bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuropsychology Outcomes Following Trephine Epilepsy Surgery: The Inferior Temporal Gyrus Approach for Amygdalohippocampectomy in Medically Refractory Mesial Temporal Lobe Epilepsy
Authors: Schoenberg Mike R , Clifton William E , Sever Ryan W , Vale Fernando L 
Published: May 2017

Abstract

BACKGROUND
Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE) that are refractory to medical management. The inferior temporal gyrus (ITG) approach provides access to the mesial temporal lobe (MTL) structures with minimal tissue disruption. Reported neuropsychology outcomes following this approach are limited.

OBJECTIVE
To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospective design.

METHODS
Fifty-four participants had Engel class I/II outcome following resection of MTL using the ITG approach. All participants had localization-related epilepsy confirmed by long-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, and neuropsychology assessment.

RESULTS
Clinical semiology/video-electroencephalography indicated that of the 54 patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) had pathology-confirmed mesial temporal sclerosis (MTS). Group level analyses found declines in verbal memory for patients with language-dominant resections (P < .05). No significant decline in neuropsychological measures occurred for patients with MTS. Participants without MTS who underwent a language-dominant lobe resection exhibited a significant decline in verbal and visual memory (P < .05). Nondominant resection participants did not exhibit significant change in neuropsychology scores (P > .05).

CONCLUSION
Neuropsychology outcomes of an ITG approach for selective mesial temporal resection are comparable to other selective AH techniques showing minimal adverse cognitive effects. These data lend support to the ITG approach for selective AH as an option for MTLE.
Ophthalmic Complications Following Acoustic Neuroma Resection
Authors: Gange William S , Kirchner Ian D , Thompson John A , Hill Jacquelyn , Grahnke Kurt , Ibrahim Tarik , Leonetti John P , Anderson Douglas E , Bouchard Charles S 
Published: May 2017

Abstract

BACKGROUND
Past studies have shown high rates of ocular complications with the need for ophthalmic surgery following acoustic neuroma resection (ANR).

OBJECTIVE
To determine the rates of ophthalmic complications, referrals, and surgery following ANR, and the factors associated with poor outcomes.

METHODS
A retrospective study of ophthalmic outcomes in patients who underwent ANR was conducted, following institutional review board approval. Surgical approach, tumor size, tumor characteristics, completeness of resection, postoperative House-Brackmann grades, ocular complications, referrals to ophthalmology, and ophthalmic treatments were recorded.

RESULTS
Between 2007 and 2012, 174 patients underwent ANR. There were 3 surgical groups: retrosigmoid (n = 97), translabyrinthine (n = 59), and combined retrosigmoid and translabyrinthine (n = 18). Median tumor size was 2.2 cm. Postoperatively, 30% of patients had facial nerve dysfunction (House-Brackmann ≥3), which recovered to 19% by 1 mo and 8.6% by 1 yr following ANR. Fifty-six (32.9%) patients experienced ocular complications postoperatively, with lagophthalmos, dry eye, and blurry vision as the most common complications. Thirty-six (67.9%) of the patients who required ophthalmic treatment were managed nonsurgically, with just 13 (7.6%) patients requiring referral to an ophthalmologist. In total, only 9 (5.3%) patients received an ophthalmic procedure. Patients with tumors >2 cm, those undergoing combined retrosigmoid and translabyrinthine resection, and those with severe facial nerve dysfunction which did not improve in the first month following surgery were more likely to have poor ophthalmic outcomes.

CONCLUSION
We present lower rates of ophthalmic complications following ANR than previously reported. Improved surgical technique, better postoperative eye care, and facial nerve monitoring most likely accounted for the improved ocular outcomes.
Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures
Authors: Manouvakhova Olga V , Macchi Veronica , Fries Fabian N , Loukas Marios , De Caro Raffaele , Oskouian Rod J , Spinner Robert J , Tubbs R Shane 
Published: May 2017

Abstract

BACKGROUND
Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon.

