bluuebunny/crossref_metadata_2025_split huggingface dataset:
Middle Meningeal Artery Embolization as Treatment for Chronic Subdural Hematoma: A Case Series
Authors: Link Thomas W , Boddu Srikanth , Marcus Joshua , Rapoport Benjamin I , Lavi Ehud , Knopman Jared 
Published: July 2017

Abstract

BACKGROUND
Traditional treatment for symptomatic subdural hematoma (SDH) has been surgical evacuation, but recurrence rates are high and patients often harbor complex medical comorbidities. Growth and recurrence is thought to be due to the highly friable nature of the vascularized membrane that forms after initial injury. There have been reported cases of middle meningeal artery (MMA) embolization for treatment of recurrent SDH after surgical evacuation with the goal of eliminating the arterial supply to this vascularized membrane.

OBJECTIVE
To present the first known case series of MMA embolization as upfront treatment for symptomatic chronic SDHs that have failed conservative management in lieu of surgical evacuation.

METHODS
Five patients with symptomatic chronic SDHs underwent MMA embolization using PVA microparticles at our institution. Size of SDH was recorded in maximum diameter and total volume.

RESULTS
Four patients underwent unilateral and 1 underwent bilateral MMA embolization successfully. All cases had significant reduction in total volume of SDH at longest follow-up scan: 81.4 to 13.8 cc (7 wk), 48.5 to 8.7 cc (3 wk), 31.7 and 88 to 0 and 17 cc (14 wk, bilateral), 79.3 to 24.2 cc (8 wk), and 53.5 to 0 cc (6 wk). All patients had symptomatic relief with no complications. Histologic analysis of the chronic SDH membrane in a separate patient that required surgery revealed rich neovascularization with many capillaries and few small arterioles.

CONCLUSION
MMA embolization could present a minimally invasive and low-risk initial treatment alternative to surgery for symptomatic chronic SDH when clinically appropriate.
Preparation and Assessment of an Individualized Navigation Template for Lower Cervical Anterior Transpedicular Screw Insertion Using a Three-Dimensional Printing Technique
Authors: Li FengNing , Huang Xuan , Wang Kun , Luo BeiEr , Zhang Fan , Chen Zhi , Li Quan , Zhang YongJin , Qi Ke , Jin ChengChun , Chen WangShenJie , Hou CangLong , Shen HongXing 
Published: July 2017

Study Design.
Prospective trial.

Objective.
To establish an individualized navigation template for safe and accurate insertion of lower cervical anterior transpedicular screw (ATPS) based on a three-dimensional (3D) printing technique.

Summary of Background Data.
Conventional screw insertion manually under fluoroscopy easily leading to deviation of ATPS screw channel, cervical instrumentation procedures demand the need for a precise technique for screw placement.

Methods.
Twenty adult cervical spine specimens (10 men and 10 women, with a mean age of 50.29 ± 6.98) were selected for computed tomography pre- and postoperatively. A 3D lower cervical spine model was reconstructed using Mimics software to measure the screw-related parameters and generate a reverse template with optimal screw channel as well as a prototype using 3D printing. Assisted by the navigation template, bilateral ATPS were inserted into the cadavers.

Results.
The mean outer width and height of pedicle were 5.31 ± 1.23 and 6.78 ± 1.10 mm, respectively. The average length, sagittal, and axial angles of the optimal screw channel obtained through the optimal entry point were 36.34 ± 4.39 mm, 40.67° ± 5.10°, and 93.7° ± 7.96°, respectively. The adjustable safe ranges of sagittal and axial angles were 3.89° ± 1.13° and 5.64° ± 0.97°, respectively. The axial and sagittal accuracies of the 200 screws were 99.5% and 97%, respectively. The average deviations of the actual entry point and the preset opening in the X, Y, and Z axes were 0.39 ± 0.43, 0.21 ± 0.41, and 0.29 ± 0.14 mm, respectively (P > 0.05).

Conclusion.
An individualized ATPS navigation template was developed using Mimics software and 3D printing prototyping, based on computed tomography, for highly accurate screw insertion.

