bluuebunny/crossref_metadata_2025_split huggingface dataset:
CGRP, Migraine, and Brain MRI in CADASIL
Authors: Goldstein Eric D. , Gopal Neethu , Badi Mohammed K. , Hodge David O. , de Havenon Adam , Glover Patrick , Durham Paul L. , Huang Josephine F. , Lin Michelle P. , Baradaran Hediyeh , Majersik Jennifer J. , Meschia James F. 
Published: February 2023

Background:
Migraine is associated with neuroimaging differences in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, it is unknown if migraine-related disability (MRD) or if calcitonin gene-related peptide (CGRP), a vasoactive peptide important in migraine pathology, have radiographic implications. The aims of this study were to identify whether MRD or interictal serum CGRP levels impacted neuroimaging findings for those with CADASIL.

Materials and Methods:
A cross-sectional analysis was performed. The primary outcomes were neuroimaging differences associated with MRD among those with migraine or interictal serum CGRP levels of those with and without migraine. MRD was defined by 2 migraine disability scales (Migraine Disability Assessment, Headache Impact Test-6). Retrospective brain magnetic resonance imaging was reviewed (average 1.7 ± 2.0 y before enrollment). Rank-sum and χ2 tests were used.

Results:
Those with migraine (n=25, vs. n=14 without) were younger [median 49 (25 to 82) y vs. 60 (31 to 82) y, P<0.007], had fewer cerebral microbleeds (0 to 31 vs. 0 to 50, P=0.02) and less frequently had anterior temporal lobe T2 hyperintensities [68% (17/25) vs 100% (14/14), P=0.02]. MRD scale outcomes had no significant radiographic associations. Interictal serum CGRP did not differ (migraine: n=18, 27.0±9.6 pg/mL vs. no migraine: n=10, 26.8±15.7 pg/mL, P=0.965).

Conclusions:
Migraine may forestall microangiopathy in CADASIL, though possibly independent of severity as measured by MRD. Interictal serum CGRP did not differ in our cohort suggesting CGRP may not be vital to migraine pathophysiology in CADASIL. Larger studies are needed to account for age differences.
Does Dry Eye Disease Severity Impact Efficacy of Varenicline Solution Nasal Spray on Sign and Symptom Treatment Outcomes?
Authors: Sheppard John D. , O’Dell Leslie E. , Karpecki Paul M. , Raizman Michael B. , Whitley Walter O. , Blemker Gretchen , Hemphill Mandy , Hendrix Laura H. , Gibson Andrea , Macsai Marian 
Published: February 2023

ABSTRACT

Significance
There is a clinical necessity for dry eye disease treatments that perform across a broad range of presenting patient severities. Varenicline solution nasal spray (VNS), a unique cholinergic agonist ocular surface-sparing nasal spray therapy, demonstrated significant improvement in both signs and symptoms of dry eye disease in subjects with mild, moderate and severe symptoms as the clinical studies enrolled a more real-world patient population.

Purpose
This study evaluated efficacy outcomes for VNS in patients with mild-moderate and severe dry eye disease.

Methods
Analysis of integrated data from two randomized clinical trials: ONSET-1 (NCT03636061) and ONSET-2 (NCT04036292) (vehicle control [VC], n = 294; VNS 0.03 mg, n = 308). Adults ≥22 years with dry eye disease, Ocular Surface Disease Index score ≥ 23, corneal fluorescein staining score ≥ 2 in ≥1 regions/≥4 all regions, and Schirmer Test Score (STS) ≤10 mm (no restrictions on eye dryness score [EDS]). Efficacy was evaluated using analysis of covariance among prespecified subgroups of mild-moderate and severe baseline disease severity defined by STS (≤5 versus >5) and EDS (<60 versus ≥60). Consistency of effect was evaluated by interaction tests.

