bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Factors Associated With Presentation Change of the Second Twin After Vaginal Delivery of the First Twin
Authors: Panelli Danielle M. , Easter Sarah Rae , Bibbo Carolina , Robinson Julian N. , Carusi Daniela A. 
Published: October 2017

OBJECTIVE:
To identify clinical factors associated with a change from vertex to nonvertex presentation in the second twin after vaginal birth of the first.

METHODS:
We assembled a retrospective cohort of women with viable vertex–vertex twin pregnancies who delivered the presenting twin vaginally. Women whose second twin changed from vertex to nonvertex after vaginal birth of the first were classified as experiencing an intrapartum change in presentation. Characteristics associated with intrapartum presentation change in a univariate analysis with a P value ≤.10 were then evaluated in a multivariate logistic regression model.

RESULTS:
Four-hundred fifty women met inclusion criteria, of whom 55 (12%) had intrapartum presentation change of the second twin. Women experiencing intrapartum presentation change were more likely to be multiparous (69% compared with 47%, P<.01) and to have had a change in the presentation of the second twin between the most recent antepartum ultrasonogram and the ultrasonogram done on admission to labor and delivery (11% compared with 4%, P=.04). In an adjusted analysis, multiparity and gestational age less than 34 weeks were significantly associated with presentation change (adjusted odds ratio [OR] 2.9, 95% CI 1.5–5.6 and adjusted OR 2.6, 95% CI 1.1–5.9, respectively). Women with intrapartum presentation change were more likely to undergo cesarean delivery for their second twin (44% compared with 7%, P<.01) with an adjusted OR of 10.50 (95% CI 5.20–21.20) compared with those with stable intrapartum presentation. Twenty of the 24 (83%) cesarean deliveries performed in the intrapartum presentation change group were done for issues related to malpresentation.

CONCLUSION:
Multiparity and gestational age less than 34 weeks are associated with intrapartum presentation change of the second twin.
Comparative Effectiveness of Uterine Leiomyoma Procedures Using a Large Insurance Claims Database
Authors: Borah Bijan J. , Yao Xiaoxi , Laughlin-Tommaso Shannon K. , Heien Herbert C. , Stewart Elizabeth A. 
Published: October 2017

OBJECTIVE:
To compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery.

METHODS:
This was a retrospective analysis of administrative claims from a large U.S. commercial insurance database. Women aged 18–54 years undergoing any of the previously mentioned leiomyoma procedures between 2000 and 2013 were included. We assessed the following outcome measures: risk of reintervention between uterine-sparing procedures, risk of other surgical procedures or complications of the index procedure, 5-year health care utilization, pregnancy rates, and reproductive outcomes. Propensity score matching along with Cox proportional hazard models were used to adjust for differences in baseline characteristics between study cohorts.

RESULTS:
Among the 135,522 study-eligible women with mean follow-up of 3.4 years, hysterectomy was the most common first-line procedural therapy (111,324 [82.2%]) followed by myomectomy (19,965 [14.7%]), uterine artery embolization (4,186 [3.1%]) and magnetic resonance-guided focused ultrasound surgery (47 [0.0003%]). Small but statistically significant differences were noted for uterine artery embolization and myomectomy in reintervention rate (17.1% compared with 15.0%, P=.02), subsequent hysterectomy rates (13.2% compared with 11.1%, P<.01) and subsequent complications from index procedures (18.1% compared with 24.6%, P<.001). During follow-up, women undergoing myomectomy had lower leiomyoma-related health care utilization, but had higher all-cause outpatient services. Pregnancy rates were 7.5% and 2.2% among myomectomy and uterine artery embolization cohorts, respectively (P<.001) with both cohorts having similar rates of adverse reproductive outcome (69.4%).

CONCLUSIONS:
Although the overwhelming majority of women having leiomyoma with bulk symptoms underwent hysterectomy as their first treatment procedure, among those undergoing uterine-sparing index procedures, approximately one seventh had a reintervention, and one tenth ended up undergoing hysterectomy during follow-up. Compared with women undergoing myomectomy, women undergoing uterine artery embolization had a higher risk of reintervention, lower risk of subsequent complications, but similar rate of adverse reproductive outcomes.
Functional Outcomes Following Operative Treatment of Tibial Tubercle Fractures
Authors: Riccio Anthony I. , Tulchin-Francis Kirsten , Hogue Grant D. , Wimberly Robert L. , Gill Corey S. , Collins DeRaan , Karol Lori A. 
Published: October 2017

Background:
Quantitative evaluation of the functional results of surgically managed tibial tubercle fractures in adolescents is unreported in the orthopaedic literature.

