bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial*
Authors: Okonkwo David O. , Shutter Lori A. , Moore Carol , Temkin Nancy R. , Puccio Ava M. , Madden Christopher J. , Andaluz Norberto , Chesnut Randall M. , Bullock M. Ross , Grant Gerald A. , McGregor John , Weaver Michael , Jallo Jack , LeRoux Peter D. , Moberg Dick , Barber Jason , Lazaridis Christos , Diaz-Arrastia Ramon R. 
Published: October 2017

Objectives:
A relationship between reduced brain tissue oxygenation and poor outcome following severe traumatic brain injury has been reported in observational studies. We designed a Phase II trial to assess whether a neurocritical care management protocol could improve brain tissue oxygenation levels in patients with severe traumatic brain injury and the feasibility of a Phase III efficacy study.

Design:
Randomized prospective clinical trial.

Setting:
Ten ICUs in the United States.

Patients:
One hundred nineteen severe traumatic brain injury patients.

Interventions:
Patients were randomized to treatment protocol based on intracranial pressure plus brain tissue oxygenation monitoring versus intracranial pressure monitoring alone. Brain tissue oxygenation data were recorded in the intracranial pressure –only group in blinded fashion. Tiered interventions in each arm were specified and impact on intracranial pressure and brain tissue oxygenation measured. Monitors were removed if values were normal for 48 hours consecutively, or after 5 days. Outcome was measured at 6 months using the Glasgow Outcome Scale–Extended.

Measurements and Main Results:
A management protocol based on brain tissue oxygenation and intracranial pressure monitoring reduced the proportion of time with brain tissue hypoxia after severe traumatic brain injury (0.45 in intracranial pressure–only group and 0.16 in intracranial pressure plus brain tissue oxygenation group; p < 0.0001). Intracranial pressure control was similar in both groups. Safety and feasibility of the tiered treatment protocol were confirmed. There were no procedure-related complications. Treatment of secondary injury after severe traumatic brain injury based on brain tissue oxygenation and intracranial pressure values was consistent with reduced mortality and increased proportions of patients with good recovery compared with intracranial pressure–only management; however, the study was not powered for clinical efficacy.

Conclusions:
Management of severe traumatic brain injury informed by multimodal intracranial pressure and brain tissue oxygenation monitoring reduced brain tissue hypoxia with a trend toward lower mortality and more favorable outcomes than intracranial pressure–only treatment. A Phase III randomized trial to assess impact on neurologic outcome of intracranial pressure plus brain tissue oxygenation–directed treatment of severe traumatic brain injury is warranted.
Blood Perfusion in Human Eyelid Skin Flaps Examined by Laser Speckle Contrast Imaging—Importance of Flap Length and the Use of Diathermy
Authors: Nguyen Cu Dinh , Hult Jenny , Sheikh Rafi , Tenland Kajsa , Dahlstrand Ulf , Lindstedt Sandra , Malmsjö Malin 
Published: October 2017

Purpose:
It is well known that blood perfusion is important for the survival of skin flaps. As no study has been conducted to investigate how the blood perfusion in human eyelid skin flaps is affected by the flap length and diathermy, the present study was carried out to investigate these in patients.

Methods:
Fifteen upper eyelids were dissected as part of a blepharoplastic procedure, releasing a 30-mm long piece of skin, while allowing the 5 mm wide distal part of the skin to remain attached, to mimic a skin flap (hereafter called a “skin flap”). Blood perfusion was measured before and after repeated diathermy, using laser speckle contrast imaging.

Results:
Blood perfusion decreased from the base to the tip of the flap: 5 mm from the base, the perfusion was 69%, at 10 mm it was 40%, at 15 mm it was 20%, and at 20 mm it was only 13% of baseline values. Diathermy further decreased blood perfusion (measured 15 mm from the base) to 13% after applying diathermy for the first time, to 6% after the second and to 4% after the third applications of diathermy.

Conclusions:
Blood perfusion falls rapidly with distance from the base of skin flaps on the human eyelid, and diathermy reduces blood perfusion even further. Clinically, it may be advised that flaps with a width of 5 mm be no longer than 15 mm (i.e., a width:length ratio of 1:3), and that the use of diathermy should be carefully considered.
In-Office Sutureless Correction of Prolapsed Subconjunctival Orbital Fat
Authors: Raparia Eva , Rafailov Leon , Shinder Roman 
Published: October 2017

Purpose:
To describe a minimally invasive, sutureless, small incision surgical technique for the treatment of subconjunctival orbital fat prolapse (SOFP) performed using local anesthesia in an office setting.

