
Published: July 2018

Abstract
Investigations into possible actinide intakes, as well as the intakes themselves, may result in significant psychological harm that should be mitigated by the internal dosimetrist. Many aspects of this psychological impact are unique to actinide intakes and have not been discussed in the literature. This paper discusses some of these unique considerations and describes how the Internal Dosimetry Team at Los Alamos National Laboratory (LANL) has, with input and guidance from LANL psychologists, tried to address them. We feel that much of the psychological harm can be mitigated by educating employees specifically about internal dosimetry and internal doses, and by improving communication with radiation workers.
Utilizing Monte Carlo Computations to Estimate Radiation Doses From Some Cosmetics
Authors: Orabi Momen , Abdurahem Om-Azez , Sherif Mohamed 
Published: July 2018

Abstract
Monte Carlo simulations are exploited to assess the annual radiation doses from some cosmetics due to the radioactive decay series of 238U and 232Th and to the radionuclide 40K. The measured radioactivity concentrations are entered into simulation codes modeled and implemented by Monte Carlo n-particle software. The concentrations are found to be relatively high for a large number of the samples. The Monte Carlo-simulated gamma-radiation annual doses are compared with the results of another theoretical approach. Both methods are in good agreement with each other and predict low doses from use of cosmetics.
Establishment of Criteria for Skin Decontamination in a Radiation Emergency
Authors: Yoo Jaeryong , Jin Young Woo 
Published: July 2018

Abstract
In the event of a radiological or nuclear emergency, internal or external contamination (or both) by radionuclides can occur. In such cases, removal of the radionuclides from the injured skin is important because such surface contamination may induce skin damage such as deterministic effects at very high skin doses (2 to 3 Gy). In addition, internal contamination will occur due to radionuclide absorption through the injured skin. Previous studies have suggested various decontamination criteria. However, those criteria are impractical in the case of large-scale population monitoring. Here, to identify practical decontamination criteria, the VARSKIN 4.0 software code is used to assess skin doses originating from surface contamination by 60Co, 131I, and 137Cs. In addition, Integrated Modules for Bioassay Assessment dosimetry software is used to assess the effective doses following radionuclide intake through external contamination for the same three radionuclides. The effective dose dependence on the soluble material type is also assessed. In particular, the effective dose due to radionuclide absorption is found to be greater than the skin dose rate due to surface contamination for the same radioactivity levels. Based on the calculation results, decontamination criteria and actions that depend on the effective dose and surface contamination level (Bq cm−2) for alpha and beta or gamma radiation are suggested. Actions for contaminated injured persons are classified as no action, optional, recommended, or required.
Calibration of Radiation Portal Monitors for Characterization of Historic Low-level Radioactive Waste
Authors: Cole David , Martin-Burtart Nicolas 
Published: July 2018

Abstract
Radiation portal monitors are large-volume radiation detectors typically positioned along roadways, railways, and pedestrian portals. They are typically used for the detection of radioactive material where no such material is expected. Applications include monitoring vehicles and personnel exiting nuclear facilities, at the entrance to steel and scrap metal facilities, and at international borders. As part of the Port Hope Area Initiative, the Port Granby Project involves the relocation of approximately 450,000 m3 of historic low-level radioactive waste, located at an existing site on the shoreline of Lake Ontario in Southeast Clarington, to a new, engineered aboveground mound. Ongoing maintenance and monitoring will continue for hundreds of years after the facility is capped and closed. The waste is transported from its current location about 700 m to the new facility using trucks. Each truck passes through a radiation portal monitor when travelling between the waste location and waste storage facility (both directions; empty and full). The radiation portal monitors have been calibrated to provide an estimate of the total radioactivity being deposited into the new waste facility. This paper describes the methodology and results of the calibration.
Importance of a Risk Stratification Strategy to Identify High-risk Patients Presenting With Cocaine-associated Acute Coronary Syndrome
Authors: Sehatbakhsh Samineh , Kushnir Alexander , Furlan Stefanie , Donath Elie , Ghumman Waqas , Chait Robert 
Published: July 2018

Objective:
Current guidelines recommend treating patients with cocaine-associated chest pain, unstable angina, or myocardial infarction similarly to patients with traditional acute coronary syndrome (ACS). Risk stratifying these patients could potentially reduce unnecessary procedures and improve resource utilization.

Methods:
This is a retrospective cross-sectional analysis of 258 patients presenting with cocaine-associated ACS who underwent cardiac catheterization in a community teaching hospital between 2006 and 2015. The primary outcome was the prevalence of acute obstructive coronary artery disease (CAD) requiring percutaneous coronary intervention and coronary artery bypass grafting compared with that of patients with normal coronary or nonobstructive disease.

Results:
Of the studied population, 36% had obstructive CAD requiring intervention and 64% were found to have normal coronaries or nonobstructive disease. Significant risk factors for obstructive CAD were older age, history of CAD, diabetes mellitus, dyslipidemia, ST-segment–elevation myocardial infarction, and troponin elevation. A logistic model was developed based on these variables, applied to the studied population, and was found to have 93% sensitivity in predicting the likelihood of obstructive CAD.

