bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining the Value of Neurosurgery in the New Healthcare Era
Authors: Benzil Deborah L. , Zusman Edie E. 
Published: January 2017

Abstract
Healthcare delivery is evolving rapidly with an increasing emphasis on the concept of “value.” At the same time, neurosurgeons are disproportionately working in employed positions where external definition of value becomes directly linked with compensation, work environment, and career satisfaction. Few neurosurgeons have an understanding of the various ways in which value is and can be defined and there are limited resources to assist in this realm. This paper covers the essential value concepts of National Standards, Pitfalls of National Standards, Call Coverage Compensation, Valuation Through Demand, Value Beyond Productivity, and Neurosurgical Value in the Accountable Care Organization Era. This framework should help neurosurgeons better understand critical trends impacting practice across the country.
Broader Practice Indications for Mohs Surgical Defect Healing by Secondary Intention: A Survey Study
Authors: Vedvyas Chetan , Cummings Patricia L. , Geronemus Roy G. , Brauer Jeremy A. 
Published: January 2017

BACKGROUND
Recent reports have indicated secondary intention (SI) healing utilization for Mohs surgical defects beyond conventionally accepted indications.

OBJECTIVE
To characterize potentially more expansive guidelines for when SI healing is indicated or appropriate in dermatologic surgery.

METHODS
A survey study was e-mailed to the American College of Mohs Surgery in 2015. A group of 293 respondents addressed factors influencing decisions to heal surgical defects secondarily.

RESULTS
The most experienced surgeons were significantly more likely to heal deep and larger wounds secondarily. Many surgeons elect SI healing in patients with current or previous wound dehiscence, flap necrosis, or infection; in patients who have undergone skin cancer excisions before, or who are elderly, and; if the lesion was sent for permanent section, or when treating high-risk, large, recurrent, or aggressive tumors.

CONCLUSION
Broader indications for SI healing of Mohs surgical defects may be appropriate than previously understood. In addition to concave, temporal, periocular, perinasal, and periauricular sites, SI healing may be appropriate for convex sites such as the scalp and anterior lower extremity, deep wounds, and large wounds, as well as wounds with dehiscence, flap necrosis, or infection. Certain patient-specific and lesional factors are also appropriate indications for SI healing.
SHORT-TERM SAFETY OF 2 MG INTRAVITREAL ZIV-AFLIBERCEPT
Authors: Chhablani Jay , Dedhia Chintan Jethalal , Peguda Hari K. , Stewart Michael ,   on behalf of Ziv-aflibercept study group
Published: January 2017

Purpose:
To evaluate the safety of single intravitreal 2 mg ziv-aflibercept (0.08 mL) injections for the treatment of choroidal neovascular membranes (CNVM).

Methods:
Eyes with choroidal neovascular membranes because of several conditions each received single intravitreal injections of 2 mg ziv-aflibercept (0.08 mL). Comprehensive ophthalmic examinations and detailed systemic evaluations were performed at baseline and Days 1, 7, and 30 after injections. Standard electroretinography was performed at baseline and Day 30. Primary outcome measures consisted of safety assessments (signs of clinical toxicity and electroretinographic abnormalities). Secondary outcome measures included changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) of the macula.

Results:
Twenty-one eyes of 20 patients (12 males) received injections. Etiologies responsible for the choroidal neovascular membranes included age-related macular degeneration (14), polypoidal choroidal vasculopathy (PCV) (3), myopia (2), and idiopathic juxtafoveal telangiectasia (2). None of the patients complained of worsening vision or pain after the intravitreal injections and no intraocular inflammation was seen. No significant changes in the electroretinographic b/a ratio from baseline to 1 month were measured (scotopic: P = 0.89; photopic: P = 0.13) and mean intraocular pressures were unchanged (14.2 ± 3.6 vs. 13.7 ± 3.0 mmHg; P = 0.62). Mean best-corrected visual acuity did not change significantly from baseline to 1 month (0.66 ± 0.37 logMAR [Snellen equivalent: 20/100] vs. 0.61 ± 0.35 logMAR [Snellen equivalent: 20/80]; P = 0.72) but significant improvements in central subfield thickness were seen (343 ± 177 vs. 210 ± 133 μm; P = 0.01).