Results
No treatment-subgroup interactions were observed for all end points (P > 0.05). Odds of achieving a ≥ 10 mm improvement in STS for VNS versus VC for patients with baseline STS ≤5 and > 5 were 3.4(95%CI, 2.0–5.6) and 2.3(1.3–4.0); for EDS <60 and ≥ 60 were 3.4(1.9–6.1) and 2.5(1.5–4.0). Least squares mean treatment/VC differences in change from baseline in EDS for patients with baseline STS ≤5 or > 5 were − 7.4(95% confidence interval, −12.5 to −2.4) and − 2.8(−8.7 to 3.1); EDS <60 and ≥ 60 were − 2.9(−8.3 to 2.5) and − 8.1(−13.6 to −2.6).

Conclusions
Compared with VC, VNS improved tear production and patient-reported symptoms in patients with dry eye disease, demonstrating consistency of effect regardless of initial presenting severity.
Learning effect for large joint diagnostic aspirations with fluoroscopy and ultrasound
Authors: Foley Justin , Roesly Heather , Provo Justin , Henrie A. Michael , Teramoto Masaru , Cushman Daniel M. 
Published: February 2023

Abstract

Objective
The first objective was to identify if increased experience, gauged by number of procedures performed post-training, is correlated with greater likelihood of obtaining joint fluid in diagnostic aspirations. The second objective was to identify whether trainee involvement at the time of procedure affected the success rate of the procedure (which in this case was obtaining fluid on aspiration).

Design
This was a retrospective analysis of fluoroscopic- and ultrasound-guided large joint aspirations. Logarithmic fit was performed to identify the presence of a learning curve to the successful attainment of fluid with experience. Logistic regression analysis was used to identify if trainee presence for a procedure affected fluid attainment.

Results
Ultrasound did not demonstrate a significant fit to the logarithmic curve (p = 0.447), while fluoroscopy did (p < 0.001), indicative of a learning curve for fluoroscopy. After adjusting for covariates, joint fluid was successfully attained at a similar rate if trainees were present or not. Significant independent factors related to successful joint fluid attainment were: image guidance technique (p = 0.001), BMI (p = 0.032), and joint aspirated (overall p < 0.001).

Conclusion
There was a statistically significant learning curve for fluoroscopic-guided joint aspirations, but not with ultrasound guidance. Trainee involvement did not affect the success rate of joint aspirations.
Incidence and disease course of COVID-19 infection amongst unvaccinated patients who received local corticosteroid injections
Authors: Okçu Mehmet , Azizov Shahin , Gündüz Osman Hakan , Şencan Savaş 
Published: February 2023

Objective
There are concerns that local corticosteroid injections may increase the risk of COVID-19 infection due to the immunosuppressive effect of corticosteroids. This study aimed to examine the relationship between local corticosteroid injections and the risk of COVID-19 infection.

Design
The date and type of procedure, the dose and type of corticosteroids used in patients who underwent local corticosteroid injections within one year after the first COVID-19 case in the country were examined retrospectively and recorded. Patients who did not receive corticosteroids were included in the control group. COVID-19 infection histories of all patients were recorded.

Results
There was no significant difference between the patients who received local corticosteroids and the control group in terms of the incidence of COVID-19 infections, and the number of patients who needed hospitalization or intensive care treatment. In addition, it was found that the administration of two injections, the type of procedure performed, and the dose and type of steroids were not associated with the incidence or severity of COVID-19 infections.

Conclusion
It has been shown that local corticosteroid injections are not associated with the incidence of COVID-19 infections and the number of patients who need hospitalization or intensive care treatment due to COVID-19.
Interventional Spine Course: Improving Fluoroscopic Safety and Procedural Efficacy Among PM&R Residents Using a Lecture and Model-based Curriculum
Authors: Appeadu Michael , Rosales Richard , Sherman Andrew L , Irwin Robert , Tiozzo Eduard , Price Chanë 
Published: February 2023

