bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of a Second Ahmed Glaucoma Implant With Mitomycin-C in Pediatric Glaucoma After Initial Valve Failure
Authors: Promelle Veronique , Lyons Christopher J. 
Published: May 2024

Précis:
After the failure of a glaucoma drainage device in children, implantation of a second Ahmed glaucoma valve with mitomycin-C allows a significant reduction of intraocular pressure and number of medications with good medium-term and long-term survival.

Introduction:
The effectiveness of glaucoma drainage devices (GDD) is limited in time. There is little literature regarding the optimal management strategy after failure of a GDD in pediatric glaucoma.

Purpose:
To report the outcomes of Ahmed glaucoma valve implantation (AGV) with mitomycin-C (MMC) after failure of a GDD in children.

Methods:
Retrospective chart review of patients with a history of at least 1 GDD receiving an AGV implantation with MMC between 2000 and 2019. We defined complete success as an IOP of 5–21 mm Hg without glaucoma medication and qualified success as a final IOP of 5–21 mm Hg with one or more glaucoma medication, without loss of vision.

Results:
Twenty-one patients (22 eyes) met the inclusion criteria. The intraocular pressure and number of medications were significantly reduced. The probability of complete success was 47% [95% CI: 29%–75%] at 2 years and 34% [95% CI: 18%–65%] at 4 years. The probability of qualified success was 74% [95% CI: 56%–97%] at 2 years, and 54% [95% CI: 34%–84%] at 5 years. Failure happened in 10 eyes after a mean time of 4.3 years ±3.6 (6 mo to 15 y), 5 of which (23%) for severe complications or loss of vision.

Discussion:
This study of implantation of a second valve with MMC reports a significant decrease in IOP and medications with medium-term and long-term success rates close to those reported for first valve implantation, although with a high risk of complications.
Correlation of Oral Microbiota With Different Immune Responses to Antiretroviral Therapy in People Living With HIV
Authors: Pan Jingying , Zhang Xiaodi , Shi Danrong , Tian Xuebin , Xu Lijun , Lu Xiangyun , Dong Mingqing , Yao Peng , Pan Zhaoyi , Wu Nanping , Yao Hangping 
Published: May 2024

Abstract
Both HIV infection and antiretroviral therapy (ART) affect the oral microbiome. Whether successful treatment with ART in people living with HIV (PLWH), which leads to a significant decline in viral loads and immune reconstitution, is associated with changes in or recovery of the oral microbiome remains unknown. Therefore, we performed a cross-sectional study of 118 PLWH receiving regular ART and 40 healthy controls (HCs). Among the 118 PLWH, 18 immunological non-responders (INRs; <200 CD4+ T cells/μL) and 30 immunological responders (IRs; ≥500 CD4+ T cells/μL) were identified. The oral microbiota composition of all participants was analyzed using 16S rRNA gene sequencing of throat swab samples. Relative abundance of bacterial genera was compared between IRs and INRs, and Pearson correlations between bacterial abundance and peripheral blood immune cell counts were evaluated. The INR group showed lower alpha diversity than the IR and HC groups, which displayed similar alpha diversity. The genera Alloprevotella, Prevotella and Neisseria were more abundant in PLWH than in HC, whereas the genera Rothia, Streptococcus and Fusobacterium were more abundant in HC than in PLWH. The genus Rothia was more abundant in the INR group, whereas Prevotella, Alloprevotella, Porphyromonas and Haemophilus were more abundant in the IR group. The genera Rothia and Alloprevotella were negatively and positively associated with CD4+ T cell counts, respectively. Thus, an increased abundance of Rothia in the oral microbiome is associated with unfavorable outcomes regarding immune reconstitution in PLWH receiving regular ART, whereas Prevotella, Alloprevotella, Porphyromonas and Haemophilus are associated with favorable outcomes.
Presentation of Spontaneous Orbital Hemorrhage
Authors: Vahdani Kaveh , Dharmasena Aruna , Rose Geoffrey E. 
Published: May 2024

Purpose:
To evaluate the presenting features of patients with nontraumatic orbital hemorrhage (NTOH) based on etiopathological factors.