Conclusion:
Single intravitreal injections of 2 mg ziv-aflibercept (0.08 mL) appear to be safe through 1 month.
INFANTS WITH CONGENITAL ZIKA SYNDROME AND OCULAR FINDINGS FROM SÃO PAULO, BRAZIL: SPREAD OF INFECTION
Authors: de Oliveira Dias João Rafael , Ventura Camila V. , Borba Paula Delegrego , de Paula Freitas Bruno , Pierroti Ligia Camera , do Nascimento Ana Patricia , de Moraes Nilva Simeren Bueno , Maia Maurício , Belfort Rubens 
Published: January 2017

Background/Purpose:
To describe the ocular findings of two infants with congenital Zika syndrome born in São Paulo state, Brazil, outside the primary outbreak region.

Methods:
Two female infants with congenital Zika syndrome were submitted to a complete screening for infectious diseases, as well as ocular examination, fundus photography, and optical coherence tomography of the retina. One of the infants was submitted to ocular ultrasound.

Results:
Both children showed positive serology for Zika virus, and other infectious diseases were ruled out. On fundus examination, one newborn had extensive bilateral macular chorioretinal atrophy with hyperpigmented borders associated with gross pigment mottling, as well as atrophic well-limited roundish peripheral lesions in the right eye. Spectral domain optical coherence tomography of the right eye showed complete chorioretinal atrophy in the temporal quadrant. The other infant presented bilateral gross pigment mottling in a paramacular location and a normal optical coherence tomography.

Discussion:
In this report, the ophthalmologic findings of two infants with Zika syndrome and ocular findings born in São Paulo state, Brazil, are described. Optical coherence tomography findings demonstrate the broad range of retinal damage caused by congenital Zika virus infection.

Conclusion:
The autochthonous cases of infants with congenital Zika syndrome and ocular findings described in this report demonstrate that Zika virus infection is not limited to northeast Brazil, with the potential for even greater spread.
MELANOCYTOMA OR JUXTAPAPILLARY MELANOMA?
Authors: Baartman Brandon J. , Ahmad Baseer , Srivastava Sunil , Jones Stephen , Singh Arun D. 
Published: January 2017

Purpose:
To report the case of a melanocytoma of the optic disc leading to severe vision loss, raising concern for possible malignant transformation and optic nerve infiltration.

Methods:
Case report.

Results:
A 36-year-old Arabic woman presented to an outside facility with severe vision loss and a clinical picture concerning for optic neuritis with central retinal vein occlusion. On referral to the authors' institution 1 month after initial presentation, the vision of the patient was no light perception in the affected eye, and examination revealed the presence of a pigmented lesion adjacent to the nerve. Although standard 3-T magnetic resonance imaging orbits suggested 15 mm of optic nerve involvement, ultrahigh resolution 7-T magnetic resonance imaging was able to detect only 2 mm of optic nerve involvement.

Conclusion:
Melanocytoma of the optic disc is most often benign and causes few visual symptoms. However, in rare cases it can lead to severe vision loss and raise concern for malignant transformation. A 7-T magnetic resonance imaging provides higher resolution optic nerve images.
Glaucoma Diagnostic Capability of Circumpapillary Retinal Nerve Fiber Layer Thickness in Circle Scans With Different Diameters
Authors: Ghassibi Mark P. , Chien Jason L. , Patthanathamrongkasem Thipnapa , Abumasmah Ramiz K. , Rosman Michael S. , Skaat Alon , Tello Celso , Liebmann Jeffrey M. , Ritch Robert , Park Sung Chul 
Published: January 2017

Purpose:
To compare varying circumpapillary optical coherence tomographic (OCT) scan diameters for glaucoma diagnosis.

Materials and Methods:
Prospective, cross-sectional, observational study. Circumpapillary retinal nerve fiber layer thickness (RNFLT) was measured using spectral-domain OCT in 1 randomly selected eye. Scans with diameters of 3.5, 4.1, and 4.7 mm were obtained, each with 7 parameters: mean global (G) RNFLT and mean RNFLT for the temporal-inferior (TI), nasal-inferior (NI), temporal-superior (TS), nasal-superior (NS), nasal (N), and temporal (T) sectors. Areas under the receiver operating characteristic curve (AUCs) were calculated.