Level of Evidence: 4
Refinement of Nasal Reconstruction with a V/Y-alar-perforator Flap
Authors: Feinendegen Dominik L. , Langer Martin F. , Roldán J. Camilo 
Published: July 2017

Background:
The ala of the nose is vascularized by a dense net of perforators originating from the lateral nasal artery or the angular artery. These vessels reach the ala in a cascade fashion from the alar groove/lateral nasal wall. Based on these vessels, a V/Y flap can be dissected with a wide range of mobility.

Materials and Methods:
Nineteen patients underwent reconstruction of the nose by means of a V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap from the lateral nasal wall and/or from the nasal dorsum for reconstruction of defects at the nasal tip, ala of the nose, and/or lateral nasal wall. All patients were followed up 8 months after surgery in average.

Results:
There was no prolonged congestion or any tissue loss. All patients presented postoperatively with excellent aesthetic results, and no nasal distortion was observed.

Conclusion:
The V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap proved to be a reliable tool in the armamentarium for reconstruction of nasal tip and alar defects providing good aesthetic results.
Partial Breast Reconstruction with Goldilocks Technique After Excision of Giant Fibroadenoma: A Case Report
Authors: Ter Louw Ryan P. , Bruce Sara B. , Nahabedian Maurice Y. 
Published: July 2017

Summary:
Giant juvenile fibroadenomas are relatively rare, accounting for less than 1% fibroadenomas. Large breast tumors create significant asymmetry and provide unique reconstructive challenges after removal. In this case, we describe a 21-year-old female with delayed presentation of a giant fibroadenoma of the right breast. This represents an unusual presentation of benign breast disease requiring reduction of the skin envelope, extensive glandular resection, lower pole reconstruction, and free nipple grafting to achieve symmetry with the opposite breast. A novel modification of the Goldilocks mastectomy technique is described for partial breast reconstruction. Adaptation of the Goldilocks mastectomy technique provides adequate soft tissue for partial breast reconstruction. Using the lower pole deepithelialization breast skin flap provides autologous vascularized tissue to supplement volume loss after tumor and glandular excision. Benign breast disease can create significant breast deformities. Application and combination of the Goldilocks mastectomy technique allow for partial breast reconstruction without the need for an additional donor site or prosthetic devices.
Lymphaticovenous Anastomosis Releases the Lower Extremity Lymphedema-associated Pain
Authors: Mihara Makoto , Hara Hisako , Zhou Han Peng , Tange Shuichi , Kikuchi Kazuki 
Published: July 2017

Background:
We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain.

Methods:
We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded.

Results:
A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of −4.7% in lower extremity lymphedema index after the surgery.

Conclusion:
LVA can release the pain in the affected limbs of lymphedema.
The BREASTrial Stage II: ADM Breast Reconstruction Outcomes from Definitive Reconstruction to 3 Months Postoperative
Authors: Mendenhall Shaun D. , Anderson Layla A. , Ying Jian , Boucher Kenneth M. , Neumayer Leigh A. , Agarwal Jayant P. 
Published: July 2017

Background:
The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a prospective randomized trial comparing outcomes of tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The trial was divided into 3 outcome stages; this study reports stage II outcomes, which are those from the time of definitive reconstruction to 3 months postoperative.

Methods:
A randomized trial was conducted to compare complication rates between AlloDerm and DermaMatrix groups. The impact of matrix type, age, obesity, radiation therapy, chemotherapy, and reconstruction type on complications was analyzed with regression models.

Results:
Of the 128 patients (199 breasts) who were randomly assigned into the trial, 111 patients (173 breasts) were available for analysis in stage II. There was no difference in overall rates of complications (15.4% vs 18.3%, P = 0.8) or implant loss (2.2% vs 3.7%, P = 0.5) between the AlloDerm and DermaMatrix groups, respectively. Obesity was the only significant predictor of complications on regression analysis (odds ratio, 4.31, P = 0.007). Matrix type, age, radiation therapy, chemotherapy, or reconstruction type had no impact on the incidence/severity of complications.