Methods:
Retrospective study of the surgical outcome of 45 patients with either bilateral or unilateral SOFP treated by a single surgeon (R.S.) between July 2010 and February 2015.

Results:
Forty-five patients (39 male, 6 female) had a mean age of 67 years. Fat prolapse was bilateral in 23 patients (51%). A total of 68 eyes were operated on. All surgeries were without any intra- or postoperative complications such as infection, dry-eye symptoms, ocular motility impairment, or recurrence with a mean follow up of 37 months. All patients had a favorable postoperative cosmetic improvement.

Conclusions:
The authors propose an office-based, cost-effective, minimally invasive, sutureless technique for treating SOFP with local anesthesia in a safe and effective manner. The lack of complications or recurrence with an adequate follow-up period following this technique is encouraging. Surgeons should consider this technique in the surgical correction of SOFP.
Long-Term Safety of Using Local Anesthetic Injections in Professional Rugby League for Modified Indications
Authors: Sebak Safaa , Orchard John W. , Golding Leigh D. , Steet Elizabeth , Brennan Steph A. , Ibrahim Ameer 
Published: October 2017

Objective:
To assess and evaluate the long-term safety of local anesthetic injections before or during games in professional rugby league players.

Design:
Retrospective case series.

Setting:
Professional rugby league team.

Participants:
Sydney Roosters players over a 6-year period (2008-2013), who had been administered a local anesthetic injection for an injury before or during a match to aid return to play.

Interventions:
Follow-up survey (no active intervention).

Main Outcome Measures:
Player self-reported satisfaction. Survey results were compared with a previous cohort who had received local anesthetic injection from 1998 to 2007.

Results:
Thirty-two players who had been injected with local anesthetic on 249 occasions for 81 injuries completed the current survey at an average of 5.64 years postinjection. In the cohort of 2008 to 2013, fewer injections were performed to areas deemed higher risk compared with the 1998 to 2007 cohort (P < 0.00002). The vast majority of players (80/81 cases) would repeat the injection in the same circumstances and reported that ongoing side effects were uncommon. There were 6 cases (8%) in which players reported significant ongoing pain in the area of injection at long-term follow-up.

Conclusions:
This study affirmed the long-term safety of injections in most cases.

Level of Evidence:
IV.
Acute kidney injury in trauma patients
Authors: Harrois Anatole , Libert Nicolas , Duranteau Jacques 
Published: October 2017

Purpose of review
To review epidemiology and pathophysiology of acute kidney injury (AKI) in trauma patients and propose strategies that aim at preventing AKI after trauma.

Recent findings
AKI in trauma patients has been reported to be as frequent as 50% with an association to a prolonged length of stay and a raise in mortality. Among the specific risk factors encountered in trauma patients, hemorrhagic shock, rhabdomyolysis severity, age, and comorbidities are independently associated with AKI occurrence. Resuscitation with balanced solutes seems to have beneficial effects on renal outcome compared with NaCl 0.9%, particularly in the context of rhabdomyolysis. However, randomized clinical studies are needed to confirm this signal. Abdominal compartment syndrome (ACS) is rare but has to be diagnosed to initiate a dedicated therapy.

Summary
The high incidence of AKI in trauma patients should lead to early identification of those at risk of AKI to establish a resuscitation strategy that aims at preventing AKI.
Damage control surgery: current state and future directions
Authors: Benz Daniel , Balogh Zsolt J. 
Published: October 2017

Purpose of review
Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts.

Recent findings
Recent efforts have attempted to synthesize evidence-based indication to guide clinical practice. Significant progress in trauma-based resuscitation techniques has led to improved outcomes in injured patients and a reduction in the requirement of DCS techniques.

Summary
DCS remains an important treatment strategy in the management of specific patient cohorts. Continued developments in early trauma care will likely result in a further decline in the required use of DCS in severely injured patients.
Rotational therapy in thoracic injuries: what is the evidence?
Authors: Störmann Philipp , Marzi Ingo , Wutzler Sebastian 
Published: October 2017

Purpose of review
To review the current use of continuous lateral rotational therapy (CLRT) in patients with thoracic injuries and its impact on clinical course, complications and outcome.