Methods:
All patients treated surgically for unilateral tibial tubercle fractures at a single institution from 2007 to 2011 were invited to return for functional evaluation. Fractures were classified using the Ogden classification system. Clinical examination at follow-up included passive knee range of motion and thigh circumference. Side-to-side knee extension strength deficits were evaluated using a Biodex dynamometer. Patient-reported outcomes were assessed using the Pediatric-International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC), Tegner-Lysholm Knee Scoring Scale, and Visual Analog Pain Scale. Chart review was performed to determine postoperative protocols including the use of physical therapy and protected weight bearing. Functional parameters were compared between the involved and uninvolved extremities using the Wilcoxon Signed Ranks Test and the Spearman correlations were performed to identify any relationships between perioperative factors, functional parameters, and subjective outcomes.

Results:
In total, 19 of 42 patients completed clinical and functional testing and 18 of 19 completed all outcome surveys. Average age at injury was 13.9 years and average follow-up was 3.0 years. There was no statistical difference in knee range of motion between sides, however, thigh circumference was slightly smaller in the injured extremity (median difference, 1.7 cm at 15 cm above the patella and 4.0 cm at 50% of the length of the thigh). In total 5/19 subjects (26%) had a significant quadriceps extension strength deficit on the involved leg compared with the contralateral side. The median Visual Analog Pain Scale for affected limbs was 8/100 and for unaffected limbs was 6/100 (P=0.017). The Tegner-Lysholm Scale revealed 9 excellent results, 5 good, 4 fair, and 1 poor (median, 90/100). Results of the Pedi-IKDC were 11 excellent, 3 good, 2 fair, and 3 poor results (median, 91/100). Outcome scores did not correlate to diminished strength or thigh circumference. No difference in outcome based upon body mass index, postoperative weight-bearing status, Ogden classification, or postoperative physical therapy was noted using regression analysis.

Conclusions:
Despite promising objective results, clinical outcomes measured by subjective validated surveys are not all excellent.

Level of Evidence:
Level III.
Recommencement of Denosumab for Unresectable Giant Cell Tumor of the Cervical Spine
Authors: Law Gin Way , Yeo Nicholas Eng Meng , Howe Tet Sen , Tan Yuan Zi , Tan Seang Beng , Siddiqui Mohammad Mashfiqul Arafin 
Published: October 2017

Study Design.
A case report.

Objective.
The aim of this study was to highlight that rapid progression or recurrence of giant cell tumor of the bone (GCTB) can still occur with cessation of Denosumab in the management of unresectable GCTB even in cases with prior demonstration of excellent response to treatment and stable disease over a protracted length of surveillance despite dose reduction. The close proximity of unresectable GCTB to vital structures makes it prudent that we monitor these patients closely given its locally aggressive nature.

Summary of Background Data.
Cervical spine GCTB is extremely rare. Unresectable GCTB has historically been a challenge to treat due to the lack of prospective, randomized clinical trials to guide treatment. Radiotherapy has fallen out of favor due to the risk of malignant transformation, especially as most GCTB patients are young.
In recent years, improved understanding of the receptor activator of nuclear factor-κB ligand (RANKL) in the pathophysiology of GCTB has led to the use of Denosumab in patients with recurrent/unresectable/metastatic GCTB and in patients whom surgical resection carries a high morbidity. To date, the optimal dosage and duration of therapy in the treatment of GCTB is unknown.

Methods.
We report a case of cervical spine GCTB in a 53-year-old male with positive surgical margins managed with Denosumab.

Results.
This is the first reported case of a cervical spine GCTB managed with Denosumab showing excellent response to treatment, recurrence of disease post cessation of Denosumab despite earlier satisfactory disease control and stabilization achieved even with dose reduction, and again an excellent response with recommencement of the drug.