Conclusions:
Acellular dermal matrix (ADM) will likely continue to have a role in breast reconstructive surgery; however, caution should be taken when using ADM because of relatively high complication rates, especially in obese patients. The particular ADM product should be selected based on individual surgeon preference, experience, and success rates. These data and forthcoming long-term outcomes from the Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial will enable surgeons to carefully weigh the risks and benefits of ADM use in breast reconstruction.
Reelevating the Mastectomy Flap: A Safe Technique for Improving Nipple-Areolar Complex Malposition after Nipple-Sparing Mastectomy
Authors: Zhang Shuhao , Blanchet Nadia P. 
Published: July 2017

Summary:
Nipple-areolar complex (NAC) malposition is one of the most common complications following nipple-sparing mastectomy with implant-based reconstruction. To maximize perfusion to the NAC, traditional methods of correcting NAC malposition limit undermining below the NAC. We demonstrate a series of cases in which improvement of NAC malposition was safely performed by reelevating the NAC and mastectomy flap to allow redraping of the soft tissue envelope over the implant and the overlying capsule. Thirty-four patients were identified in a span over 4 years where 44 NACs were repositioned using this method. There was zero incidence of postoperative ischemia or necrosis of the NAC or mastectomy flaps. There was noticeable improvement in the NAC position on the breast mound. Reelevation of the mastectomy skin flap to correct malposition of the NAC after nipple-sparing mastectomy is a safe and effective option, avoids additional scars, and can be performed more than once to further improve positioning of the NAC.
Comparison of 3 Symptom Classification Methods to Standardize the History Component of the HEART Score
Authors: Marchick Michael R. , Setteducato Michael L. , Revenis Jesse J. , Robinson Matthew A. , Weeks Emily C. , Payton Thomas F. , Winchester David E. , Allen Brandon R. 
Published: July 2017

Objectives:
The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac testing.

Methods:
Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively. Each patient’s history component score was calculated using 3 models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed.

Results:
Seven hundred forty nine patients were studied, 58 of which had an abnormal stress test or computed tomography coronary angiography. The mean HEART scores for models 1, 2, and 3 were 2.97 (SD 1.17), 2.57 (SD 1.25), and 3.30 (SD 1.35), respectively, and were significantly different (P < 0.001). However, for each model, the likelihood of an abnormal cardiovascular test did not correlate with higher scores on the symptom component of the HEART score (P = 0.09, 0.41, and 0.86, respectively).

Conclusions:
While the objective scoring models produced different distributions of HEART scores, no model performed well with regards to identifying patients with abnormal advanced cardiac studies in this relatively low-risk cohort. Further studies in a broader cohort of patients, as well as comparison with the performance of subjective history scoring, is warranted before adoption of any of these objective models.
Quality Improvement in Management of Acute Coronary Syndrome: Continuing Medical Education and Peer Coaching Improve Antiplatelet Medication Adherence and Reduce Hospital Readmissions
Authors: Larkin Amy , LaCouture Michael , Geissel Kathleen , Barr Peri , Bates Eric R. , Cannon Christopher P. , Bhatt Deepak L. 
Published: July 2017

Background:
Reducing hospital readmissions and improving patient adherence to antiplatelet medications after an acute coronary syndrome (ACS) event are important goals for improving patient health and decreasing healthcare costs. Nearly half of patients will have a secondary event within 1 year of the initial ACS event. Quality improvement (QI) initiatives that include continuing medical education and peer coaching may improve physician practice patterns and, therefore, patient outcomes.

Methods:
This study evaluated the impact of a QI initiative on antiplatelet (P2Y12 inhibitor) medication adherence (measured via pharmacy fill rates postdischarge) and hospital readmissions.

Results:
Notable physician performance and patient-level changes included significant increases in antiplatelet medication counseling at hospital discharge (30%–57%; P < 0.0001), in P2Y12 inhibitor prescribing at hospital discharge (76%–84%; P = 0.02), and in patient fill rates for branded P2Y12 inhibitors (72%–100%; P = 0.0001). There were numerical trends toward lower rates of ACS-related rehospitalizations at 60 days postdischarge (from 11% to 7%; P = 0.15) and of all-cause rehospitalizations at 60 days (from 20% to 14%; P = 0.10).

