bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior Cartilage Endplate Disruption on T1-weighted Magnetic Resonance Imaging as a Predictor for Postoperative Recurrence of Lumbar Disk Herniation
Authors: Inomata Kazuhiro , Takasawa Eiji , Mieda Tokue , Tsukui Toshiki , Takakura Kenta , Tomomatsu Yusuke , Honda Akira , Chikuda Hirotaka 
Published: August 2024

Study design:
A retrospective cohort study.

Objective:
This study aimed to investigate the relationship between disruption of cartilage endplates and postoperative recurrence of lumber disk herniation (LDH) using preoperative T1-weighted magnetic resonance imaging (MRI-T1WI).

Summary of Background Data:
Recurrence of LDH is a relatively common complication after discectomy. Although several risk factors have been identified, their predictive capability remains limited. Previous histologic studies reported that cartilage endplates were present in 85% of patients with recurrent LDH.

Methods:
Patients with a single level of LDH who underwent open or microendoscopic discectomy were retrospectively reviewed. On the basis of preoperative sagittal MRI-T1WI, cartilage endplates were divided into anterior and posterior portions at the center of the disk and evaluated for discontinuity. Patient background characteristics, spinopelvic sagittal parameters, degrees of disk degeneration, and recurrence level were also evaluated.

Results:
A total of 100 patients were included in this study (mean age, 50.5 years old; 41% female). Symptomatic recurrence of LDH occurred in 15 patients (15%). There were no significant differences in patient background characteristics (age, 46.9 vs. 51.2 years old; %female, 60% vs. 38%; smoking, 33% vs. 41%; diabetes mellitus, 27% vs. 29%) or spinopelvic parameters (PI, 44.1 vs. 47.0 degrees; PT, 16.8 vs. 19.4 degrees; SS, 27.3 vs. 27.6 degrees; LL, 37.7 vs. 33.7 degrees). In the recurrence group, MRI-T1WI showed a higher rate of cartilage endplate disruption in the posterior portion than in the no-recurrence group (73% vs. 34%, P=0.01). A multivariate analysis demonstrated that the disruption of the posterior cartilage endplate remained an independent predictor of recurrence.

Conclusions:
Disruption in the posterior cartilage endplate on preoperative MRI-T1WI was closely associated with recurrence after LDH surgery. These results suggest that this MRI finding is a practical and useful predictor of LDH recurrence.

Level of Evidence:
Level III.
MACULAR THICKNESS FLUCTUATIONS AND VISUAL ACUITY OUTCOMES AFTER INTRAVITREAL DEXAMETHASONE IMPLANT FOR DIABETIC MACULAR EDEMA
Authors: Torres-Villaros Héloïse , Timoumi Rhyme , Fajnkuchen Franck , Klokner Arnaud , Giocanti-Aurégan Audrey 
Published: August 2024

Purpose:
To assess macular thickness fluctuations and their association with visual acuity outcomes in eyes with diabetic macular edema treated with an intravitreal dexamethasone (DEX) implant.

Methods:
The SD of all postbaseline central subfield thicknesses (CST) recorded over a 12-month period after the first injection of the DEX implant was used to quantify CST fluctuations. Linear regression models were used to identify factors associated with the visual acuity at 12 months (measured with the Early Treatment of Diabetic Retinopathy Study score) and predictors of CST SD.

Results:
A retrospective review of 80 eyes of 80 patients treated with the DEX implant for diabetic macular edema revealed a CST SD of 75.3 ± 50.3 µm. The CST SD was negatively associated with the visual acuity at 12 months (−7.7 Early Treatment of Diabetic Retinopathy Study letters for each 100-µm increase in CST SD, P = 0.01), while changes in CST from baseline did not show any significant association. Eyes were stratified into quartiles based on the CST SD, and a difference by −14.2 letters in visual acuity at 12 months was observed between the first and fourth quartiles (P <0.001). Significant predictors of CST SD included the baseline visual acuity (−12.0 µm for each 10-letter increase, P = 0.02) and the number of DEX injections received (n = 17.1, P = 0.03).