Conclusion.
Denosumab is an excellent option in patients with unresectable GCTB or when surgery will result in excessive morbidity. However, further studies are required to determine optimal dosing, treatment duration, side effect profile, and whether Denosumab is truly able to achieve partial or complete disease remission in the long run.

Level of Evidence: 4
Epidemiology and Outcomes of Infectious Spondylodiscitis in Hemodialysis Patients
Authors: Lu Yueh-An , Sun Wei-Chiao , Kuo George , Chen Chao-Yu , Kao Huang-Kai , Lin YuJr , Lee Chia-Hui , Hung Cheng-Chieh , Tian Ya-Chung , Ko Yu-Shien , Hsu Hsiang-Hao 
Published: October 2017

Study Design.
A retrospective study of patients who were hospitalized for infectious spondylodiscitis over a 13-year period.

Objective.
To elucidate the epidemiology and prognostic factors of infectious spondylodiscitis in hemodialysis (HD) patients and to identify the impact of HD on infectious spondylodiscitis.

Summary of Background Data.
Only a few case studies of infectious spondylodiscitis in HD patients can be found in the literature. Reports of prognostic factors are limited and patients’ outcomes have not been well described.

Methods.
The cases of 1402 patients who were hospitalized for infectious spondylodiscitis over a 13-year period were retrospectively reviewed. Of these, 102 patients on maintenance HD were enrolled in this study. Cox proportional hazard model was used to evaluate the risk factors of mortality and recurrence.

Results.
The 102 enrolled patients had an average age 63.3 ± 11.2 years old and male-to-female ratio of 1:1.04. Back pain was present in 75.5% of patients and the most commonly infected site was the lumbosacral spine. Infection associated with vascular access was identified in 31.4% of patients. The prevalence of dialysis via central venous catheters was higher than prevalent HD patients. Methicillin-resistant Staphylococcus aureus was the most common pathogen, followed coagulase-negative staphylococci. The patients’ in-hospital survival rate was 82.4%; their vascular access survival rate was 75.5%; their 1-year survival rate was 78.4%, and their 1-year recurrence rate was 20.2%. Congestive heart failure was associated with an increased 1-year mortality. Other variables exhibited no significant relationship with patients’ in-hospital mortality, 1-year mortality or recurrence.

Conclusion.
The characteristics and outcomes of infectious spondylodiscitis in HD patients were elucidated. Most of the demographic and clinical variables, evaluated upon admission, did not predict mortality or recurrence.

Level of Evidence: 3
Use of CT Scan-derived Patient-specific Instrumentation in Total Ankle Arthroplasty
Authors: Saito Guilherme H. , Sanders Austin E. , Sturnick Daniel R. , Demetracopoulos Constantine A. 
Published: October 2017

Abstract:
Total ankle arthroplasty has evolved significantly in the last 2 decades. Improvements in surgical technique and instrumentation, as well as advances in implant design, have contributed significantly to the increased adoption of ankle replacement for the treatment of ankle arthritis. Achieving proper alignment and correct positioning of the components is critical for the function and survivorship of the prosthesis. Patient-specific instrumentation generated by preoperative computed tomography is a tool which may allow for more reliable and reproducible component positioning. This article will provide a brief review of the technique and our early results of utilizing patient-specific instrumentation in total ankle arthroplasty.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Botulinum Toxin in Aesthetic Medicine: Myths and Realities
Authors: Dover Jeffrey S. , Monheit Gary , Greener Mark , Pickett Andy 
Published: October 2017

BACKGROUND
Several formulations of Botulinum toxin serotype A (BoNT-A) for aesthetic indications are available, with numbers likely to increase. Preparations are not interchangeable, based on dose unit comparisons.

OBJECTIVE
Numerous myths and misconceptions regarding the use of BoNT-A for aesthetic indications have arisen, which this review aims to lay to rest.

MATERIALS AND METHODS
This review assesses evidence for and against each of the most common myths regarding BoNT use in aesthetics.