Results:
Mean age was 55±18 years in 68 healthy eyes and 59±15 years in 95 glaucomatous eyes (P=0.12). Visual field mean deviation was −7.55±6.61 dB in glaucomatous eyes. In all 3 circle scans, mean TI RNFLT had the greatest AUC (0.974 to 0.983), followed by mean G RNFLT (0.949 to 0.956). The AUC of mean TI RNFLT in the 4.1-mm scan (0.983) was greater than the AUCs of mean TI RNFLTs in the 4.7- (0.978; P=0.128) and 3.5-mm (0.974; P=0.049) scans. The AUC of mean TI RNFLT in the 4.1-mm scan (0.983) was greater than the AUCs of mean G RNFLTs in the 3.5- (0.954; P=0.011), 4.1- (0.956; P=0.016), and 4.7-mm (0.949; P=0.011) scans. In 2 eyes with large parapapillary atrophy, RNFL segmentation error was noted only in the 3.5-mm scan in the area of parapapillary atrophy.

Conclusions:
Further investigations to find the spectral-domain OCT circle scan diameter with the best diagnostic capability and the least artifacts are warranted, especially focusing on larger-than-conventional circle scans.
Eyepass Glaucoma Implant in Open-Angle Glaucoma After Failed Conventional Medical Therapy: Clinical Results of a 5-Year-Follow-up
Authors: Wittmann Barbara , Huchzermeyer Cord , Rejdak Robert , Reulbach Udo , Dietlein Thomas , Hohberger Bettina , Jünemann Anselm 
Published: January 2017

Purpose of the Study:
The purpose of the study was to evaluate the long-term safety and intraocular pressure (IOP) lowering effect of the Eyepass glaucoma implant (GMP Vision Solutions, Inc.).

Patients and Methods:
The prospective study included 15 patients (16 eyes) with primary open-angle glaucoma who underwent an implantation of the Y-shaped Eyepass glaucoma implant. This shunt diverts aqueous from the anterior chamber directly into Schlemm’s canal to increase outflow and to lower the IOP. IOP, visual acuity, potential complications and the number of antiglaucomatous medications were monitored over a period of 5 years.

Results:
The implant was successfully inserted in 14 of 16 eyes. Mean IOP was reduced from 26.4±8.1 mm Hg (SD) to 16.4±5.3 mm Hg (P=0.032) at the end of the follow-up. Mean number of antiglaucomatous medications dropped from 2.1±1.2 (SD) to 0.9±1.2 (SD). In 5 cases, no pressure-lowering medications were necessary 5 years after surgery. Mean best-corrected visual acuity did not change significantly (P>0.05). In all cases, filtering blebs were observed and sustained using antimetabolites. The most common complication was temporary ocular hypotony. Two patients required a revision surgery due to implant malposition.

Conclusions:
The Eyepass glaucoma implant seems to be a safe and effective treatment option for patients with primary open-angle glaucoma. The use of this device resulted in a significant decrease of IOP.
Nonmedical Out-of-Pocket Patient and Companion Expenditures Associated With Glaucoma Care
Authors: Schehlein Emily M. , Im Lily T. , Robin Alan L. , Onukwugha Eberechukwu , Saeedi Osamah J. 
Published: January 2017

Purpose:
Nonmedical out-of-pocket cost to both patients and their companions of office visits for routine glaucoma care has not been extensively studied in the United States. We evaluate potential key predictors of patient expenditures that are critical to assessing the cost-effectiveness of glaucoma health care delivery.

Materials and Methods:
In total, 300 patients responded to the survey in 3 clinics in 2 clinical practice settings. Main outcome measures included both average visit and yearly expenditures.

Results:
Of the 300 patients, the majority were female (n=187, 62.3%) and African American (n=171, 57.0%). The median age was 66 years. The median [range; mean (SD)] expenditure per patient visit was $22.10 ($11.1, $42.9; $44.1 (72.8)). Patients with companions paid $38.77 more in average visit expenditure (β: 0.87, P<0.001). The average visit expenditure for retired patients was $17.37 less when compared with nonretired patients (β: −0.4, P=0.004). Patients living in a rural or suburban area paid $43.91 and $14.13 more per visit, respectively (β: 0.73, P=0.0004; β: 0.31, P=0.03), compared with patients living in an urban area. Patients with noncommercial insurance paid $24.01 less in average visit expenditure (β: −0.66, P=0.0008). The median yearly patient expenditure was $96.70 [$44.6, $222.7; $210.4 (333.9)]. Patients with companions paid $192.37 more in yearly expenditure (β: 0.9, P<0.001) than those without companions, whereas retired patients paid $80.83 less in yearly expenditure (β: −0.39, P=0.03) than nonretirees. Patients with noncommercial insurance paid $109.34 less in yearly expenditure (β: −0.63, P=0.01).