Conclusion:
Greater fluctuations in retinal thickness were found to be associated with poorer visual outcomes in eyes with diabetic macular edema treated with the DEX implant. Analyzing the CST SD could be a more predictive indicator of visual prognosis than individual measurements of the CST.
Efficacy and Safety of Interleukin-12/23 and Interleukin-23 Inhibitors for Ulcerative Colitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Jaber Fouad , Ayyad Mohammed , Alsakarneh Saqr , Alsharaeh Tala , Salahat Ahmed-Jordan , Jaber Mohammad , Gangwani Manesh Kumar , Abboud Yazan , Mohamed Islam , Ali Hassam , Kilani Yassine , Farraye Francis A. , Hashash Jana G. 
Published: August 2024

Background:
Targeting interleukin-23 (IL-23) represents a significant therapeutic avenue for treating ulcerative colitis (UC).

Study Question:
What are the effectiveness and safety of selective inhibitors targeting IL-23p19 and IL-12/23p40 in individuals with moderate-to-severe UC?

Data Sources:
MEDLINE, Embase, Scopus, and Cochrane databases.

Study Design:
A systematic search of MEDLINE, Embase, Scopus, and Cochrane databases till January 15, 2024, to identify randomized controlled trials comparing IL-23p19 and IL-12/23p40 inhibitors against placebo or active comparators in UC patients. The primary outcome was clinical remission, with secondary outcomes including clinical response, endoscopic remission, and safety profiles during induction and maintenance phases. Using a fixed-effect model, we pooled dichotomous data with risk ratio (RR) and 95% confidence interval (CI) for analysis.

Results:
In 5 trials involving 1120 patients with moderate to severe UC, targeting IL-23 showed significant superiority in inducing clinical remission [RR: 2.08, 95% CI, (1.66–2.61)], endoscopic remission [RR: 1.73, 95% CI, (1.39–2.16)], and histologic remission [RR: 1.88, 95% CI, (1.34–2.64)]. Additionally, individuals treated with IL-12/23p40 or IL-23p19 antagonists maintained clinical remission [RR: 1.85, 95% CI, (1.53–2.23)], endoscopic remission [RR: 2.03, 95% CI, (1.60–2.57)], and histologic remission [RR: 1.66, 95% CI, (1.11–2.48)]. Targeting IL-23 was linked with a reduced risk of any adverse events (AE) during both induction [RR: 0.94, 95% CI, (0.86–1.02)] and maintenance phases [RR: 0.93, 95% CI, (0.86–0.99)], any serious AE during the induction phase [RR: 0.53, 95% CI, (0.36–0.78)], and withdrawal due to AEs compared to patients receiving placebo during induction [RR: 0.24, 95% CI (0.14, 0.43)].

Conclusion:
Targeting IL-23 demonstrates efficacy and safety for inducing and maintaining clinical and endoscopic remission in moderate-to-severe UC patients.
18F FDG PET/CT versus 99m Tc MDP Bone scintigraphy in imaging of metastatic osseous disease in breast cancer patients; Solving the discrepancies in light of serum markers
Authors: Nasr Hatem , Alnajashi Nejoud , Farghaly Hussein , Alqarni Abdullah 
Published: August 2024

Aim
To assess the performance of 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) versus 99mTc MDP bone scan in assessment of metastatic osseous disease in breast cancer patients in relation to serum markers.

Material and methods
We reviewed PET/CT studies and bone scans for 37 patients (mean age of 55.38 ± 13.08 years) with metastatic breast cancer to bone. To assess metastatic osseous burden, we used semiquantitative scores derived from PET/CT (PMS) and bone scans (BMS). We used McNemar test to compare lesion detection between both modalities and receiver operator characteristic analysis to define the cutoff value of serum CA 15-3 that best predicts additional value for PET/CT over bone scan.

Results
In 13 patients (35.1%), more lesions or higher-intensity lesions were detected on PET/CT, while only 4 patients (10.8%) had more prominent lesions on bone scans (P = 0.049). Additional lesions seen on PET/CT are predominantly osteolytic or medullary (early phase). Most lesions with higher uptake on bone scans appear sclerotic (late phase). CA 15-3 was positively correlated to PMS (r = 0.386; P = 0.018) but not to BMS (r = −0.027; P = 0.874). However, serum alkaline phosphatase was positively correlated to both PMS (r = 0.389; P = 0.017) and BMS (r = 0.363; P = 0.027). CA 15-3 value of >47 U/ml best predicted additional findings on PET/CT compared to bone scans (area under the curve = 0.708; P = 0.0261).