Recent findings
Patient positioning is a key factor in the treatment of severe thoracic injuries and CLRT, and intermittent supine and prone position are basic options. There is a lack of randomized controlled studies for trauma patients with chest injury undergoing kinetic therapy as standard of care. A positive effect of kinetic therapy for prevention of secondary respiratory complications has been reported; nevertheless, no positive effect on mortality or length of hospital stay could be affirmed so far. In general, standardized therapeutic regimes for treatment of chest trauma have been implemented, including ventilator settings and positioning therapy. However, the available data do not allow a clear recommendation for rotational/kinetic therapy or prone positioning as superior or inferior.

Summary
The benefit of changing the patients’ position for secret mobilization and recruitment of atelectasis after chest trauma and therefore preventing secondary complications seems to be self-evident. Since only few studies report about the utility of CLRT in critically ill chest trauma patients, randomized controlled multicenter trials are necessary to analyze the overall benefit of such means.
High Baseline Anal Human Papillomavirus and Abnormal Anal Cytology in a Phase 3 Trial of the Quadrivalent Human Papillomavirus Vaccine in Human Immunodeficiency Virus–Infected Individuals Older Than 26 Years: ACTG 5298
Authors: Cranston Ross D. , Cespedes Michelle S. , Paczuski Pawel , Yang Ming , Coombs Robert W. , Dragavon Joan , Saah Alfred , Godfrey Catherine , Webster-Cyriaque Jennifer Y. , Chiao Elizabeth Y. , Bastow Barbara , Wilkin Timothy 
Published: October 2017

Background
The quadrivalent human papillomavirus (HPV) vaccine (qHPV; types 6, 11, 16, 18) is indicated for men and women aged 9 to 26 years to prevent HPV associated anogenital high-grade squamous intraepithelial lesions (HSIL) and cancer. ACTG 5298 was a randomized placebo controlled Phase 3 study in human immunodeficiency virus (HIV)-infected men who have sex with men, and women of qHPV to prevent persistent anal HPV infection. Baseline data are presented here.

Methods
Human immunodeficiency virus–infected men who have sex with men, and women 27 years or older without previous anogenital or oral cancer were enrolled. Baseline anal cytology, high-resolution anoscopy and collection of anal, oral, and vaginal specimens for HPV genotyping were performed and acceptability assessed.

Results
Five hundred seventy-five (575) participants were enrolled (82% men and 18% women). Median age was 47 years. Race/ethnicity was 46% white, 31% black, and 20% Hispanic. Plasma HIV-1 RNA was less than 50 copies/mL in 83% and median CD4 T count was 602 cells/μL. Abnormal anal cytology was detected in 62%, with corresponding HSIL on biopsy (bHSIL) in 33%. Anal HPV 6, 11, 16, and 18 were detected in 25%, 13%, 32%, and 18% of the participants, respectively. Prevalence of 0, 1, 2, 3, and 4 qHPV types was 40%, 38%, 17%, 4%, and 1%, respectively. Oral infection with 1 or more qHPV type was detected in 10% of the participants. Study procedures were generally acceptable.

Conclusions
At study baseline, there was a high prevalence of abnormal anal cytology, bHSIL, and HPV infection. Sixty percent of the participants had anal infection with preventable qHPV types.
Effect of Scattering and Aberrations on Visual Acuity for Band Keratopathy
Authors: Kamiya Kazutaka , Kobashi Hidenaga , Takahashi Masahide , Shoji Nobuyuki , Shimizu Kimiya 
Published: October 2017

SIGNIFICANCE
The progressive accumulation of the calcification may deteriorate corneal transparency, especially in the interpalpebral area, and subsequent visual performance for patients with band keratopathy. However, the detailed quantitative analysis of light scattering or higher-order aberrations on visual performance for these patients so far has not been elucidated.

PURPOSE
The aim of this study was to assess the relationship of intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations with visual acuity in eyes with band keratopathy.

METHODS
This prospective study comprised 27 eyes of 27 consecutive patients who were diagnosed as having band keratopathy and age-matched 27 eyes of 27 healthy subjects. We quantitatively assessed objective scattering index using the double-pass instrument (Optical Quality Analysis System II; Visiometrics, Terrassa, Spain), corneal densitometry using the Scheimpflug rotating camera (Pentacam HR; Oculus, Wetzlar, Germany), and corneal higher-order aberrations using the Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan).