Abstract
Therapeutic interventional techniques using fluoroscopy are often utilized in the management of spinal pain. Currently, there are no standardized means of instruction and assessment of fluoroscopic interventional spinal procedures for physiatry trainees. The aim of our study was to evaluate the utility of an interventional spine training course for PM&R residents in improving safety and efficacy when performing these procedures. We performed a prospective multiple cohort study analyzing interventional spine knowledge and procedural ability among PM&R residents after implementing a training course that utilized lectures, hands-on training, and video-recorded OSCE self-assessments. Out of the total of 28 PM&R residents over the two-year study period, each class saw a statistically significant improvement in mean OSCE scores from pre to post-examination (p < 0.05). Written examination scores also had a statistically significant pre to post improvement in the PGY2 and PGY3 classes. Our study supports the use of an interventional spine course for PM&R residents, and by following the existing cohorts and adding more cohorts in the future we will continue to demonstrate valuable and comprehensive results.
A Comparison of Patients Discharged to Skilled Nursing and Inpatient Rehabilitation Facilities Following Hospitalization for COVID-19: A Retrospective Study
Authors: Valbuena Valecillos Adriana D. , Gober Joslyn , Palermo Annie , Johnson-Greene Doug , Shapiro Lauren T. 
Published: February 2023

Abstract

Objectives
To identify differences in demographics, severity of disease, and rates of hospital readmission among adults discharged to skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) following hospitalization for coronavirus-2019 (COVID-19).

Design
Retrospective cohort study of adults hospitalized with COVID-19 infection at academic medical centers participating in the Vizient® Clinical Data Base (CDB) between April 1, 2020 and June 30, 2021 who were discharged to SNFs or IRFs (n = 39,882). Data from the CDB is used with permission of Vizient, Inc. All rights reserved.

Results
Among adults hospitalized with COVID-19 infection, those discharged to SNFs were 1.4 times more likely to require hospital readmission than those discharged to IRFs. They were, on average, older (73 versus 61 years, p < .001) and had shorter hospital lengths of stay (15 versus 26 days, p < .0001) than the patients discharged to IRFs. Persons discharged to IRFs were more likely to have received intensive care and mechanical ventilation while hospitalized (p < .001).

Conclusion
Individuals discharged to IRFs following hospitalization for COVID-19 differ from those discharged to SNFs on a number of key variables, including age, hospital length of stay, having received intensive care, and odds of hospital readmission.
Clinical interpretability of quadriceps strength and gait speed performance in total knee arthroplasty: A longitudinal study
Authors: Pua Yong-Hao , Poon Cheryl Lian-Li , Seah Felicia Jie-Ting , Tan John Wei-Ming , Woon Ee-Lin , Chong Hwei-Chi , Thumboo Julian , Clark Ross Allan , Yeo Seng-Jin 
Published: February 2023

ABSTRACT

Objective
Following a total knee arthroplasty (TKA), physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function.

Design
A sample of 2,624 patients with primary TKA participated in this retrospective longitudinal study. Monthly, for 4 months post-surgery, quadriceps strength and gait speed were quantified. At the Month-6 timepoint, self-reported walking and stair climbing function was measured.

Results
All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher Month-6 self-reported walking and stair climbing function (P-values<0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P-values<0.001). Amongst female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 weeks post TKA.

Conclusions
By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting.
Quantifying Surgical Complications for Reduction Mammaplasty in Adolescents
Authors: Morrison Kerry A. , Vernon Rebecca , Choi Mihye , Karp Nolan S. 
Published: February 2023

Background:
Reduction mammaplasty is a safe, effective procedure to alleviate symptoms of adolescent macromastia. However, there remains limited data on surgical complications associated with reduction mammaplasty in adolescents, which may not be concordant with those cited for adults seeking reduction mammaplasty.

Methods:
A retrospective review was conducted of all consecutively performed reduction mammaplasty cases for symptomatic macromastia in patients aged 20 years old and younger over a seven-year period from 2014 to 2021.

Results:
One hundred sixty total breasts were analyzed in 80 patients. Mean age was 18.3±1.4 years with an age range from 15 to 20 years old. Mean BMI was 27.17±5.49. Mean reduction weight was 584.79±261.19 grams. A medial pedicle was used in 91%, and inferior pedicle in 9%. For skin incision, Wise pattern was used in 60%, and short-scar in 40%. There was a 16.3% rate of any surgical complication, which included wound healing by secondary intention treated with local wound care. There were no significant risk factors for a surgical complication in reduction mammaplasty, and no differences in surgical complications related to skin incision type, pedicle use, or breast reduction weight. Performance of a ROC curve for age at surgery and complication demonstrated that there was no age cut-off where the risk of surgical complication was appreciably increased or decreased.