Conclusion
FDG PET/CT detects metastatic osseous lesions during an earlier phase. A higher CA 15-3 predicts a higher metastatic burden on PET/CT but not on bone scan. Bone scans are less specific, likely by missing early lesions and detecting persistent uptake in healing sclerotic lesions.
Clinician Wellbeing and Mental Health Assessment Across Two Acute Care Hospitals During the COVID-19 Pandemic
Authors: Kaplow Roberta , Willis Polly , Steele Dinah , Swann Julie , Feistritzer Nancye R. 
Published: August 2024

Objective
The purposes of this study were to determine whether positive work environments affect clinician wellbeing and mental health, and to identify participants’ priority interventions to improve clinician wellbeing. This study was designed to determine the potential benefit of modifying the aforementioned factors for clinicians and hospitals to impact positive patient outcomes.

Background
The SARS-CoV-2 virus pandemic has become one of the leading causes of death in the United States and worldwide, and has exacerbated widespread burnout among health care professionals. This has resulted in negative collateral implications for the stability of the clinician workforce. A Clinician Wellbeing study (CWS) was launched in two Magnet®-designated hospitals in the southeast. The CWS was part of a multi-site collaborative research project led by the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing.

Method
A cross-sectional observational study design was implemented. Data were collected through anonymous surveys of 708 registered nurses (RNs) and advanced practice providers (APPs) working in two Magnet hospitals in the southeastern United States. Each participant completed 8 surveys.

Results
Clinicians’ self-reported level of burnout was higher for both RNs and APPs at Emory University Hospital than Emory Saint Joseph’s Hospital including intent to leave and dissatisfaction with their jobs. RNs and APPs self-reported their overall health to be good or excellent and they reported sleep quality as fair. Both groups in both hospitals indicated that they experienced anxiety, depression, and stress. The APPs reported a higher percent that their work did not leave enough time for personal and family life. Data also indicated that the primary work environment concern was related to inadequate nurse staffing.

Conclusions
The data illuminated opportunities for the two hospitals to employ continuous improvement interventions to positively transform the work environment.
Facial Symmetry Enhancement and Brain Network Modifications in Facial Palsy Patients after Botulinum Toxin Type A Treatment
Authors: Ma Hao , Zhou Yu-lu , Wang Wen-jin , Chen Gang , Zhang Chen-hao , Lu Ye-chen , Wang Wei 
Published: August 2024

Background:
Facial palsy, often resulting from trauma or iatrogenic treatments, leads to significant aesthetic and functional impairment. Surgical interventions, such as masseteric-to-facial nerve transfer combined with static suspension, are frequently recommended to restore facial nerve function and symmetry.

Methods:
This study examined the impact of botulinum toxin type A (BoNT-A) treatment on the unaffected side with regard to facial symmetry and brain connectivity in patients with severe oral commissure droop from facial nerve damage. Patients were divided into 2 groups: 1 group received BoNT-A injections on the unaffected side, and the other did not.

Results:
The authors’ findings revealed that BoNT-A treatment not only improved facial symmetry but also induced significant modifications in brain functional network connectivity. These modifications extended beyond the sensorimotor network, involving high-level cognitive processes, and exhibited a significant correlation with the degree of facial asymmetry.

Conclusions:
These results provide valuable insights into the mechanisms underlying the positive effects of BoNT-A intervention on motor recovery and brain plasticity in facial palsy patients. Furthermore, the study emphasizes the importance of a multidisciplinary approach to facial palsy rehabilitation. Understanding these intricate interactions between facial symmetry restoration and brain network adaptations may pave the way for more effective treatments and improved quality of life for individuals dealing with facial palsy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Nasal Tip Deprojection in Rhinoplasty
Authors: Datta Shaishav , Tugertimur Buğra , Hanna Steven A. , Goote Paige , Morris Matthew , Mattos David , Reish Richard G. 
Published: August 2024

Background:
Rhinoplasty is one of the most commonly performed facial operations in the United States, and many major and minor nasal tip support structures affect tip projection. Overprojection may result from anatomical factors or occur iatrogenically during primary rhinoplasty. Achieving reliable, reproducible, and stable results is the aim of nasal tip deprojection rhinoplasty. The authors’ technique is designed to decrease nasal tip deprojection in patients with an overly projected nasal tip.

