bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transorbital Endoscopic Approach to the Foramen Rotundum for Infraorbital Nerve Stripping
Authors: Tong Jessica Y. , Sung Jeffrey , Chan WengOnn , Valentine Rowan , Psaltis Alkis J. , Selva Dinesh 
Published: January 2024

Purpose:
To develop and evaluate a transorbital endoscopic approach to the foramen rotundum to excise the maxillary nerve and infraorbital nerve branch.

Methods:
Cadaveric dissection study of 10 cadaver heads (20 orbits). This technique is predicated upon 1) an inferior orbital fissure release to facilitate access to the orbital apex and 2) the removal of the posterior maxillary wall to enter the pterygopalatine fossa (PPF). Angulations along the infraorbital nerve were quantified as follows: the first angulation was measured between the orbitomaxillary segment within the orbital floor and the pterygopalatine segment suspended within the PPF, while the second angulation was taken between the pterygopalatine segment and maxillary nerve as it exited the foramen rotundum. With refinement of the technique, the minimum amount of posterior maxillary wall removal was quantified in the final 5 cadaver heads (10 orbits).

Results:
The mean distance from the inferior orbital rim to the foramen rotundum was 45.55 ± 3.24 mm. The first angulation of the infraorbital nerve was 133.10 ± 16.28 degrees, and the second angulation was 124.95 ± 18.01 degrees. The minimum posterior maxillary wall removal to reach the PPF was 11.10 ± 2.56 mm (vertical) and 11.10 ± 2.08 mm (horizontal).

Conclusions:
The transorbital endoscopic approach to an en bloc resection of the infraorbital nerve branch up to its maxillary nerve origin provides a pathway to the PPF. This is relevant for nerve stripping in the context of perineural spread. Other applications include access to the superior portion of the PPF in selective biopsy cases or in concurrent orbital pathology.
Experiences of bias in a multidisciplinary hospital medicine group
Authors: Bromberg Gabrielle Kis , Berwick Jessica R. , Horick Nora K. , Burnett-Bowie Sherri-Ann M. 
Published: January 2024

ABSTRACT
Clinicians report experiencing bias at work. Although previous studies have characterized these experiences among trainees and clinical faculty, ours is the first to describe experiences of bias within a multidisciplinary hospital medicine group. In our study, 82.5% of surveyed nurse practitioners (NPs), physician assistants (PAs), and physicians reported experiencing gender, racial, or other forms of bias in the workplace. In addition to women reporting higher rates of gender bias and Asian/Black/Latinx/multiracial/other race respondents reporting higher rates of racial bias, half of participants reported experiencing other forms of bias related to gender expression, perceived sexual orientation, body habitus, age, accent, country of origin, or perceived socioeconomic status. Respondents infrequently addressed bias with the person expressing it. Our study expands on the existing literature about experiences of bias by studying a large, multidisciplinary, academic hospital medicine group. With the increasing inclusion of NPs and PAs in hospital medicine, understanding their experiences will enable development of tailored interventions to reduce harm from experiences of bias.
The effectiveness of fire needle therapy in the treatment of recurrent aphthous stomatitis: A systematic review and meta-analysis
Authors: Wu Yuxiang , Cheng Zhenda , Ma Weiwei , Li Zhaodong , Weng Punan , Li Bushuang , Zhao Wenjie 
Published: January 2024

Background:
Recurrent aphthous stomatitis (RAS) is common in clinical practice and imposes both physical and psychological distress on patients.

Objective:
This study aimed to evaluate the clinical effectiveness of fire needle therapy for the treatment of RAS, providing a basis for clinical decision-making.

Methods:
Eight databases, in both Chinese and English, were searched from their inception until December 2022. All randomized controlled trials (RCTs) that utilized fire needle therapy, either alone or combined with other treatments for RAS, were considered. Data evaluation and extraction were conducted independently by 2 authors.

Results:
The revised Cochrane Risk of Bias Version 2 tool was employed to assess the risk of bias in the included RCTs. A meta-analysis was conducted using Review Manager 5.4 and Stata 15.0. Nine RCTs involving 1469 patients were selected for inclusion. The meta-analysis revealed that, compared to a non-fire-needle control group (primarily utilizing vitamin and transfer factor treatments), fire needle therapy for RAS significantly improved the total effective rate (relative risk = 1.25, 95% confidence interval [CI] [1.14, 1.36], P < .00001), reduced the visual analogue scale score (mean difference = −1.68, 95% CI [−1.82, −1.53], P < .0001), diminished the Traditional Chinese Medicine symptom score (standardized mean difference = −1.20, 95% CI [−1.76, −0.65], P < .0001), and shortened the healing time (mean difference = −1.66, 95% CI [−2.73, −0.59], P = .002). Notably, there was no significant difference in the recurrence rate between the groups (relative risk = −0.18, 95% CI [−0.36, 0.01], P = .06). Further subgroup analysis on total efficacy rate was performed based on variables such as experimental group intervention, control group intervention, and duration of therapy to explore potential sources of heterogeneity.