RESULTS
BoNT-A neurotoxin/protein complexes are irrelevant to the toxin's therapeutic/aesthetic indications. BoNT-A neurotoxin/protein complexes do not influence movement from injection site or immunogenicity. Any relationship between neutralizing antibody formation and clinical response is complex and clinicians should consider other factors that may induce an apparent loss of clinical response. Diffusion appears predominately, perhaps exclusively, dose dependent. Careful placement and correct dosing optimizes likelihood of good outcomes. Manufacturers recommend reconstitution of products with sterile nonpreserved saline. However, compelling evidence suggests that reconstitution using preserved saline dramatically improves patient comfort without compromising efficacy. Several post-treatment instructions/restrictions are widely used despite the lack of evidence, but muscle activity after injection may be beneficial. Cooling the treatment area might hinder BoNT-A translocation and should probably be abandoned.

CONCLUSION
The existing evidence suggests that experienced users should achieve equivalent results regardless of BoNT-A formulation, but additional, well-designed, adequately powered, controlled randomized studies should be performed.
Histologic Accuracy of Mohs Micrographic Surgery
Authors: Highsmith James T. , Highsmith M. Jason , Monheit Gary D. 
Published: October 2017

BACKGROUND
Mohs micrographic surgery enables the surgeon to maximize tumor removal while minimizing the amount of tissue being removed using advanced mapping techniques combined with microscopy. Interpretation of frozen section slides is vital to the success of Mohs micrographic surgery.

OBJECTIVE
Evaluate and confirm the congruence of frozen section slide interpretation between fellowship-trained Mohs surgeons and dermatopathologists.

METHODS
Retrospective cohort concordance study spanning 10 years (n = 1,720 cases).

RESULTS
The concordance rate for frozen slide interpretation between fellowship-trained Mohs surgeons and dermatopathologists in this study was 99.5%.

CONCLUSION
This study demonstrates agreement between the interpretation of histologic frozen section slides when evaluated by fellowship-trained Mohs surgeons and dermatopathologists.
CONCURRENT IDIOPATHIC MACULAR TELANGIECTASIA TYPE 2 AND CENTRAL SEROUS CHORIORETINOPATHY
Authors: Matet Alexandre , Yzer Suzanne , Chew Emily Y. , Daruich Alejandra , Behar-Cohen Francine , Spaide Richard F. 
Published: October 2017

Purpose:
To describe cases presenting with features of idiopathic macular telangiectasia (MacTel) Type 2 and central serous chorioretinopathy (CSC).

Methods:
Databases from four tertiary retina centers were searched for cases copresenting CSC and MacTel Type 2.

Results:
Five cases were identified (4 men, 1 woman; mean age: 67.2 years). Four patients were referred for chronic or nonresolving CSC, and the diagnosis of MacTel Type 2 was made based on multimodal imaging findings. One patient had advanced MacTel Type 2, and developed acute CSC. Regarding the MacTel Type 2 findings, all subjects presented perifoveal telangiectasia on fluorescein angiography, and four subjects showed intraretinal cavitations typical of MacTel Type 2 on optical coherence tomography, in one or both eyes. Regarding the CSC findings, fluorescein angiography identified focal or extended retinal pigment epithelium alteration in all eyes, and an active leakage in two eyes. Indocyanine green angiography showed choroidal vascular hyperpermeability in four subjects. On optical coherence tomography, pigment epithelial detachments were detected in five eyes (four subjects), and foveal detachments were present in five eyes (three subjects), which spontaneously resolved (two eyes), responded to photodynamic therapy (two eyes), or persisted (one eye). Mean choroidal thickness was 402 ± 99 μm.

Conclusion:
The codiagnosis of CSC and MacTel Type 2 should be considered in atypical presentations associating features from both disorders.
QUANTITATIVE ANALYSIS OF HYPERAUTOFLUORESCENT RINGS TO CHARACTERIZE THE NATURAL HISTORY AND PROGRESSION IN RPGR-ASSOCIATED RETINOPATHY
Authors: Tee James J. L. , Kalitzeos Angelos , Webster Andrew R. , Peto Tunde , Michaelides Michel 
Published: October 2017

Purpose:
Quantitative analysis of hyperautofluorescent rings and progression in subjects with retinitis pigmentosa associated with retinitis pigmentosa GTPase regulator (RPGR) gene mutations.