Methods:
A retrospective case-note review for demographics and presenting features of patients with nontraumatic orbital hemorrhage. Patients were categorized into 3 groups: group I with known systemic vascular disease, group II with known or newly revealed orbital vascular anomalies, and group III with no known underlying vasculopathy.

Results:
One hundred and seventeen patients (68 female; 58%), with 37 (32%) in group I, 47 (40%) in group II, and 33 (28%) in group III. The average age at presentation was 70.9, 30.1, and 49.9 years, respectively, but the incidence peaked in the first decade for patients with underlying local vascular anomalies and in the eighth for those without. Of the group I patients with known cardiovascular disease, 43% were on antithrombotic agents. The most common presenting symptoms were orbital pain (59%), proptosis (56%), and diplopia (45%), while 13% had associated nausea or vomiting. Ipsilateral optic neuropathy occurred in 14% of cases, higher in group II (22%), along with nonaxial globe displacement (25%), reduced eye movements (47%), optic disc swelling (10%), and choroidal folds (9%). Imaging in patients without evident vascular anomalies showed that hemorrhages commonly occurred in the inferotemporal quadrant (32%), with about half of these having a “beached whale” configuration (46%).

Conclusion:
Nontraumatic orbital hemorrhages affect all ages, typically presenting with acute proptosis or pain (over half), various degrees of visual impairment, and reduced motility. About half of those without vascular anomalies had cardiovascular risk factors, imaging often revealing an inferotemporal mass with a “beached whale” appearance.
The Effectiveness of Facial Exercise Therapy in Ophthalmic Complications of Facial Nerve Palsy and the CADS Grading Scale as an Ophthalmic-Specific Grading System
Authors: Lim Christina S. , Nagendran Sonali , Neville Catriona , Nduka Charles , Kannan Ruben , Malhotra Raman 
Published: May 2024

Purpose:
The effectiveness of facial exercise therapy in facial nerve palsy is well documented in the literature. However, there is no study examining its effect on ophthalmic manifestations of facial nerve palsy. The study reports its impact on the ophthalmic manifestations of facial nerve palsy using the ophthalmic-specific CADS grading system.

Methods:
A retrospective case series of patients aged 18 years or older with facial nerve palsy was performed in a single specialist center between 2013 and 2019. Inclusion criteria were ophthalmic involvement, recorded CADS, and Sunnybrook grading scale pre- and post-treatment.

Results:
A total of 73 patients were identified. There were 24 patients (M = 11, F = 13) who received facial exercise therapy only (group 1) and 49 patients (M = 17, F = 32) who received combined treatment of facial exercise therapy and eyelid surgery (group 2). The mean ages were 54.8 and 49.7 years, respectively. The groups were further subdivided into early (<3 months), intermediate (3–12 months), and late presenters (>12 months). In group 1, statistically significant improvements were seen in early (static asymmetry and dynamic function), intermediate (cornea), and late groups (cornea, static asymmetry, and dynamic function). The Sunnybrook grading scale was unable to detect changes in the ophthalmic features post-therapy or to report the corneal status.

Conclusions:
Facial exercise therapy is likely to improve ophthalmic manifestations of facial nerve palsy, in particular, those with static asymmetry and dynamic function of eye closure. The CADS grading scale is more suitable for the ophthalmic assessment.
An Analysis of Surgical Factors Associated With Clinically Significant Eyelid Edema (CSEE) in Patients Undergoing Blepharoplasty: Lid Crease Techniques Associated with CSEE
Authors: Park Kristen E. , Guo Sarah , Mehta Preeya , Li Joy , Shen Alice , Bokman Christine L. , Chang Jessica R. , Zhang-Nunes Sandy 
Published: May 2024

Purpose:
Severe postoperative edema after eyelid surgery can have negative clinical and psychological effects. In this study, the authors investigated whether surgical factors, including surgical techniques and suture type, were associated with clinically significant eyelid edema (CSEE).

Methods:
A chart review was performed on 269 patients who underwent upper eyelid blepharoplasty with or without external levator advancement by 2 surgeons at a single institution between January 2021 and December 2022. Postoperative photos were graded by 2 physicians for eyelid edema using a standardized grading scale ranging from 0 (no edema) to 3 (severe edema). CSEE was defined either as having a grade of 3 at any point postoperatively or any grade that was 1 or greater after 90 days postoperatively. Logistic regression controlling for race was used for analysis; the statistical significance level was defined as p < 0.05.