Conclusions:
Although a small part of the total cost of glaucoma care, nonmedical out-of-pocket costs constitute a substantial noncovered medical expense to most patients in the United States. Patients who are employed, come with companions, live in nonurban areas, or are on Medicare have greater expenditures.
Long-term Clinical and Radiologic Outcome in 500 Children With Parenchymal Neurocysticercosis
Authors: Singhi Pratibha , Suthar Renu , Deo Brijendra , Malhi Prabhjot , Khandelwal Niranjan K. 
Published: January 2017

Background:
Our aim was to study long-term clinical and radiologic outcome in children with parenchymal neurocysticercosis (NCC) and its predictors.

Method:
Five hundred children with NCC registered in the pediatric NCC clinic between January 1996 and December 2002 and followed till December 2009 were enrolled. Demographic details, clinical presentations and therapy received were recorded. Outcome was evaluated in terms of seizure recurrence and resolution of lesions on neuroimaging. Various factors that could influence outcome were studied.

Results:
Mean age at presentation was 8 ± 2.7 years, and the mean duration of follow-up was 8.8 ± 2.03 years; 79.6% (398) had single lesion, and 20.4% (102) had multiple lesions at presentation; 14.5% (58) of children with single lesion, and 28.4% (29) of children with multiple lesions had recurrent seizures (P < 0.001) during follow-up. At 6-month follow-up neuroimaging, resolution was seen in 52.7% (210) and 31.3% (32) of children with single and multiple lesions, respectively (P < 0.001). On prolonged follow-up, 94.6% (384) of single-lesion NCC and 88% (90) of multiple-lesion NCC (P < 0.001) had radiologic resolution. Single-lesion NCC, radiologic resolution and cysticidal therapy were associated with better seizure outcome (P < 0.05). Children with multiple lesions had significantly higher percentage of calcified lesions on long-term follow-up compared with those with a single lesion (11.7% vs. 3.6%, P < 0.05).

Conclusions:
Children with a single-lesion NCC have favorable outcome with resolution of most of the lesions and few seizure recurrences. Cysticidal therapy leads to better seizure control and increased resolution of lesions on short-term follow-up.
Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed With HIV in the First 12 Weeks of Life
Authors: Sheahan Anna , Feinstein Lydia , Dube Queen , Edmonds Andrew , Chirambo Chawanangwa Mahebere , Smith Emily , Behets Frieda , Heyderman Robert , Van Rie Annelies 
Published: January 2017

Background:
Based on clinical trial results, the World Health Organization recommends infant HIV testing at age 4–6 weeks and immediate antiretroviral therapy (ART) initiation in all HIV-infected infants. Little is known about the outcomes of HIV-infected infants diagnosed with HIV in the first weeks of life in resource-limited settings. We assessed ART initiation and mortality in the first year of life among infants diagnosed with HIV by 12 weeks of age.

Methods:
Cohort of HIV-infected infants in Kinshasa and Blantyre diagnosed before 12 weeks to estimate 12-month cumulative incidences of ART initiation and mortality, accounting for competing risks. Multivariate models were used to estimate associations between infant characteristics and timing of ART initiation.

Results:
One hundred and twenty-one infants were diagnosed at a median age of 7 weeks (interquartile range, 6–8). The cumulative incidence of ART initiation was 46% [95% confidence interval (CI), 36%, 55%] at 6 months and 70% (95% CI 60%, 78%) at 12 months. Only age at HIV diagnosis was associated with ART initiation by age 6 months, with a subdistribution hazard ratio of 0.70 (95% CI 0.52, 0.91) for each week increase in age at DNA polymerase chain reaction test. The 12-month cumulative incidence of mortality was 20% (95% CI 13%, 28%).

Conclusions:
Despite early diagnosis of HIV, ART initiation was slow and mortality remained high, underscoring the complexity in translating clinical trial findings and World Health Organization’s guidance into real-life practice. Novel and creative health system interventions will be required to ensure that all HIV-infected infants achieve optimal treatment outcomes under routine care settings.
HIV-infected Children in Malawi Have Decreased Performance on the 6-minute Walk Test With Preserved Cardiac Mechanics Regardless of Antiretroviral Treatment Status
Authors: Sims Sanyahumbi Amy E. , Hosseinipour Mina C. , Guffey Danielle , Hoffman Irving , Kazembe Peter N. , McCrary Madeline , Minard Charles G. , van der Horst Charles , Sable Craig A. 
Published: January 2017

Aim:
The aims of this study were to 1) determine if cardiac disease can be detected in HIV-infected children by strain imaging and 2) to evaluate differences in exercise performance between HIV-infected children on antiretroviral therapy (ART) and HIV-infected children not yet on ART and in HIV-uninfected children by 6-minute walk tests (6MWTs).