RESULTS
The mean objective scattering index, corneal densitometry, corneal higher-order aberrations, and logarithm of the minimal angle of resolution (logMAR) visual acuity in eyes with band keratopathy were 5.14 ± 3.11, 36.42 ± 10.55 gray-scale units, 0.33 ± 0.10 μm, and 0.03 ± 0.11 logMAR, respectively. These parameters were significantly larger in the band keratopathy group than in those in the control group (Mann-Whitney U test, P < .001). We found significant correlations of visual acuity with the objective scattering index (Spearman correlation coefficient, r = 0.465, P = .015), but no significant association with the corneal densitometry (r = 0.082, P = .683) or with corneal higher-order aberrations (r = −0.073, P = .718), in eyes having band keratopathy.

CONCLUSIONS
Intraocular forward scattering, corneal backward scattering, and corneal higher-order aberrations in eyes with band keratopathy were significantly higher than those in normal eyes. Visual acuity was significantly correlated with intraocular forward scattering, but not with corneal backward scattering or corneal aberrations in the band keratopathy group, suggesting that intraocular forward scattering plays a vital role in visual performance in eyes with band keratopathy.
Randomized Trial of Desktop Humidifier for Dry Eye Relief in Computer Users
Authors: Wang Michael T. M. , Chan Evon , Ea Linda , Kam Clifford , Lu Yvonne , Misra Stuti L. , Craig Jennifer P. 
Published: October 2017

SIGNIFICANCE
Dry eye is a frequently reported problem among computer users. Low relative humidity environments are recognized to exacerbate signs and symptoms of dry eye, yet are common in offices of computer operators. Desktop USB-powered humidifiers are available commercially, but their efficacy for dry eye relief has not been established.

PURPOSE
This study aims to evaluate the potential for a desktop USB-powered humidifier to improve tear-film parameters, ocular surface characteristics, and subjective comfort of computer users.

METHODS
Forty-four computer users were enrolled in a prospective, masked, randomized crossover study. On separate days, participants were randomized to 1 hour of continuous computer use, with and without exposure to a desktop humidifier. Lipid-layer grade, noninvasive tear-film breakup time, and tear meniscus height were measured before and after computer use. Following the 1-hour period, participants reported whether ocular comfort was greater, equal, or lesser than that at baseline.

RESULTS
The desktop humidifier effected a relative difference in humidity between the two environments of +5.4 ± 5.0% (P < .001). Participants demonstrated no significant differences in lipid-layer grade and tear meniscus height between the two environments (all P > .05). However, a relative increase in the median noninvasive tear-film breakup time of +4.0 seconds was observed in the humidified environment (P < .001), which was associated with a higher proportion of subjects reporting greater comfort relative to baseline (36% vs. 5%, P < .001).

CONCLUSIONS
Even with a modest increase in relative humidity locally, the desktop humidifier shows potential to improve tear-film stability and subjective comfort during computer use.
Trial registration no: ACTRN12617000326392.
The Fate of the Adipose-Derived Stromal Cells during Angiogenesis and Adipogenesis after Cell-Assisted Lipotransfer
Authors: Hong Ki Yong , Yim Sangjun , Kim Hyun Jung , Jin Ung Sik , Lim SooA , Eo SuRak , Chang Hak , Minn Kyung Won 
Published: October 2017

Background:
Cell-assisted lipotransfer is a process in which fat grafting is supplemented with autologous adipose-derived stromal cells. Since the efficacy of the technique was demonstrated, studies have focused on the mechanism by which cell-assisted lipotransfer enhances the rate of graft survival. However, the microenvironmental changes in donor and recipient tissue associated with cell-assisted lipotransfer remain unclear.

Methods:
The authors introduced an animal model of cell-assisted lipotransfer using two different transgenic reporter mice. Donor fat from green fluorescent protein–expressing C57BL/6J mice and donor adipose-derived stromal cells from DsRed-expressing C57BL/6J mice were co-transplanted into recipient C57BL/6J mice. During adipose remodeling after cell-assisted lipotransfer, the fate of each donor adipocyte and donor adipose-derived stromal cell was traced using immunofluorescent staining with the whole-mount method.