OBJECTIVE
To identify landmarks for the identification of this hidden site within an anterior approach.

METHODS
In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen.

RESULTS
From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°.

CONCLUSION
Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm.
Creating an “Education Shark Tank” to Encourage and Support Educational Scholarship and Innovation
Authors: Cofrancesco Joseph , Wright Scott M. , Vohr Eric , Ziegelstein Roy C. 
Published: May 2017

Problem
Creating and supporting opportunities for innovation that showcase and reward creativity in medical and biomedical education is critically important for academic institutions, learners, and faculty.

Approach
In 2014, the Institute for Excellence in Education at Johns Hopkins University School of Medicine created a small grant program called Education Shark Tank, in which two to five finalist teams present their proposals on innovative initiatives to improve education to four or five senior educator “sharks” at an educational conference, with an audience. The sharks then “grill” the presenters, considering which if any to fund, focusing on the rationale, feasibility, appropriateness of the outcome measures, evaluation and assessment plan, and proposed method of dissemination. They also make suggestions that challenge the presenters to assess and improve their designs.

Outcomes
In the program’s first year (2014), funds were divided equally between two projects, both of which were successfully completed and one of which led to a journal publication; this led to increased funding for the program in 2015. Participants have called Education Shark Tank a “challenging and rewarding experience.”

Next Steps
Education Shark Tank can facilitate educational innovation and scholarship via engaging and challenging interactions between grant applicants and reviewers in a public venue. The authors plan to conduct a five-year survey (after 2018) of all Education Shark Tank finalists to determine the success and challenges the funded projects have had, what scholarly dissemination has occurred, whether nonfunded projects were able to move forward, and the value of the feedback and mentoring received.
Vertically Oriented Femoral Neck Fractures: A Biomechanical Comparison of 3 Fixation Constructs
Authors: Johnson Joey P. , Borenstein Todd R. , Waryasz Gregory R. , Klinge Stephen A. , McClure Philip K. , Chambers Alison B. , Hayda Roman A. , Born Christopher T. 
Published: May 2017

Objectives:
To compare the static and dynamic mechanical properties of a modified crossed cannulated screw (CS) configuration, the inverted triangle (IT) cannulated screw configuration, and a compression hip screw (CHS) with derotation screw in Pauwels type III femoral neck fractures.

Methods:
Thirty synthetic femora were divided into 3 groups, and vertical femoral neck osteotomies were made. Ten osteotomized femora were fixed with a CS configuration, 10 were fixed with 3 parallel screws in an IT configuration, and the remaining 10 osteotomized femora were fixed with a CHS construct. All groups were tested using a cyclic (up to 15,000 load cycles) axial loading protocol, and survivors were statically loaded to failure. Cycles to failure, load to failure, and stiffness were calculated. The Kaplan–Meier method was used to estimate survival functions and were compared among fixation methods. The relationship between construct structural properties (maximum load and stiffness) and treatment were assessed using general linear modeling.

Results:
All CHS fixation constructs survived the 15,000 cycle loading protocol. They endured longer (P = 0.034) than the CS fixation constructs (mean failure 13,332 cycles), but were not different from IT fixation constructs (mean failure 13,592 cycles). Maximum loads to failure for CS (3870 N) and IT (3756 N) fixation constructs were not different, but were less (P < 0.0001) than the maximum loads to failure for the CHS fixation constructs (5654 N). These findings parallel the results of the axial stiffness measurements: CS fixation constructs (663.01 N/mm) were not stiffer than IT fixation constructs (620.0 N/mm), but were less (P = 0.0005) than the axial stiffness of the CHS fixation constructs (1241.86 N/mm).