Methods:
A retrospective chart review of 2003 rhinoplasty cases in the senior author’s (R.G.R.) practice was conducted for the period between July of 2014 and June of 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases with nasal tip deprojection, with a minimum of 12 months of follow-up. Outcomes of interest included the rate of operative revisions and the rate of postoperative infection.

Results:
A total of 447 patients met the inclusion criteria. The mean age of our study group was 32.1 years, with 409 female patients, and 291 cases were primary rhinoplasties. The mean follow-up period was 22.4 months. Eight patients (1.8%) required empiric antibiotics postoperatively, and 17 patients (3.8%) required operative revision.

Conclusions:
The authors’ case series demonstrates that combining resection of the medial crura with lateral crural steal and a columellar strut graft allows the surgeon to achieve considerable nasal tip deprojection. The comprehensive patient follow-up (mean, 22.4 months) further supports the reliability of the authors’ technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Effect of Tourniquet-Related Nerve Ischemia on Response to Handheld Nerve Stimulation in Ulnar Nerve Transposition
Authors: Brogan David M. , Lee Tony Y. , Beamer Yosita , Dy Christopher J. 
Published: August 2024

Background:
Tourniquet-related nerve ischemia has been well studied in several reconstructive procedures, but the time course of impaired response to intraoperative stimulation is unclear. The present study evaluated ischemic effects on conduction during ulnar nerve transposition and examined the relationship between intraoperative and preoperative diagnostics. The authors hypothesized that intraoperative ischemia would have minimal impact on conduction.

Methods:
Thirty patients scheduled for anterior transposition were enrolled after preoperative examination, electrodiagnostic testing, and ultrasound. Demographic and symptom severity data were recorded. A handheld biphasic nerve stimulator was used intraoperatively to assess minimum amplitude and pulse duration needed for muscle response. Measurements were taken at 15-minute intervals after placement.

Results:
Changes in threshold amplitude and pulse duration were calculated between each 15-minute interval; no significant difference was found in the change of either value (P = 0.70 and P = 0.178). A weak negative correlation existed between preoperative compound muscle action potential amplitudes and average intraoperative pulse duration, which increased to a moderate correlation when compared with 45-minute pulse duration (r = −0.62; P < 0.01). Preoperative ulnar nerve cross-sectional area demonstrated no significant correlation with average pulse duration but a moderate correlation with pulse duration at 45 minutes (r = 0.63; P = 0.01).

Conclusions:
Tourniquet use did not prevent effective intraoperative stimulation of the ulnar nerve for at least 45 minutes. The window for meaningful stimulation with tourniquet use appears to be greater than previously thought. Preoperative nerve compound muscle action potential amplitude and cross-sectional area does appear to influence pulse duration required after 45 minutes of ischemia, suggesting that injured nerves are more susceptible to ischemia.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Primary Maxillary Hypoplasia in Complete Unilateral Cleft Lip and Palate: Analysis of Clinical Data and Associations
Authors: Scarpa Marcela B. , Câmara Paulo R.P. , Fabiani Isadora M. , Melhem-Elias Fernando , Tames Hugo L.V.C. , Dornelles Rodrigo , Alonso Nivaldo 
Published: August 2024

Objective:
Investigate the volumetric differences between the cleft and noncleft hemi-maxillae in patients with complete unilateral CLP and compare them with the average population. It also aimed to correlate the hemi-maxilla volumetry with maxillary sinuses’ volumes, with the occlusal index in digitized models and tooth agenesis.

Design:
This is a retrospective cohort study. Setting: Cleft lip and palate center in quaternary-level institutions.

Patients, Participants:
This study included 23 patients with complete unilateral CLP who underwent cheiloplasty between 2008 and 2012 and a control group of 24 patients without craniofacial abnormalities.

Interventions:
None.