Results:
Of 269 patients, 56 developed CSEE. Of those who underwent blepharoplasty with mini crease enhancement (closure with every other bite incorporating levator aponeurosis), 40.5% developed CSEE versus 12.5% of those without (p < 0.001). Patients with lid crease formation using buried interrupted sutures had greater CSEE than those with externalized interrupted sutures removed at 1 week (43.8% versus 11.5%, p < 0.01). There was no increased risk of CSEE with additional procedures performed versus blepharoplasty alone.

Conclusions:
Patients who underwent blepharoplasty with mini crease enhancement, where more than 4 sutures are placed from skin to levator, and/or had buried suture lid crease formation had greater rates of CSEE.
An Instrument to Assess the Digital Competence of Nurse Educators
Authors: Pajari Juha , Sormunen Marjorita , Salminen Leena , Elonen Imane , Pasanen Miko , Saaranen Terhi 
Published: May 2024

Background:
The Educators and Educator Candidates’ Competence in Digital Pedagogy instrument needed to be tested before using it in nursing education.

Purpose:
This study describes the further testing of this instrument to measure nurse educators’ digital competence.

Methods:
The study is reported according to the 7 steps of the MEASURE Approach. Psychometric testing was conducted with a sample of 111 Finnish nurse educators from 9 universities of applied sciences. The study was conducted during the years 2020 and 2023.

Results:
The exploratory factor analysis results explained 56% of the variance with 3 factors, including 20 items. The factors were labeled to describe the nurse educators’ digital competence: implementing appropriate independent and community learning, acting safely and responsibly, and guiding learning based on the evidence. Cronbach α and McDonald ω coefficients showed good reliability.

Conclusions:
The instrument can be used to assess digital competence and identify the development needs to facilitate educators’ continuous professional development.
An Evaluation of the Performance, Patient Acceptability, and Feasibility of a Point-of-Care HIV-Syphilis Assay in an Urban Emergency Department
Authors: Maliszewski Kendall N. , Hsieh Yu-Hsiang , Curbeam Deanna , Rizkallah Ann , Perez Danielle A. , Dashler Gaby , Ricketts Erin P. , Rompalo Anne M. , Gaydos Charlotte A. , Manabe Yukari C. , Melendez Johan , Rothman Richard E. 
Published: May 2024

BackgroundPoint-of-care (POC) tests for sexually transmitted infections (STIs) permit delivery of results during the patient's emergency department (ED) encounter. We evaluated performance, patient acceptability, and feasibility of a new duplex POC test, Chembio Dual Path Platform HIV-Syphilis Assay, in an urban ED setting.MethodsConvenience sampling approach prioritizing those considered at increased risk for an STI and/or with a history of HIV. For the performance evaluation, participants were tested for HIV/syphilis with the Chembio POC assay and the reference laboratory tests; sensitivity and specificity were determined. For the patient acceptability evaluation, participants completed pre- and post-user surveys. For the feasibility evaluation, ED clinical technicians completed a survey evaluating their perceptions regarding feasibility of use of this POC test.ResultsA total of 327 patients were consented and enrolled. The diagnostic sensitivity and specificity of the Chembio POC assay for HIV were 96.5% (95% confidence interval [CI], 90.1%–99.3%) and 99.6% (95% CI, 97.7%–100.0%), respectively, and for syphilis, the values were 93.9% (95% CI, 85.0%–98.3%) and 99.6% (95% CI, 97.9%–100.0%), respectively. Regarding patient acceptability, 87% trusted the result, and 93% reported that they were more likely to seek treatment if they received a positive STI test result in the ED rather than after the ED visit. Regarding feasibility, 90% of the technicians reported that they would recommend using the test in EDs.ConclusionsThe Chembio Dual Path Platform HIV-Syphilis POC Assay had excellent performance characteristics when evaluated in an ED population, as well as high perceived acceptability from patients, and feasibility for ED use from clinical technicians. The test may have utility for HIV-syphilis screening among high-risk ED patients.
The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medical Spa Directorship and Practitioner Trends in Florida
Authors: Soares Danny J. , Bowhay Alexis , Fakhre Fadia , Hynes Stephanie D. , Lee Alina , Yi Christina H. 
Published: May 2024

Background:
The rapid proliferation of medical spas (med spas) in the United States has raised concerns over the continued shift of nonsurgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting surgical treatment guidance and education of cosmetic surgery patients. The authors assessed trends in the growth of independent med spa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida.