Conclusions:
The biomechanical performance of the CHS fixation method was superior to both the CS fixation method and the IT fixation method using a synthetic femoral model and this test protocol. Biomechanical performance of the latter 2 groups was indistinguishable. We recommend the use of CHS with the derotational screw construct for Pauwels III femoral neck fractures whenever possible.
Does Provisional Plating of Closed Tibia Fractures Have Higher Complication Rates?
Authors: Haller Justin M. , Githens Michael , Scolaro John , Firoozabadi Reza 
Published: May 2017

Objectives:
To compare infection and nonunion rates after provisional plating (PP) with standard reduction (SR) techniques for closed tibia fractures treated with an intramedullary nail.

Design:
Retrospective comparative study.

Setting:
Level 1 academic trauma center.

Patients/Participants:
Of the 348 closed tibia fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 42) treated using an intramedullary nail from January 2007 through June 2015, 231 (40 PP and 191 SR) patients met inclusion/exclusion criteria.

Intervention:
The patients received either a provisional plate or an SR before intramedullary nail placement.

Main Outcome Measurement:
Infection and nonunion.

Results:
The PP cohort had a significantly higher proportion of high-energy injury mechanism and a significantly higher proportion of diabetes than the SR cohort. We were unable to demonstrate a difference in rates of infection [PP cohort (1/40, 2.5%) vs. SR cohort (6/191, 3.1%), P = 1.0], nonunion [PP cohort (3/40, 7.5%) vs. SR cohort (9/191, 4.7%), P = 0.44], or malunion [PP cohort (0/40, 0%) vs. SR cohort (8/191, 4.2%), P = 0.36]. Symptomatic implant removal was similar between the 2 groups [PP cohort (4/40, 10%) vs. SR cohort (27/191, 14%), P = 0.61].

Conclusion:
PP can be used for complex, closed tibia fractures without an increased risk of infection, nonunion, and malunion compared with standard closed reduction techniques.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Medial Clamp Tine Positioning Affects Ankle Syndesmosis Malreduction
Authors: Cosgrove Christopher T. , Putnam Sara M. , Cherney Steven M. , Ricci William M. , Spraggs-Hughes Amanda , McAndrew Christopher M. , Gardner Michael J. 
Published: May 2017

Objectives:
To determine whether the position of the medial clamp tine during syndesmotic reduction affected reduction accuracy.

Design:
Prospective cohort.

Setting:
Urban Level 1 trauma center.

Patients:
Seventy-two patients with operatively treated syndesmotic injuries.

Intervention:
Patients underwent operative fixation of their ankle syndesmotic injuries using reduction forceps. The position of the medial clamp tine was then recorded with intraoperative fluoroscopy. Malreduction rates were then assessed with bilateral ankle computerized tomography.

Main Outcome Measurement:
Fibular position within the incisura was measured with respect to the uninjured side to determine whether a malreduction had occurred. Malreductions were then analyzed for associations with injury pattern, patient demographics, and the location of the medial clamp tine.

Results:
A statistically significant association was found between medial clamp position and sagittal plane syndesmosis malreduction. In reference to anterior fibular translation, there was a 0% malreduction rate in the 18 patients where the clamp tine was placed in the anterior third, a 19.4% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.006). In reference to posterior fibular translation, there was a 11.1% malreduction when clamp placement was in the anterior third, a 16.1% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.062). There were no significant associations between medial clamp position and coronal plane malreductions (overcompression or undercompression) (P = 1).

Conclusions:
When using reduction forceps for syndesmotic reduction, the position of the medial clamp tine can be highly variable. The angle created with off-axis syndesmotic clamping is likely a major culprit in iatrogenic malreduction. Sagittal plane malreduction appears to be highly sensitive to clamp obliquity, which is directly related to the medial clamp tine placement. Based on these data, we recommend placing the medial clamp tine in the anterior third of the tibial line on the lateral view to minimize malreduction risk.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Spectrum of Diagnosis and Disposition of Patients Referred to a Pediatric Orthopaedic Center for a Diagnosis of Intoeing
Authors: Faulks Shawne , Brown Kaitlyn , Birch John G. 
Published: May 2017

Background:
Orthopaedic surgeons frequently evaluate otherwise healthy children for concern of intoed gait. Intoeing in otherwise healthy young children due to metatarsus adductus, internal tibial torsion, and increased femoral anteversion do not typically require orthopaedic treatment. This study reviewed the actual diagnosis, management, and disposition of patients referred to a pediatric orthopaedic specialty hospital for a diagnosis of intoeing; the efficacy of an Advanced Practice Provider (APP) assessment program to screen and triage patients with a primary complaint of intoeing; and parental satisfaction with that program.