Main Outcome Measure(S):
The computed tomography scans of cleft patients were analyzed before and after alveolar bone grafting. Following 3-dimensional tomographic reconstruction, a volumetric index was calculated as the ratio of cleft and normal side volumes (CV/NV). Cuts and measurements were also conducted in the control group. Additionally, the volumetric index of the maxillary sinuses (MSCV/MSNV) was calculated, and occlusal index analyses were performed using digitized models. In addition, dental agenesis was observed.

Results:
The CV/NV relationship was significantly lower in the prealveolar and postalveolar bone grafting periods than in the normal population (P<0.01), confirming primary maxillary hypoplasia in patients with complete unilateral CLP. The CV/NV decreased progressively with worsening occlusal index classifications (P=0.03). No associations were observed between MSV and any of the studied variables.

Conclusion:
The complex anatomy of patients with complete unilateral CLP impairs treatment outcomes, and maxillary hypoplasia must be considered an important predictive factor.
A Novel Technique for Repairing Alveolar Clefts: Computer-Assisted Design With Posterior of Mandible Block Bone Grafts
Authors: Gao Yisu , Chen Kai , Li Nannan , Xu Dianhang , Pang Wanyu , Zhu Zihe , Wu Guomin 
Published: August 2024

Objective:
Iliac cancellous bone graft is the gold standard for the treatment of alveolar clefts. However, the resorption rate of iliac cancellous bone is generally high. In this study, the authors propose a new method for repairing alveolar clefts using block bone grafts in the posterior region of the mandibular molar and the anterior margin of the ascending branch.

Methods:
Ten patients with a diagnosis of unilateral or bilateral alveolar cleft were collected. Block bone grafting between the posterior mandibular molar region and the inner and outer oblique lines of the anterior margin of the ascending branch was used to treat the alveolar synostosis. Preoperative, 1-week postoperative, and 6-month postoperative multislice spiral computed tomography scans of the patients were collected and analyzed for preoperative design and postoperative graft bone morphology using computer-assisted software tools, which were also required to measure the changes in the bone tissue density in the posterior mandibular bone extraction area.

Results:
At 6 months postoperatively, the mean bone resorption rate of the posterior mandibular bone grafts for cleft alveolar processes was 33.96% ± 11.23%. Bone tissue density in the posterior mandibular bone grafting area recovered to near preoperative levels at 6 months postoperatively.

Conclusion:
The novel method of bone grafting for the cleft alveolar process used in this paper is really effective. Postoperative posterior mandibular bone extraction did not cause sequelae such as mandibular bone defects or poor morphology in the patients. Computer-assisted design and three-dimensional printing technology helped to improve intraoperative bone grafting accuracy and postoperative assessment.
A Comprehensive Review of Bilobed Flaps in Nasal Reconstruction: Technique, Outcomes, and Considerations
Authors: Bennett Anne , Peters Victoria , Meade Anna , Thornton James 
Published: August 2024

Purpose:
Reconstruction of nasal defects, particularly in the lower third of the nose, presents significant challenges due to the area’s complex 3-dimensional structure and thicker, more sebaceous skin. The bilobed flap, a double transposition flap, has been a popular method for addressing these nasal defects.

Methods:
This retrospective review examines a single surgeon’s experience with bilobed flaps for nasal reconstruction over the last 15 years. Demographics, defect characteristics, intraoperative details, postoperative complications, and revisionary procedures were documented, and univariate and multivariate logistic regression analyses were used to assess complication rate associations.

Results:
In all, 148 bilobed reconstructions were analyzed, with a mean patient age of 62.6 years and 46.0% male prevalence. The most common indication for the procedure was basal cell carcinoma following Mohs surgery, with the majority of the defects located on the lower third of the nose. The average defect size was 1.11 cm². Complications occurred in 52.0% of cases, including pincushioning, scar thickening, asymmetry, alar stenosis, and wound dehiscence. Reoperations and additional treatments such as dermabrasion, steroid injections, and laser therapy were frequently necessary to address these issues. Logistic regression analysis demonstrated significantly more postoperative complications when the defect was located on the lower third of the nose when compared with the upper two-thirds.

Conclusions:
While the bilobed flap can provide adequate skin coverage with perfect color match, it is associated with notable complications that impact esthetic outcomes. Proper patient selection and surgical technique are crucial for optimizing results.