Methods:
The authors performed a comprehensive, statewide survey of all independent med spas in Florida by municipality using online business search engines. Information gathered included the number of locations, business stakeholders, and director or practitioner licensing and certification obtained from the Florida Division of Corporations or Department of Health databases and respective medical boards.

Results:
A total of 1038 med spas were identified, revealing a 100% increase in number relative to 2021 estimates. Nonphysician practitioners represented 84% of med spa providers, with core specialty medical director supervision present in only 22% of facilities and a large proportion of directors lacking specialty training (77%) or board certification (42%). In addition, 25% of med spas appeared to disregard state guidelines pertaining to medical directorship, autonomous nonphysician practice, and numeric or geographic restrictions on directorship, with 96% of facilities lacking licensing or registration with Florida’s Agency for Health Care Administration.

Conclusions:
Med spa growth in Florida has been explosive, with continued departure from core supervision, increasingly limited specialty training and integration, and nonadherence to state guidelines. Enhanced regulation and integrated nonphysician practitioner training are likely necessary to ensure patient safety and the cohesive practice of aesthetic medicine and surgery.
Outcomes of Centrally versus Laterally Based Tarsoconjunctival Pedicle Flap Reconstruction for Large, Full-Thickness Lower Eyelid Defects
Authors: Gur Zvi , Chan Alison , Ting Michelle , Alameddine Ramzi , Liu Catherine Y. , Korn Bobby S. , Kikkawa Don O. 
Published: May 2024

Background:
The purpose of this study was to compare the outcomes of 2 types of tarsoconjunctival pedicle flaps for reconstruction of large lower eyelid defects.

Methods:
The authors performed a retrospective medical record review of consecutive patients who underwent centrally or laterally based tarsoconjunctival pedicle transconjunctival flap for lower eyelid reconstruction for defects greater than 50% of the lid margin. Full-thickness skin grafts were used for anterior lamellar reconstruction in all cases. The primary outcome measure was eyelid position, function, and satisfactory appearance.

Results:
A total of 43 patients were identified. Twenty-six patients underwent reconstruction with a centrally based tarsoconjunctival pedicle flap; 17 patients underwent reconstruction with a laterally based tarsoconjunctival pedicle flap. The average size of the lid defect was 77.7% (range, 50% to 100%) in the central group and 75% (range, 50% to 100%) in the lateral group (P = 0.604). Mean follow-up time was 61.5 weeks in the central group and 46.6 weeks in the lateral group (P = 0.765). After division of the flap and during follow-up, 27% of the centrally based group required revisional surgery, versus none in the laterally based group (P = 0.03). All the patients with centrally based flaps required second-stage flap division, whereas only 52% of patients with a laterally based flap underwent second-stage flap division (P < 0.001).

Conclusion:
For reconstruction of large lower lid defects requiring lid-sharing procedures, centrally and laterally based procedures had equivalent functional outcome, but the laterally based group had less need for revisional procedures and may not need a second-stage division of the flap.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Disappearance of “Elongated Pony Tail Sign” Following Chemoradiotherapy in a Case of Primary Cerebellopontine Angle Ependymoma With Spinal Drop Metastasis: 18F-FDG PET/CT Scan Findings
Authors: Krishna Sarin , Ashwathanaryana Abhiram G. , Mishra Rakesh Kumar , Asrani Shubham , Dewangan Vinita 
Published: May 2024