Conclusions:
Cardiac catheterization in patients presenting with cocaine-associated ACS may be overutilized. A predictive model based on clinical risk factors may help individualize patient care and reduce unnecessary invasive diagnostic interventions.
Cervical Spine Dysfunction Following Pediatric Sports-Related Head Trauma
Authors: Ellis Michael J. , McDonald Patrick J. , Olson Ashley , Koenig James , Russell Kelly 
Published: July 2018

Objective:
To examine the prevalence of cervical spine injuries among children and adolescents referred with suspected and diagnosed sports-related concussion (SRC); and evaluate the effect of cervical spine dysfunction (CSD) on physician-documented clinical recovery following SRC.

Setting:
A multidisciplinary pediatric concussion program.

Participants:
A total of 266 patients (6-19 years) referred with suspected SRC.

Design:
A retrospective cohort study.

Main Measures:
CSD defined as neurological symptoms localized to the cervical spine or the presence of neck pain, headache, or dizziness and abnormal cervical spine examination findings; physician-documented clinical recovery.

Results:
One patient was diagnosed with a T1 compression fracture. Of the 246 patients diagnosed with SRC, 80 (32.5%) met the clinical criteria for CSD including 4 patients with central cord neuropraxia and 1 with a spinal cord injury without radiographic abnormality (SCIWORA). Excluding patients with central cord neuropraxia OR SCIWORA, patients with SRC with CSD took longer to achieve physician-documented clinical recovery (28.5 days vs 17 days, P < .0001) and were 3.95 times more likely to experience delayed physician-documented clinical recovery (>4 weeks postinjury) compared with those without CSD.

Conclusions:
Patients with suspected and diagnosed SRC can present with a wide spectrum of coincident cervical spine injuries. Cervical spine dysfunction may be a risk factor for delayed clinical recovery.
Early Elementary School Outcome in Children With a History of Traumatic Brain Injury Before Age 6 Years
Authors: Haarbauer-Krupa Juliet , King Tricia Z. , Wise Justin , Gillam Schauna , Trapani Julie , Weissman Barbara , DePompei Roberta 
Published: July 2018

Objective:
To describe elementary school outcomes for children who experienced a traumatic brain injury (TBI) before age 6 years compared with a control group of children with orthopedic injuries.

Participants:
Children ages 6 to 9 years recruited from community and trauma registries in a large southeastern state.

Design:
Descriptive findings from the first year of a 3-year longitudinal study.

Main Measures:
Child assessment and parent report measures were administered to capture cognitive, language, reading, and behavior outcomes. Medical record review confirmed injuries and injury severity.

Results:
The TBI group (n = 39) had a mean age of 7.55 years (standard deviation = 1.29) and was 5.15 (standard deviation = 1.56) years postinjury. The TBI group had primarily classified as mild complicated TBI (63%). On average, children in both groups performed within normal limits on most cognitive, language, and reading measures. Group differences were identified in verbal IQ, receptive language, and reading comprehension, with robust performance differences in pragmatic language, story retell and word fluency, and parent report of executive functions.

Conclusions:
Findings indicate the importance of in-depth follow-up specialist assessments (eg, neuropsychologist and speech and language pathologists) to identify potential nuanced difficulties in children with mild complicated TBI that may be missed by general evaluations.
Inertial Sensors Reveal Subtle Motor Deficits When Walking With Horizontal Head Turns After Concussion
Authors: Fino Peter C. , Wilhelm Jennifer , Parrington Lucy , Stuart Samuel , Chesnutt James C. , King Laurie A. 
Published: July 2018

Objective:
To examine whether horizontal head turns while seated or while walking, when instrumented with inertial sensors, were sensitive to the acute effects of concussion and whether horizontal head turns had utility for concussion management.

Setting:
Applied field setting, athletic training room.

Participants:
Twenty-four collegiate athletes with sports-related concussion and 25 healthy control athletes.

Design:
Case-control; longitudinal.

Main Measures:
Peak head angular velocity and peak head angle (range of motion) when performing head turns toward an auditory cue while seated or walking. Gait speed when walking with and without head turns.

Results:
Athletes with acute sports-related concussion turned their head slower than healthy control subjects initially (group β = −49.47; SE = 16.33; P = .003) and gradually recovered to healthy control levels within 10 days postconcussion (group × time β = 4.80; SE = 1.41; P < .001). Peak head velocity had fair diagnostic accuracy in differentiating subjects with acute concussion compared with controls (areas under the receiver operating characteristic curve [AUC] = 0.71-0.73). Peak head angle (P = .17) and gait speed (P = .64) were not different between groups and showed poor diagnostic utility (AUC = 0.57-0.62).