Conclusion:
Fire needle therapy appears to be a clinically effective treatment for RAS, offering benefits such as pain alleviation, symptom improvement based on the Traditional Chinese Medicine parameters, and faster recovery. Nonetheless, the overall quality of the RCTs available raises concerns. Future research, involving high-quality RCTs, is essential to confirm the clinical efficacy and safety of this treatment. Registration number: PROSPERO (CRD42023387973).
The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis
Authors: Han Congli , Tang Jiqin , Tang Bingshun , Han Tao , Pan Jienuo , Wang Nan 
Published: January 2024

Background:
Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis.

Methods:
Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software.

Results:
Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions.

Conclusion:
The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.
Scapular dislocation following radical surgical excision of lung sarcomatoid carcinoma: A rare case report
Authors: Wu Qiang , Qiao Kun , Liu Jixian , Zhen Shuo , Zhou Zizi 
Published: January 2024

Rationale:
Scapular prolapse is a rare complication of thoracotomy. Only a few cases of scapular prolapse after thoracotomy have been reported. Here, we report the case of a 52-year-old male patient who underwent standard posterior thoracotomy for lung sarcomatoid carcinoma invading the left upper chest wall.

Patient concerns:
The surgery was performed to remove some ribs and chest wall muscles; however, no reconstruction or repair of the chest wall defect was performed. The patient experienced a sharp pain and severe limitation of movement of the left shoulder within 1 month of receiving adjuvant therapy.

Diagnoses:
The patient was diagnosed with left intrathoracic scapular prolapse after careful consideration of medical history, physical examination, and chest radiography.

Interventions:
We performed closed manual reduction because the patient refused to undergo surgery.

Outcomes:
The patient’s shoulder pain and movement limitation were significantly relieved, but the symptoms relapsed. After repeated closed manual reduction, the patient was instructed not to abduct the shoulder joint above 90°. The patient did not relapse during a 1-year observation period.

Conclusion:
If scapular prolapse occurs, manual or surgical reduction can be selected based on the needs. If a patient refuses to undergo surgery, manual reduction can be an effective treatment method.
Abnormal bleeding after lumbar vertebrae surgery because of acquired factor XIII deficiency: A case report and literature review
Authors: Zhang Peng , Zhang Ruijing , Jing Cheng 
Published: January 2024

Rationale:
Abnormal bleeding due to low fibrinogen (Fib) and coagulation factor XIII (FXIII) levels after lumbar vertebral surgery is exceedingly rare. Excessive bleeding is also associated with secondary hyperfibrinolysis. This report presents a case of abnormal incision bleeding caused by coagulation factor XIII deficiency (FXIIID) and secondary hyperfibrinolysis in a state of low fibrinogen after lumbar vertebral surgery.

Patient concerns:
A middle-aged woman experienced prolonged incision and excessive bleeding after lumbar vertebral surgery.

Diagnosis:
Combined with coagulation factors, coagulation function tests, and thromboelastography, the patient clinical presentation supported the diagnosis of FXIIID and secondary hyperfibrinolysis in a hypofibrinogenemic state.

Interventions:
Cryoprecipitat, Fresh Frozen Plasma, Fibrinogen Concentrate, Leukocyte-depleted Red Blood Cells, Hemostatic (Carbazochrome Sodium Sulfonate; Hemocoagulase Bothrops Atrox for Injection; Tranexamic Acid).

Outcomes:
After approximately a month of replacement therapy and symptom treatment, the patient coagulation function significantly improved, and the incision healed without any hemorrhage during follow-up.

Lessons:
Abnormal postoperative bleeding may indicate coagulation and fibrinolysis disorders that require a full set of coagulation tests, particularly coagulation factors. Given the current lack of a comprehensive approach to detect coagulation and fibrinolysis functions, a more comprehensive understanding of hematology is imperative. The current treatment for FXIIID involves replacement therapy, which requires supplementation with both Fib and FXIII to achieve effective hemostasis.
Diagnostic Utility of Restriction Spectrum Imaging in Head and Neck Tumors: A Pilot Study
Authors: Baris Mustafa Mahmut , Quarterman Patrick , Shin Jaemin , Fung Maggie M. , Jambawalikar Sachin R. , Moonis Gul 
Published: January 2024

Objective
Imaging is crucial in the assessment of head and neck cancers for site, extension, and enlarged lymph nodes. Restriction spectrum imaging (RSI) is a new diffusion-weighted magnetic resonance imaging (MRI) technique that enhances the ability to differentiate aggressive cancer from low-grade or benign tumors and helps guide treatment and biopsy. Its contribution to imaging of brain and prostate tumors has been previously published. However, there are no prior studies using RSI sequence in head and neck tumors. The purpose of this study was to evaluate the feasibility of performing RSI in head and neck cancer.