Conclusion:
Age was not identified as a risk factor for surgical complications in adolescent reduction mammaplasty. Overall, complication rates are very low and minor in nature for adolescent reduction mammaplasty with no significant risk factors identified.
“National Undervaluation of Cleft Surgical Services: Evidence from a Comparative Analysis of 50,450 Cases”
Authors: Rochlin Danielle H. , Chaya Bachar F. , Flores Roberto L. 
Published: February 2023

Background:
Relative value units (RVUs) are broadly used for billing and physician compensation, however the accuracy of RVU assignments has not been scientifically evaluated for craniofacial surgery. We hypothesize that unbalanced RVU allocation creates inappropriate disparities in value amongst procedures performed by cleft and craniofacial surgeons.

Methods:
The NSQIP Pediatric database was queried to identify all cleft and craniofacial surgery cases performed by plastic surgeons from 2012-2019 based on Current Procedural Terminology (CPT) code. Microsurgical cases and CPT codes with a case count of fewer than 10 were excluded. Efficiency was defined as total RVUs divided by total operative time (i.e. RVUs/hour). Mean efficiency per CPT code was ranked and compared by quartile using Student’s t-tests.

Results:
The sample consisted of 69 CPT codes with 50,450 cases. In the top quartile, most CPT codes were craniofacial procedures including frontofacial procedures (23.53%) and craniectomies for craniosynostosis or bony lesions (35.29%) (mean 15.65±4.22 RVUs/hour). The lowest quartile was comprised mainly of CPT codes for cleft procedures including surgeries for velopharyngeal insufficiency (17.65%), cleft palate repair (23.53%), and cleft septoplasty (5.88%) (mean 7.39±0.98 RVUs/hour, p<0.001). It was 2.5 times more efficient for a cleft and craniofacial surgeon to perform a local skin flap (15.18 RVUs/hour) than a secondary palatal lengthening for cleft palate (6.09 RVUs/hour).

Conclusions:
The current RVU allocation to cleft and craniofacial procedures creates arbitrary disparities in physician efficiency, with cleft procedures disproportionately negatively affected. RVU assignments should be reevaluated to avoid disincentivizing cleft surgical care.
A Two Center Review of Three Techniques for Posterior Vault Expansion Following Either a Staged or Expectant Approach to the treatment of Crouzon and Apert Craniosynostosis
Authors: Breakey Richard W.F. , Mercan Ezgi , van de Lande Lara S. , Sidpra Jai , Birgfeld Craig , Lee Amy , Schievano Silvia , Dunaway David J. , Jeelani N. Owase , Hopper Richard A. 
Published: February 2023

Introduction:
Timing of posterior cranial expansion for the management of intracranial pressure can be ‘staged’ by age and dysmorphology or ‘expectant’ by pressure monitoring. We report shared outcome measures from one center performing posterior vault remodeling (PCVR) or distraction (PVDO) following a ‘staged’ approach and another performing spring assisted expansion (SAPVE) following an ‘expectant’ protocol.

Methods:
Apert or Crouzon syndrome cases who underwent posterior expansion less than two years old were included. Perioperative outcomes and subsequent cranial surgeries were recorded up to last follow-up and intracranial volume changes measured and adjusted using growth curves.

Results:
38 patients were included. Following the ‘expectant’ protocol, Apert cases underwent SAPVE at a younger age (8 months) than Crouzon cases (16 months). The initial surgery time was shorter but total operative time, including device removal, longer for PVDO (3:52) and SAPVE (4:34) than for PCVR (3:24). Growth-adjusted volume increase was significant and comparable. 14% PCVR, 33% PVDO, and 11% SAPVE cases had complications, but without long-term deficits. Following the staged approach, 5% only underwent PVDO, 85% had a staged posterior followed by anterior surgery, and 10% required a third expansion. Following the expectant approach, 42% patients had only posterior expansion at last follow-up, 32% had a secondary cranial surgery, and 26% had a third cranial expansion.