Conclusion:
Inertial sensors can improve traditional clinical assessments by quantifying subtle, nonobservable deficits in people following sports-related concussion.
ULTRA-WIDEFIELD MULTIMODAL IMAGING OF PRIMARY VITREORETINAL LYMPHOMA
Authors: Lavine Jeremy A. , Singh Arun D. , Sharma Sumit , Baynes Kimberly , Lowder Careen Y. , Srivastava Sunil K. 
Published: July 2018

Purpose:
To determine the features of primary vitreoretinal lymphoma on multimodal ultra-widefield imaging and correlate these findings to clinical outcomes.

Methods:
We report a retrospective, observational case series of 43 eyes of 23 patients with biopsy-proven B-cell primary vitreoretinal lymphoma. Fundus photography, fluorescein angiography (FA), optical coherence tomography, fundus autofluorescence, and indocyanine green angiography images were reviewed. Medical records were assessed for the central nervous system involvement and visual acuity outcomes at 6 and 12 months after presentation.

Results:
Common fundus photography findings were sub–retinal pigment epithelium lesions and vitritis alone. Common ultra-widefield FA findings were vascular leakage and scleral staining. Retinal optical coherence tomography features overlying sub–retinal pigment epithelium lesions or within the macula predicted fluorescence patterns. The presence of retinal fluid or disorganization associated with hyperfluorescence and late leakage. Normal retinal structures associated with hypofluorescence of sub–retinal pigment epithelium lesions or macular leopard spotting on FA and fundus autofluorescence. Peripheral abnormalities noted on ultra-widefield fundus photography, FA, and indocyanine green angiography were more frequent than posterior pole abnormalities. No imaging characteristics predicted time to the central nervous system progression.

Conclusion:
Ultra-widefield imaging was more informative than posterior pole imaging in fundus photography, FA, and indocyanine green angiography. Common findings on multimodal ultra-widefield imaging may lead to early diagnostic vitrectomy and may reduce the delay in primary vitreoretinal lymphoma diagnosis.
UNDERDIAGNOSED OPTIC DISK PIT MACULOPATHY
Authors: Iglicki Matias , Busch Catharina , Loewenstein Anat , Fung Adrian T. , Invernizzi Alessandro , Mariussi Miriana , Arias Romina , Gabrielle Pierre-Henry , Cebeci Zafer , Okada Mali , Nawrocki Jerzy , Michalewska Zofia , Goldstein Michaella , Barak Adiel , Zur Dinah ,   On behalf of The International Retina Group
Published: July 2018

Purpose:
To report a cohort with optic disk pit maculopathy (ODPM) presenting with neurosensory macular detachment that were initially misdiagnosed and mistreated; and to describe structural features on spectral domain optical coherence tomography in misdiagnosed and all other consecutive cases of ODPM.

Methods:
Multicenter international retrospective cohort study. Participants: 59 eyes from 59 patients with ODPM. Main outcome measures: 1) Proportion of patients with ODPM initially misdiagnosed, inaccurate diagnosis and treatment. 2) Morphologic features on spectral domain optical coherence tomography: other causes of subretinal and/or intraretinal fluid, inner/outer retinoschisis, communication with optic disk pit, and retinal pigment epithelium alterations. 3) Visual and anatomical outcomes 6 months after proper treatment.

Results:
Fifteen patients (25.4%) with ODPM were correctly diagnosed initially and those were significantly younger than misdiagnosed cases (age 33.8 ± 15.2 vs. 58.7 ± 15.8 years, P < 0.0001). Forty of forty-four misdiagnosed eyes (90.9%) were treated for their presumed diagnosis before referral. Eyes with initial misdiagnosis had significantly more outer retinoschisis at baseline (88.4 vs. 40.0%, P = 0.0002) and more retinal pigment epithelium alterations (90.0 vs. 27.3%, P < 0.0001) 6 months after proper treatment.

Conclusion:
Optic disk pit maculopathy is an underdiagnosed entity and can mimic other causes for subretinal fluid. Awareness and identification of pertinent spectral domain optical coherence tomography features can help avoid inappropriate and delayed treatment.
BILATERAL CHOROIDAL DETACHMENTS SECONDARY TO IPILIMUMAB AND PEMBROLIZUMAB USE
Authors: O'Bryhim Bliss Elizabeth , Sychev Yevgeniy , Rao Prabakar Kumar 
Published: July 2018

Purpose:
To report the occurrence of bilateral choroidal detachments due to the use of ipilimumab and pembrolizumab immunochemotherapeutics to treat widely metastatic cutaneous melanoma and to raise awareness about this potentially vision-threatening adverse drug event.

Methods:
A 77 year-old man presented with acute onset, painless, and bilateral blurry vision. He had started ipilimumab and pembrolizumab 2 weeks prior for Stage IV metastatic cutaneous melanoma.

Results:
Clinical examination revealed bilateral choroidal detachments. After discussion with the patient's medical oncologist, the patient discontinued both medications and began oral prednisone to expedite visual recovery. The choroidal detachments subsequently resolved, and visual acuity improved 2 weeks later.

Conclusion:
Ipilimumab and pembrolizumab have been reported both in monotherapy and in combination to cause a wide variety of ophthalmic adverse events. This is the first report of choroidal detachments as a complication.