Methods
An additional RSI sequence was added in the routine MRI neck protocol for 13 patients diagnosed with head and neck cancer between November 2018 and April 2019. Restriction spectrum imaging sequence was performed with b values of 0, 500, 1500, and 3000 s/mm2 and 29 directions on 1.5T magnetic resonance scanners.
Diffusion-weighted imaging (DWI) images and RSI images were compared according to their ability to detect the primary malignancy and possible metastatic lymph nodes.

Results
In 71% of the patients, RSI outperformed DWI in detecting the primary malignancy and possible metastatic lymph nodes, whereas in the remaining cases, the 2 were comparable. In 66% of the patients, RSI detected malignant lymph nodes that DWI/apparent diffusion coefficient failed to detect.

Conclusions
This is the first study of RSI in head and neck imaging and showed its superiority over the conventional DWI sequence. Because of its ability to differentiate benign and malignant lymph nodes in some cases, the addition of RSI to routine head and neck MRI should be considered.
Surgical Delay of Thoracodorsal Artery Perforator Flaps for Total Autologous Breast Reconstruction
Authors: Maier Mark A. , Hoffman Ryan D. , Kordahi Anthony M. , Levine Joshua , St. Hilaire Hugo , Allen Robert J. 
Published: January 2024

Background
When abdomen-based free flap reconstruction is contraindicated, the muscle-sparing thoracodorsal artery perforator (TDAP) flap may be considered for total autologous breast reconstruction. The TDAP flap is often limited by volume and is prone to distal flap necrosis. We aim to demonstrate our experience combining the delay phenomenon with TDAP flaps for total autologous breast reconstruction.

Methods
Patients presenting for autologous breast reconstruction between April 2021 and August 2023 were recruited for surgically delayed TDAP flap reconstruction when abdominally based free flap reconstruction was contraindicated because of previous abdominal surgery or poor perforator anatomy. We dissected the TDAP flap except for a distal skin bridge and then reconstructed the breast 1 to 7 days later. Data included flap dimensions (in centimeters × centimeters), delay time (in days), predelay and postdelay perforator caliber (in millimeters) and flow (in centimeters per second), operative time (in minutes), hospital length of stay (in days), complications/revisions, and follow-up time (in days).

Results
Fourteen patients and 16 flaps were included in this study. Mean age and body mass index of patients were 55.9 ± 9.6 years and 30.1 ± 4.3 kg/m2, respectively. Average flap skin island length and width were 32.1 ± 3.3 cm (n = 8 flaps) and 8.8 ± 0.7 cm (n = 5 flaps), respectively. Beveled flap width reached 16.0 ± 2.2 cm (n = 3 flaps). Average time between surgical delay and reconstruction was 2.9 days, ranging from 1 to 7 days (n = 18 flaps). Mean predelay and postdelay TDAP vessel caliber and flow measured by Doppler ultrasound increased from 1.4 ± 0.3 to 1.8 ± 0.3 mm (P = 0.03) and 13.3 ± 5.2 to 43.4 ± 18.8 cm/s (P = 0.03), respectively (n = 4 flaps). Complications included 1 donor site seroma and 1 mastectomy skin flap necrosis. Follow-up ranged from 4 to 476 days (n = 17 operations).

Conclusions
We demonstrate surgically delayed TDAP flaps as a viable option for total autologous breast reconstruction. Our series of flaps demonstrated increased perforator caliber and flow and enlarged volume capabilities and had no incidences of flap necrosis.
Temporary Portocaval Shunt Provides Superior Intra-operative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation
Authors: YL Manoj Kumar , Patil Nilesh Sadashiv , Mohapatra Nihar , Sindwani Gaurav , Dhingra Udit , Yadav Anil , Kale Pratibha , Pamecha Viniyendra 
Published: January 2024

Objective:
The primary objectives were to compare intra operative hemodynamic parameters, blood loss, renal function, and duration of surgery with and without TPCS in live donor liver transplantation (LDLT) recipients. Secondary objectives were post-operative early graft dysfunction (EGD), morbidity, mortality, total ICU and hospital stay.

Background:
Blood loss during recipient hepatectomy for liver transplantation (LT) remains a major concern. Routine use of temporary portocaval shunt (TPCS) during LT is not yet elucidated.

Methods:
A single centre, open label, randomized control trial. The sample size was calculated based on intraoperative blood loss. After exclusion, a total of 60 patients, 30 in each arm (TPCS versus no TPCS) were recruited in the trial.