Methods:
We established an “Intoeing Clinic” conducted by APPs to conduct initial evaluations of patients referred for a diagnosis of intoeing meeting-specific criteria, including (1) a referring provider’s diagnosis of “intoeing”; (2) the patient was under the age of 9 years; and (3) there was no suggestion of comorbidity in the information provided by the referring provider to imply a diagnosis other than “benign” intoeing. Under pediatric orthopaedic surgeon “on-call” supervision, APPs were authorized to perform clinical assessments supplemented by radiographs and laboratory investigations as deemed necessary. We performed an Institutional Review Board-approved, retrospective medical record review of all patients appointed to our Intoeing Clinic over a 30-month period (March 2010 to September 2013).

Results:
About 95% of 926 patients appointed to APP Intoeing Clinic were confirmed to have a diagnosis of “benign” intoeing or a similar “benign” diagnosis; 5% of these patients requested a reevaluation for the same concern. Approximately 5% were determined to have a nonbenign diagnosis, either known to the family/provider, but not conveyed at the time of referral (4%), or identified at our institution (1%). Two patients (0.2%) were determined at follow-up examination to have a neurological abnormality at the subsequent examination.

Conclusions:
An “Intoeing Clinic” staffed by experienced Advanced Pediatric Practitioners or equivalent, with appropriate orthopaedic surgeon availability for consultation can be an effective and efficient method of evaluating patients referred for a diagnosis of “intoeing.”

Level of Evidence:
Level IV—case series.
Recommendations for Methicillin-Resistant Staphylococcus aureus Prevention in Adult ICUs: A Cost-Effectiveness Analysis*
Authors: Whittington Melanie D. , Atherly Adam J. , Curtis Donna J. , Lindrooth Richard C. , Bradley Cathy J. , Campbell Jonathan D. 
Published: May 2017

Objective:
Patients in the ICU are at the greatest risk of contracting healthcare-associated infections like methicillin-resistant Staphylococcus aureus. This study calculates the cost-effectiveness of methicillin-resistant S aureus prevention strategies and recommends specific strategies based on screening test implementation.

Design:
A cost-effectiveness analysis using a Markov model from the hospital perspective was conducted to determine if the implementation costs of methicillin-resistant S aureus prevention strategies are justified by associated reductions in methicillin-resistant S aureus infections and improvements in quality-adjusted life years. Univariate and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness.

Setting:
ICU.

Patients:
Hypothetical cohort of adults admitted to the ICU.

Interventions:
Three prevention strategies were evaluated, including universal decolonization, targeted decolonization, and screening and isolation. Because prevention strategies have a screening component, the screening test in the model was varied to reflect commonly used screening test categories, including conventional culture, chromogenic agar, and polymerase chain reaction.

Measurements and Main Results:
Universal and targeted decolonization are less costly and more effective than screening and isolation. This is consistent for all screening tests. When compared with targeted decolonization, universal decolonization is cost-saving to cost-effective, with maximum cost savings occurring when a hospital uses more expensive screening tests like polymerase chain reaction. Results were robust to sensitivity analyses.