Conclusion:
Important in the rapidly evolving landscape of quality healthcare, QI involving continuing medical education and peer coaching demonstrably impacted physician performance and patient outcomes after an ACS event.
Open: Precannulated Fenestrated Endovascular Aneurysm Repair using Guidewire Fixator
Authors: Bosaeus Linus , Mani Kevin , Wanhainen Anders , Liungman Krister 
Published: July 2017

Objective By using a guidewire fixator, the distal guidewire position can be secured in an artery. This new principle enables a method for fenestrated endovascular aortic repair where the connection between the aortic branches and the stent graft fenestrations is made before inserting and deploying the stent graft. Methods This is conducted using a fenestrated stent graft with preloaded catheters, through which the prepositioned and distally secured guidewires from the branches are inserted. Results This report covers the method when implementing a single fenestration stent graft in pig. Conclusions Successful tests with single and dual fenestrated grafts have been conducted in pigs.
Trends in Otitis Media and Myringotomy With Tube Placement Among American Indian and Alaska Native Children and the US General Population of Children After Introduction of the 13-valent Pneumococcal Conjugate Vaccine
Authors: Singleton Rosalyn , Seeman Sara , Grinnell Margaret , Bulkow Lisa , Kokesh John , Emmett Susan , Holve Stephen , McCollum Jeffrey , Hennessy Thomas 
Published: July 2017

Background:
American Indian/Alaska Native (AI/AN) children have experienced higher otitis media (OM) outpatient visit rates than other US children. To understand recent trends, we evaluated AI/AN OM rates before and after 13-valent pneumococcal conjugate vaccine introduction.

Methods:
We analyzed outpatient visits listing OM as a diagnosis among AI/AN children <5 years of age from the Indian Health Service National Patient Information Reporting System for 2010–2013. OM outpatient visits for the general US child population <5 years of age were analyzed using the National Ambulatory Medical Care and National Hospital Ambulatory Care Surveys for 2010–2011.

Results:
The 2010–2011 OM-associated outpatient visit rate for AI/AN children (63.5 per 100/year) was similar to 2010–2011 rate for same-age children in the general US population (62.8) and decreased from the 2003 to 2005 AI/AN rate (91.4). Further decline in AI/AN OM visit rates was seen for 2010–2011 to 2012–2013 (P < 0.0001). The AI/AN infant OM visit rate (130.5) was 1.6-fold higher than the US infant population. For 2010–2011, the highest AI/AN OM visit rate for <5 year olds was from Alaska (135.0).

Conclusions:
AI/AN <5-year-old OM visits declined by one third from 2003–2005 to 2010–2011 to a rate similar to the US general population <5 years. However, the AI/AN infant OM rate remained higher than the US infant population. The highest AI/AN <5-year-old OM rate occurred in Alaska.
The Influence of Heavier Football Helmet Faceguards on Head Impact Location and Severity
Authors: Schmidt Julianne D. , Phan Tracy T. , Courson Ron W. , Reifsteck Fred , Merritt Eric D. , Brown Cathleen N. 
Published: July 2017

Objective:
To determine whether players with heavier faceguards have increased odds of sustaining top of the head impacts and head impacts of higher severity.

Design:
Cohort study.

Setting:
On-field.

Participants:
Thirty-five division I collegiate football players.

Interventions:
Faceguard mass was measured. Head impact location and severity (linear acceleration [gravity], rotational acceleration [radian per square second], and Head Impact Technology severity profile [unitless]) were captured for 19 379 total head impacts at practices using the Head Impact Telemetry System.

Main Outcome Measures:
Players' faceguards were categorized as either heavier (>480 g) or lighter (≤480 g) using a median split. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for sustaining top of the head impacts between faceguard groups using a random intercepts generalized logit model. We compared head impact severity between groups using random intercepts general linear models (α = 0.05). Player position was included in all models.

Results:
Overall, the 4 head impact locations were equally distributed across faceguard groups (F
(3,26) = 2.16, P = 0.117). Football players with heavier faceguards sustained a higher proportion impacts to the top of the head (24.7% vs 17.5%) and had slightly increased odds of sustaining top (OR, 1.72; 95% CI, 1.01-2.94) head impacts rather than front of the head impacts.