Results:
Adipose-derived stromal cell supplementation altered inflammation and promoted angiogenesis and subsequent revascularization in recipient tissue. Tracing at postoperative week 4 revealed that surviving donor adipose-derived stromal cells participated in angiogenesis by differentiating into endothelial cells. Moreover, newly differentiated fat from donor adipose-derived stromal cells and recipient tissue integrated with surviving donor fat, leading to improved retention of the graft. Adipose-derived stromal cell supplementation resulted in a quantitative difference in angiogenesis and adipogenesis during adipose remodeling according to the concentration of adipose-derived stromal cells.

Conclusions:
The authors characterized the dynamic changes occurring in donor adipose-derived stromal cells and fat and recipient tissue by tracing these cellular components following cell-assisted lipotransfer. The authors’ findings highlight the therapeutic value of cell-assisted lipotransfer in tissue transplantation.
Appropriateness of the Use of Magnetic Resonance Imaging in the Diagnosis and Treatment of Wrist Soft Tissue Injury
Authors: Michelotti Brett F. , Mathews Alexandra , Chung Kevin C. 
Published: October 2017

Background:
When diagnosing wrist soft tissue injury, the authors hypothesize that magnetic resonance imaging is used injudiciously and is associated with unnecessary cost.

Methods:
A retrospective review was conducted of patients aged 20 to 60 years who underwent magnetic resonance imaging for possible wrist soft tissue injury at a tertiary care center between 2009 and 2014. Treatment recommendation was classified as nonoperative, operative, or equivocal. If the magnetic resonance imaging–directed treatment recommendation differed from the pre-imaging recommendation, it was noted that the imaging influenced patient care (impact study). The cost estimate of an impact study was calculated by dividing the total studies performed by the number of studies that impacted the treatment recommendation and multiplying this value by the institutional wrist magnetic resonance imaging cost ($2246 in 2016).

Results:
One hundred forty patients were included. Magnetic resonance imaging affected treatment recommendation in 28 percent of patients. Independent predictors of impact on treatment recommendation were “question specific injury” (OR, 9.46; 95 percent CI, 3.18 to 28.16; p < 0.001) and “question scapholunate injury” (OR, 2.88; 95 percent CI, 1.21 to 6.88; p = 0.02). The only independent predictor of surgery was ordering physician (hand surgeon) (OR, 3.69; 95 percent CI, 1.34 to 10.13; p = 0.01). The cost of an impact study ordered by a non–hand surgeon versus a hand surgeon was $13,359 versus $6491, respectively.

Conclusions:
The provider must carefully consider the pretest probability of ordering a study that will affect treatment recommendation. Injudicious screening with magnetic resonance imaging ($15,565) incurred a cost nearly seven times the cost of the one imaging scan ($2246) before impacting one treatment recommendation. In the current era of cost containment and bundled payment, diagnostic test probability must be appreciated to guide physician ordering practices.
A Comparison of Functional Outcomes and Therapeutic Costs: Single-Digit Replantation versus Revision Amputation
Authors: Zhu Hongyi , Bao Bingbo , Zheng Xianyou 
Published: October 2017

Background:
The functional outcomes and therapeutic costs between digit replantation and revision amputation have remained controversial.

Methods:
A total of 1023 patients with single-digit traumatic amputation or devascularization who underwent successful digit replantation (failure excluded) or revision amputation from January 1, 2013, to January 1, 2016, were included in this study. All cases were subgrouped based on Tamai level of amputation and the injured digit. The clinical outcomes were assessed using the Michigan Hand Outcomes Questionnaire 1 year after the initial operation. The authors also compared the cost of treatment, the duration of hospitalization, and the duration of sick leave between the two treatments.

Results:
Replantation of small (level I to V), ring (level I to III), and long (level I) fingers showed no functional benefit compared with initial revision amputation. In contrast, replantation of thumb (level I to V), index (level I to V), long (level II to V), and ring (level IV to V) fingers had better outcomes. The cost of replantation was higher and the durations of hospitalization and sick leave of replantation were also longer compared with the revision amputation group.

Conclusions:
Single amputated injuries of small (level I to V), ring (level I to III), and long (level I) fingers are a relative contradiction for replantation. Replantation of thumb (level I to V), index (level I to V), long (level II to V), and ring (level IV to V) fingers showed extra benefit compared with revision amputation.