Methods:
This cross-sectional study evaluated cardiac function by echocardiogram and exercise performance by 6MWT in HIV-infected and HIV-uninfected children 4–18 years of age in Lilongwe, Malawi. Analyses compared HIV uninfected, HIV infected not yet on ART, and HIV infected on ART. Comparisons used χ2 test, t test, analysis of variance and multiple linear regression.

Results:
No differences were found in ejection fraction, shortening fraction or strain in 73 children not yet on ART, 149 on ART and 77 HIV-uninfected controls. As viral load increased, children had worse circumferential strain. In addition, children receiving ART had better circumferential strain than those not yet on ART. Increased CD4 percentage was associated with better longitudinal strain and farther 6MWT distance. As longitudinal strain worsened, the 6MWT distance decreased. HIV-infected children not yet on ART walked a mean of 25.8 m less than HIV-uninfected children, and HIV-infected children on ART walked 25.9 m less (P = 0.015 comparing 3 groups).

Conclusions:
HIV-uninfected children performed better on the 6MWT than HIV-infected children. Lower viral load, being on ART, and higher CD4 percentage were associated with better strain measures. Better longitudinal strain was associated with a farther 6MWT distance. Overall, ejection fraction, shortening fraction and strain measures between groups were similar, so cardiac strain did not detect cardiac dysfunction in this young population.
Epigenetic divergence in the TRPA1 promoter correlates with pressure pain thresholds in healthy individuals
Authors: Gombert Sara , Rhein Mathias , Eberhardt Mirjam , Münster Tino , Bleich Stefan , Leffler Andreas , Frieling Helge 
Published: January 2017

Abstract
The expression pattern of important transduction molecules in nociceptive sensory neurons is likely to dictate pain sensitivity. While this notion is well established for increased pain sensitivities under conditions like inflammation and neuropathy, less is known as to which molecules are defining interindividual differences in pain sensitivity in healthy subjects. A genome-wide methylation analysis on monozygotic twins found that methylation of a CpG dinucleotide in the promoter of transient receptor potential ankyrin 1 (TRPA1) is inversely associated with the threshold for heat-induced pain. Several in vitro studies also suggest that TRPA1 mediates mechanical sensitivity of sensory afferents, thus potentially mediating pressure-evoked pain. In the present study, we therefore investigated the epigenetic predisposition for pressure pain by analyzing the methylation status of 47 CpG sites in the promoter region of TRPA1. Using DNA from whole-blood samples of 75 healthy volunteers, we found that the same CpG site previously found to affect the threshold for heat-evoked pain is hypermethylated in subjects with a low threshold for pressure pain. We also found gender differences, with females displaying higher methylation rates combined with higher pressure pain sensitivities as compared with males. In conclusion, our findings support the notion that epigenetic regulation of TRPA1 seems to regulate thermal and mechanical pain sensitivities.
Intense pain influences the cortical processing of visual stimuli projected onto the sensitized skin
Authors: Torta Diana M.E. , Van Den Broeke Emanuel N. , Filbrich Lieve , Jacob Benvenuto , Lambert Julien , Mouraux André 
Published: January 2017

AbstractSensitization is a form of implicit learning produced by the exposure to a harmful stimulus. In humans and other mammals, sensitization after skin injury increases the responsiveness of peripheral nociceptors and enhances the synaptic transmission of nociceptive input in the central nervous system. Here, we show that sensitization-related changes in the central nervous system are not restricted to nociceptive pathways and, instead, also affect other sensory modalities, especially if that modality conveys information relevant for the sensitized body part. Specifically, we show that after sensitizing the forearm using high-frequency electrical stimulation (HFS) of the skin, visual stimuli projected onto the sensitized forearm elicit significantly enhanced brain responses. Whereas mechanical hyperalgesia was present both 20 and 45 minutes after HFS, the enhanced responsiveness to visual stimuli was present only 20 minutes after HFS. Taken together, our results indicate that sensitization involves both nociceptive-specific and multimodal mechanisms, having distinct time courses.