Methods:
Prospective observational study of 46 subjects. Ring area, horizontal and vertical diameter measurements taken from outer and inner ring borders. Intraobserver repeatability, baseline measurements, progression rates, interocular symmetry, and association with age and genotype were investigated.

Results:
Baseline ring area was 11.8 ± 13.4 mm2 and 11.4 ± 13.2 mm2 for right and left eyes, respectively, with very strong interocular correlation (r = 0.9398; P < 0.0001). Ring area constriction was 1.5 ± 2.0 mm2/year and 1.3 ± 1.9 mm2/year for right and left eyes, respectively, with very strong interocular correlation (r = 0.878, P < 0.0001). Baseline ring area and constriction rate correlated negatively with age (r = −0.767; P < 0.0001 and r = −0.644, P < 0.0001, respectively). Constriction rate correlated strongly with baseline area (r = 0.850, P < 0.0001). Age, but not genotype, exerted a significant effect on constriction rates (P < 0.0001), with greatest rates of progression seen in younger subjects. An exponential decline overall was found.

Conclusion:
This study provides disease-specific baseline values and progression rates together with a repeatability assessment of fundus autofluorescence metrics. Our findings can guide future treatment trials and contribute to the clinical care of patients with RPGR-associated retinitis pigmentosa.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN GEOGRAPHIC ATROPHY
Authors: Sacconi Riccardo , Corbelli Eleonora , Carnevali Adriano , Querques Lea , Bandello Francesco , Querques Giuseppe 
Published: October 2017

Purpose:
To analyze choriocapillaris (CC) vessel density (VD) around geographic atrophy (GA) secondary to non-neovascular dry age-related macular degeneration using optical coherence tomography angiography.

Methods:
We compared CC VD surrounding GA margin (500 μm radius) with control CC (outside GA margin) in a consecutive series of GA patients presenting between August 2016 and February 2017 at the Medical Retina and Imaging Unit of University Vita-Salute, IRCCS Ospedale San Raffaele in Milan. Images were obtained through thresholding and binarization. We also compared the CC VD in a sample area of 500 μm × 500 μm surrounding GA margin rated as hyperautofluorescent on fundus autofluorescence to a similar area rated as isoautofluorescent.

Results:
Fifty eyes of 29 patients (19 women and 10 men; mean age 77 ± 6 years) with mean GA area of 9.43 ± 5.08 mm2 and mean subfoveal choroidal thickness of 164 ± 73 μm were included. Choriocapillaris VD surrounding GA margin as detected by optical coherence tomography angiography revealed a significant impairment compared with control CC outside GA margin (0.317 ± 0.083 vs. 0.461 ± 0.054, P < 0.001), which was even greater in patients with foveal involvement (P = 0.013). Furthermore, mean VD in hyperautofluorescent areas was significantly lower compared with isoautofluorescent areas (0.242 ± 0.112 vs. 0.327 ± 0.130, P = 0.001). A positive correlation was disclosed between VD surrounding GA margin and subfoveal choroidal thickness (r = 0.332, P = 0.019).

Conclusion:
Optical coherence tomography angiography discloses CC impairment surrounding GA margin. Such CC impairment at GA margin seems to precede retinal pigment epithelium alterations at fundus autofluorescence. Optical coherence tomography angiography could be a new valuable tool for detecting CC alterations and to evaluate potential therapeutic responses in clinical studies.
ENLARGEMENT OF SCLEROCHOROIDAL CALCIFICATIONS: MULTIMODAL IMAGING UPDATE
Authors: Slean Geraldine R. , Kalevar Ananda , Chen Judy , Johnson Robert 
Published: October 2017

Purpose:
To report the multimodal imaging and enlargement of sclerochoroidal calcifications over a 10-year period.

Methods:
Case report of a 74-year-old white man who presented for routine follow-up and was found to have yellow chorioretinal lesions in the right eye.

Results:
Multimodal imaging was performed and confirmed sclerochoroidal calcifications. Comparison of fundus photography over a 10-year period demonstrated growth of preexisting lesions and the development of new lesions in the right eye.

Conclusion:
Over time, this patient developed new sclerochoroidal calcifications and enlargement of preexisting calcifications. We, therefore, recommend regular follow-up with periodic multimodal imaging for these patients.