Results:
The baseline recipient and donor characteristics were comparable between the groups. The median intra-operative blood loss (P = 0.004) and blood product transfusions (P<0.05) were significantly less in TPCS group. TPCS group had significantly improved intraoperative hemodynamics in anhepatic phase as compared to no-TPCS group (P<0.0001), requiring significantly less vasopressor support. This led to significantly better renal function as evidenced by higher intraoperative urine output in TPCS group (P=0.002). Because of technical simplicity, TPCS group had significantly fewer IVC injuries (3.3 vs. 26.7%, P=0.026) and substantially shorter hepatectomy time and total duration of surgery (529.4 ± 35.54 vs. 606.83 ± 48.13 mins, P<0.0001). ). Time taken for normalisation of lactate in the immediate post-operative period was significantly shorter in TPCS group (median, 6 h vs. 13 h; P=0.04). Although post-operative endotoxemia, major morbidity, 90day mortality, total ICU and hospital stay were comparable between both the groups, tolerance to enteral feed was earlier in the TPCS group.

Conclusion:
In LDLT, TPCS is a simple and effective technique that provides superior intraoperative hemodynamics and reduces blood loss and duration of surgery.
Predictive models of epilepsy outcomes
Authors: Sheikh Shehryar , Jehi Lara 
Published: January 2024

Purpose of review
Multiple complex medical decisions are necessary in the course of a chronic disease like epilepsy. Predictive tools to assist physicians and patients in navigating this complexity have emerged as a necessity and are summarized in this review.

Recent findings
Nomograms and online risk calculators are user-friendly and offer individualized predictions for outcomes ranging from safety of antiseizure medication withdrawal (accuracy 65–73%) to seizure-freedom, naming, mood, and language outcomes of resective epilepsy surgery (accuracy 72–81%). Improving their predictive performance is limited by the nomograms’ inability to ingest complex data inputs. Conversely, machine learning offers the potential of multimodal and expansive model inputs achieving human-expert level accuracy in automated scalp electroencephalogram (EEG) interpretation but lagging in predictive performance or requiring validation for other applications.

Summary
Good to excellent predictive models are now available to guide medical and surgical epilepsy decision-making with nomograms offering individualized predictions and user-friendly tools, and machine learning approaches offering the potential of improved performance. Future research is necessary to bridge the two approaches for optimal translation to clinical care.
The Leading Causes of Optic Disc Edema Seen in Tertiary Care, Academic Neuro-Ophthalmology Clinics
Authors: Jhaveri Aaditeya , Pandya Bhadra , Shamshad Farooq , Soor Deep , Margolin Edward , Micieli Jonathan A. 
Published: January 2024

Background:
Optic disc edema (ODE) is one of the most common reasons for referral to a neuro-ophthalmologist. There are various causes that require vastly different workup. Thus, differentiating among each cause is important. Our goal was to determine the causes of ODE and various clinical characteristics of consecutive patients with ODE presenting to neuro-ophthalmology clinics.

Methods:
A retrospective review of consecutive patients with ODE over a period of 5 years were included. Fundus photographs were routinely obtained as part of clinical care. Clinical data including retinal nerve fiber layer thickness, best-corrected visual acuity, and visual field mean deviation were retrieved, and patients were grouped by etiology.

Results:
A total of 654 patients (n = 462 or 70.6% women and 192 or 29.4% men) with ODE were included with a mean age of 41.2 ± 17.9 years. Female patients were significantly younger than male patients (mean age female participants: 38.7 years, male participants: 47.6; P < 0.001). The top 5 most common causes of ODE in our clinics were idiopathic intracranial hypertension (IIH; 351/654 or 53.7%), nonarteritic anterior ischemic optic neuropathy (NAION; 116/654 or 17.4%), non-IIH papilledema (71/654 or 10.9%), optic neuritis (ON; 46/654 or 7.0%), and uveitis (17/654 or 2.6%). When considering female-only patients, the top 3 causes of ODE were IIH, non-IIH papilledema, and NAION. Among male-only patients, the top 3 causes were NAION, IIH, and non-IIH. Among the top 5 causes of ODE, visual acuity was the worst at presentation in the ON group and the best in the patients with IIH. The Humphrey mean deviation was the worst in ON/NAION groups and best in IIH group. The ODE was most severe in patients with non-IIH papilledema and least severe in ON group. Non-IIH patients with papilledema were not significantly different in visual acuity and visual field parameters at presentation compared with patients with IIH papilledema. Patients with papilledema (both IIH and non-IIH etiologies) had significantly better visual function at presentation compared with other top causes of disc edema (P < 0.001).

Conclusions:
The most common cause of ODE seen in neuro-ophthalmology clinics was IIH, and these patients were more likely to present with preserved visual function. The higher prevalence of IIH was likely why most patients with ODE were women. Visual function at presentation was not able to differentiate the specific cause of papilledema; however, it was an important differentiating factor for all papilledema cases compared with all other causes of ODE including ON and NAION.