Conclusions:
As compared with screening and isolation, the current standard practice in ICUs, targeted decolonization, and universal decolonization are less costly and more effective. This supports updating the standard practice to a decolonization approach.
BIOMARKERS OF NEOVASCULAR ACTIVITY IN AGE-RELATED MACULAR DEGENERATION USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Al-Sheikh Mayss , Iafe Nicholas A. , Phasukkijwatana Nopasak , Sadda SriniVas R. , Sarraf David 
Published: May 2017

Purpose:
To study the qualitative and quantitative features of choroidal neovascular (NV) membranes in age-related macular degeneration using optical coherence tomography angiography in patients with active and quiescent NV lesions before and after treatment with anti–vascular endothelial growth factor.

Methods:
Macular optical coherence tomography angiography images were obtained using RTVue XR Avanti with AngioVue. Morphologic features and quantitative measurements of the NV lesion were analyzed using en face projection images. The NV lesion was subdivided into inner segment and outer fringe for further fractal dimension analysis.

Results:
In a series of 31 eyes, 11 eyes with active NV lesions at baseline and after consecutive follow-up after treatment with anti–vascular endothelial growth factor therapy and 20 eyes with quiescent NV lesions were included in this study. Morphologically, all the quiescent NV lesions versus 63.6% of the active NV lesions demonstrated a prominent central vessel and active leasions demonstrated a greater rate of small vessels branching (82%) and peripheral arcades (82%) than quiescent lesions (30% and 40% respectively) and this was statistically significant. The lesion area and vessel density was not statistically significantly different after treatment or versus quiescent lesions although the latter lesions were reduced in area. Lesion pattern complexity measured by the fractal dimension was statistically significantly lower in the inner part of the lesion after treatment and statistically significantly lower in the total lesion of the quiescent NV compared with the active NV.

Conclusion:
Optical coherence tomography angiography is a new, noninvasive imaging modality that can be used to perform qualitative and quantitative analyses of NV lesions. In the future, OCT angiography may provide biomarkers of activity and guide the evaluation and treatment and monitoring of neovascularization in age-related macular degeneration.
MACULAR EDEMA AFTER CATARACT SURGERY IN EYES WITH PREOPERATIVE RETINAL VEIN OCCLUSION
Authors: Cho Han Joo , Hwang Hyun Ji , Kim Hyoung Seok , Lee Dong Won , Kim Chul Gu , Kim Byoung Yeop , Kim Jong Woo 
Published: May 2017

Purpose:
To evaluate the incidence of pseudophakic macular edema (PME) in eyes with a history of retinal vein occlusion before cataract surgery and to identify any associated risk factors.

Methods:
The records of 21,332 eyes that underwent cataract surgery were retrospectively reviewed. Eyes that had retinal vein occlusion preoperatively with no evidence of macular pathology on optical coherence tomography at the time of surgery and no macular edema treatment at least 6 months before surgery were included. Eyes with diabetes or diabetic retinopathy, those with a history of previous intraocular surgery or with intraoperative complications, and those administered glaucoma and nonsteroidal antiinflammatory eye drops were excluded.

Results:
Pseudophakic macular edema developed in 31 (27.4%) of 113 eyes within 3 months of cataract surgery. Mean visual acuity for eyes with PME (0.48 logarithm of the minimum angle of resolution [logMAR; 20/60 Snellen equivalent]) at 3 months after surgery was significantly worse than that for eyes without PME (0.28 logMAR; 20/38, P = 0.020). However, there was no significant difference in the visual acuity between the 2 groups 6 months after the surgery. Taking into consideration various baseline factors, a history of previous treatment of macular edema was significantly associated with an increased risk of PME (odds ratio, 11.022; 95% confidence interval, 7.258–17.712; P = 0.009). A higher number of intravitreal injections used to treat macular edema also significantly increased the risk of PME (odds ratio, 1.902; 95% confidence interval, 1.032–4.227; P = 0.031).

Conclusion:
Pseudophakic macular edema frequently developed after phacoemulsification cataract surgery in patients with a history of retinal vein occlusion. The risk of PME further increased when the patient had undergone macular edema treatment and had a higher prevalence of intravitreal injection treatment.