Conclusions:
Football players wearing heavier faceguards might be slightly more prone to sustaining a higher proportion of top of the head impacts, suggesting that greater faceguard mass may make players more likely to lower their head before collision. Individuals involved with equipment selection should consider the potential influence of faceguard design on head impact biomechanics when recommending the use of a heavier faceguard.
Near Point of Convergence and Gait Deficits in Adolescents After Sport-Related Concussion
Authors: Howell David R. , O'Brien Michael J. , Raghuram Aparna , Shah Ankoor S. , Meehan William P. 
Published: July 2017

Objective:
To prospectively examine gait characteristics of participants acutely after concussion with and without receded near point of convergence (NPC), compared with healthy controls.

Design:
Cross-sectional study.

Setting:
Sports-medicine clinic.

Participants:
Patients examined after concussion (n = 33; mean ± SD = 7.2 ± 3.1 days) and a group of uninjured athletes (n = 31) completed a Postconcussion Symptom Scale, underwent NPC testing, and single/dual-task gait assessments.

Independent Variables:
Near point of convergence was defined as the patient-reported diplopia distance when a fixation target moved toward the nose. Receded NPC was defined as a distance >5 cm from the tip of the nose.

Main Outcome Measures:
Spatiotemporal gait characteristics in single-task and dual-task conditions were evaluated with analysis of variance; correlations were calculated between NPC and gait measures.

Results:
Eighteen of 33 (55%) patients with concussion presented with receded NPC. Those with receded NPC exhibited slower gait speed (single-task = 1.06 ± 0.14 m/s vs 1.19 ± 0.15 m/s; dual-task = 0.80 ± 0.13 m/s vs 0.94 ± 0.13 m/s; P = 0.003) and shorter stride lengths (single-task = 1.11 ± 0.10 m vs 1.24 ± 0.11 m; dual-task = 0.97 ± 0.11 m vs 1.09 ± 0.11 m; P = 0.001) than healthy controls. Near point of convergence was moderately correlated with dual-task average walking speed for the normal NPC group (ρ = −0.56; P = 0.05). Postconcussion Symptom Scale scores did not significantly differ between groups (27 ± 18 vs 28 ± 16).

Conclusions:
After concussion, adolescents with receded NPC exhibited significant gait-related deficits compared with healthy controls, whereas those with normal NPC did not. Vergence and gross motor system dysfunction may be associated after concussion. Gait and vergence measures may contribute useful information to postconcussion evaluations.
Short Sleep and Adolescents' Performance on a Concussion Assessment Battery: An Experimental Sleep Manipulation Study
Authors: Beebe Dean W. , Powers Scott W. , Slattery Eric W. , Gubanich Paul J. 
Published: July 2017

Objective:
Correlational studies have linked short sleep to adolescents' report of postconcussion symptoms and cognitive performance during concussion assessments. This study tested whether those are cause–effect relationships.

Design:
Three-week randomly counterbalanced, within-subjects, crossover experiment.

Setting:
Adolescents slept at home with weekly visits to an outpatient clinic for sleep monitor uploads and outcome assessments.

Participants:
Twenty-four healthy 14- to 17.9-year-olds.

Conditions:
After an initial sleep-stabilization period, adolescents experienced 5-night spans of short sleep (SS; 6.5 hours/night in bed) versus Healthy Sleep Opportunity (HS; 9.5 hours/night in bed).

Main Outcome Measures:
Cognitive indexes and the postconcussion symptom scale (PCSS) from the Immediate PostConcussion Assessment and Cognitive Testing.

Results:
Adolescents reported significantly worse symptoms on the PCSS after SS than HS, even after excluding items manifestly related to sleep. Verbal memory was also worse after SS than HS, though the effect was small. The manipulation did not significantly affect other cognitive indexes.

Conclusions:
A realistic “dose” of short sleep, similar to what many adolescents experience regularly on school nights, can cause or contribute to symptom reports during concussion assessments. Consistent with previous sleep research, one-on-one cognitive tests seem to be less sensitive than measures of emotional and behavioral functioning to the effects of short sleep.