Conclusions:
Two approaches involving posterior vault expansion in young syndromic patients using three techniques resulted in comparable early volume expansion and complication profiles.
Effects of an anti-adhesive agent on capsule formation in implant-based breast reconstruction: A randomized controlled trial
Authors: Hong Ki Yong , Kim Il-Kug , Sakong Yong , Park Bo-Yoon , Jin Ung Sik 
Published: February 2023

Background:
Although implant-based breast reconstruction is a common surgical modality, a periprosthetic capsule inevitably forms and worsens in cases of postmastectomy radiation therapy. Previous animal studies have reported that anti-adhesive agents (AAAs) inhibit periprosthetic capsule formation. We prospectively examined the clinical effects of an AAA (Mediclore®) on capsule formation in implant-based breast reconstruction.

Methods:
We analyzed patients who underwent immediate two-stage implant-based breast reconstruction following total mastectomy for breast malignancy between November 2018 and March 2019. Each patient was randomly allocated to the control or AAA group. After inserting the breast expander and acellular dermal matrix, AAA was applied around the expander prior to skin closure. The capsule specimen was obtained during the expander-implant change; capsule thickness and immunohistochemistry were investigated.

Results:
A total of 48 patients were enrolled and allocated to the control (n = 22) and AAA (n = 26) groups. There were no significant differences in patient- and operation-related characteristics. Submuscular capsule thickness was significantly reduced in the AAA group than in the control group. The levels of pro-capsular-forming cells (myofibroblasts, fibroblasts, and M1 macrophages) in the capsule were significantly lower in the AAA group than in the control group.

Conclusions:
AAA reduced the thickness of periprosthetic capsules, and changed the profiles of cells involved in capsule formation during the tissue expansion. These findings demonstrate the clinical value of AAA for mitigating capsule formation in implant-based breast reconstruction.
“Efficacy of Platelet-Rich Plasma Plus Basic Fibroblast Growth Factor on the Treatment of Androgenic Alopecia”
Authors: Qu Qian , He Ye , Guo Zhi , Sun Yang , Fan Zhe-xiang , Yi Yan-hua , Zhu De-cong , Hu Zhi-qi , Miao Yong 
Published: February 2023

Importance:
Studies have identified platelet-rich plasma (PRP) as a novel adjuvant therapy in AGA. However, the efficacy of PRP still needs to be improved.

Objective:
To assess the efficacy of PRP plus basic fibroblast growth factor (PRPF) for the treatment of AGA.

Design, setting, and participants:
This was a prospective randomized, double-blind, placebo-controlled, half-head study. 80 patients whose AGA staged Norwood-Hamilton III–VII or Ludwig I–III were enrolled in the study from February 2019 to September 2019.

Interventions:
Patients were randomly divided into two groups of 40 patients each and were given the following treatment: (Group1) PRPF was injected in right-half and left-half with placebo; (Group2) PRPF was injected in right-half and left-half with PRP.

Main outcomes and measures:
The treatment was processed 3 times, 1 month apart. Hair growth parameters were evaluated by trichoscope monthly until the sixth month of the study. Patients’ satisfaction, hair pull test and side effects were recorded during follow-up.

Results
Of the 80 patients included in the study, 47 were men and 33 were women with a mean age of 28.96±4.82 (ranged from 21 to 46). Both PRP and PRPF showed positive improvement (p<0.05) on hair count, terminal hair and anagen hair after the treatment. Efficacy of PRPF revealed a significant improvement(p<0.05) in hair count, terminal hair, vellus hair and anagen hair versus PRP. There was no statistical difference among any of the parameters in the placebo group.

Conclusions and Relevance
PRPF can be a safe and valuable form of AGA treatment, and has proven to be more effective than PRP.

Trial registration.
Reviewed and approved by research ethics board at Nanfang Hospital, Southern Medical University NFEC-2019-212