Abstract
Ependymomas are rare glial tumors that commonly arise from the lining cells of ventricular system and constitute ~10% of intracranial pediatric malignancies. The incidence of ependymoma in adults is rare. Due to close approximation with the ventricular system, subtentorial ependymomas are more prone to show cerebrospinal fluid metastasis compared with supratentorial ependymomas. We present a case of subtentorial cerebellopontine angle ependymoma with diffuse spinal drop metastases showing “elongated pony tail appearance” in a 69-year-old man with complete metabolic response on 18F-FDG PET/CT imaging following chemoradiotherapy.
Child-Patient Perspective on Results After Correction of Sagittal Synostosis and the Difference Between Child-Patient and Parent’s Perspectives
Authors: Kurniawan Melissa S.I.C , Kamst Nathalie W. , Mathijssen Irene M.J. , Erler Nicole S. , van Veelen Marie-Lise C. 
Published: May 2024

Objective:
This study assesses the level of child-patient satisfaction with the surgical result after scaphocephaly correction and the difference between child-patient and parents' perspectives.

Methods:
A questionnaire was sent out to children between 6 and 18 years old with isolated sagittal synostosis, who had undergone either a frontobiparietal remodeling or extended strip craniotomy, and separately to their parents.

Results:
The questionnaire was completed by 96 patients, 81.2% of the patients considered their head to be similar or slightly different from others. Despite the majority being satisfied with the outcome, 33% would change the shape of their head if they could. Patients who underwent extended strip craniotomy wanted to change the back of their head more often (P = 0.002), whereas patients who underwent frontobiparietal remodeling wanted to change their forehead (P = 0.005). The patients’ own perspective on head shape was independent of the cephalic index (CI). However, patients with a relatively narrow CI received more remarks from others about their heads (P = 0.038). Parent and child agreement was 49.7% on average. Differences between child-patients and parents were found in reporting adaptive behavior.

Conclusion:
The majority of patients were satisfied with the outcome of their intervention. The child’s perspective seems to be a valuable addition to evaluate sagittal synostosis surgery as it is independent of the CI and differentiates between different surgical techniques. In addition, the patient’s perspective is comparable to the parent’s perspective, but gives more details on adaptive behavior.
Beyond surviving: A scoping review of collaborative care models to inform the future of postdischarge trauma care
Authors: Ilkhani Saba , Comrie Cameron E. , Pinkes Nathaniel , Zier Carolyn L. , Gaudino Shonali G. , Slavin Mary D. , Kazis Lewis E. , Ryan Colleen M. , Schneider Jeffrey C. , Livingston David H. , Salim Ali , Anderson Geoffrey A. , Herrera-Escobar Juan P. 
Published: May 2024

ABSTRACT
Trauma centers demonstrate an impressive ability to save lives, as reflected by inpatient survival rates of more than 95% in the United States. Nevertheless, we fail to allocate sufficient effort and resources to ensure that survivors and their families receive the necessary care and support after leaving the trauma center. The objective of this scoping review is to systematically map the research on collaborative care models that have been put forward to improve trauma survivorship. Of 833 articles screened, we included 16 studies evaluating eight collaborative care programs, predominantly in the United States. The majority of the programs offered care coordination and averaged 9 months in duration. Three fourths of the programs incorporated a mental health provider within their primary team. Observed outcomes were diverse: some models showed increased engagement (e.g., Center for Trauma Survivorship, trauma quality-of-life follow-up clinic), while others presented mixed mental health outcomes and varied results on pain and health care utilization. The findings of this study indicate that collaborative interventions may be effective in mental health screening, posttraumatic stress disorder and depression management, effective referrals, and improving patient satisfaction with care. A consensus on core elements and cost-effectiveness of collaborative care models is necessary to set the standard for comprehensive care in posttrauma recovery.
Resuscitation for injured patients requiring massive transfusion: A personal perspective
Authors: Lucas Charles E. 
Published: May 2024

ABSTRACT
The past century has seen many advances in the field of resuscitation. This is particularly true in the subset of patients who sustain major injuries causing hemorrhagic shock (HS) and require massive transfusion of more than 10 U of blood within the first 24 hours. Controversies on how best to resuscitate these patients include the role of fresh whole blood, stored whole blood, fresh frozen plasma, platelets, colloid solutions, balanced electrolytes solution, vasopressors, and diuretics. This review summarizes the often-contradictory recommendations observed and studied by a single trauma surgeon working in a busy urban acute care center for 65 years.

LEVEL OF EVIDENCE
Level I.