bluuebunny/crossref_metadata_2025_split huggingface dataset:
Appropriate Telemedicine Utilization in Spine Surgery
Authors: Iyer Sravisht , Bovonratwet Patawut , Samartzis Dino , Schoenfeld Andrew J. , An Howard S. , Awwad Waleed , Blumenthal Scott L. , Cheung Jason P.Y. , Derman Peter B. , El-Sharkawi Mohammad , Freedman Brett A. , Hartl Roger , Kang James D. , Kim Han Jo , Louie Philip K. , Ludwig Steven C. , Neva Marko H. , Pham Martin H. , Phillips Frank M. , Qureshi Sheeraz A. , Radcliff Kris E. , Riew K. Daniel , Sandhu Harvinder S. , Sciubba Daniel M. , Sethi Rajiv K. , Valacco Marcelo , Zaidi Hasan A. , Zygourakis Corinna C. , Makhni Melvin C. 
Published: February 2022

Study Design.
Delphi expert panel consensus.

Objective.
To obtain expert consensus on best practices for appropriate telemedicine utilization in spine surgery.

Summary of Background Data.
Several studies have shown high patient satisfaction associated with telemedicine during the COVID-19 peak pandemic period as well as after easing of restrictions. As this technology will most likely continue to be employed, there is a need to define appropriate utilization.

Methods.
An expert panel consisting of 27 spine surgeons from various countries was assembled in February 2021. A two-round consensus-based Delphi method was used to generate consensus statements on various aspects of telemedicine (separated as video visits or audio visits) including themes, such as patient location and impact of patient diagnosis, on assessment of new patients. Topics with ≥75% agreement were categorized as having achieved a consensus.

Results.
The expert panel reviewed a total of 59 statements. Of these, 32 achieved consensus. The panel had consensus that video visits could be utilized regardless of patient location and that video visits are appropriate for evaluating as well as indicating for surgery multiple common spine pathologies, such as lumbar stenosis, lumbar radiculopathy, and cervical radiculopathy. Finally, the panel had consensus that video visits could be appropriate for a variety of visit types including early, midterm, longer term postoperative follow-up, follow-up for imaging review, and follow-up after an intervention (i.e., physical therapy, injection).

Conclusion.
Although telemedicine was initially introduced out of necessity, this technology most likely will remain due to evidence of high patient satisfaction and significant cost savings. This study was able to provide a framework for appropriate telemedicine utilization in spine surgery from a panel of experts. However, several questions remain for future research, such as whether or not an in-person consultation is necessary prior to surgery and which physical exam maneuvers are appropriate for telemedicine.

Level of Evidence: 4
The Impact of Spinopelvic Parameters on Hip Degeneration After Spinal Fusion
Authors: Kawai Toshiyuki , Shimizu Takayoshi , Goto Koji , Kuroda Yutaka , Okuzu Yaichiro , Otsuki Bungo , Fujibayashi Shunsuke , Matsuda Shuichi 
Published: February 2022

Study Design.
Retrospective cohort study.

Objective.
This study aimed to investigate the effects of spinopelvic alignment parameters after spinal fusion on the rate of joint space narrowing in nonarthritic hips.

Summary of Background Data.
Spinal fusion affects the forces on the adjacent hip joint. Therefore, hip joint narrowing may be increased after spinal fusion surgery. However, the relationship between spinal alignment and hip degeneration remains unclarified.

Methods.
We retrospectively reviewed data from patients who underwent lumbar spinal fusion from 2011 to 2018 at our institute. Patients with hip osteoarthritis (Kellgren-Lawrence grade ≥II) or hip dysplasia were excluded. The rate of hip joint space narrowing after spinal fusion was measured in 191 patients (382 hips). We assessed the effects of the following spinopelvic alignment parameters on the joint narrowing rate: pelvic tilt, sacral slope (SS), pelvic incidence (PI), lumbar lordosis (LL), PI-LL, sagittal vertical axis, and distance between the C7 plumb line, and the central sacral vertical line (C7-CSVL).

Results.
The hip joint narrowing rate was greater when four or more levels were fused compared with single-level fusion. After adjusting for the effects of patient-related factors, the alignment parameters significantly associated with the hip joint narrowing rate were the PI (P = 0.0002), SS (P = 0.047), and PI-LL (P = 0.0022). A subgroup analysis of patients who underwent long fusion (four or more levels combined with iliac screws) also indicated that the PI (P = 0.013), SS (P = 0.0054), and PI-LL (P = 0.046) were associated with the hip joint narrowing rate.

Conclusion.
The PI, SS, and PI-LL were associated with the progression of hip joint narrowing after spinal fusion, especially after fusion of four or more levels. Surgeons need to be aware of the risk of increased hip joint narrowing in patients with a large PI, SS, and PI-LL after fusion surgery.
Racial and Gender Differences in Patient Satisfaction Scores Among Oncologists
Authors: Odei Bismarck C. , Pan Xueliang , Bello-Pardo Erika , Mitchell Darrion , Thomas Charles R. , Diaz Dayssy A. 
Published: February 2022

Background:
Patient satisfaction scores (PSS) have been adopted in health care reimbursement and faculty promotion metrics. Oncology patients face a challenging prognosis, where PSS may be perceived differently. We hypothesized that PSS differed based on gender and racial demographics of oncologists.

Materials and Methods:
This was an institutional review board exempt cross-sectional study utilizing PSS data for outpatient oncologists within a large comprehensive cancer center. Patient demographics included age, gender, race/ethnicity, geographical residence, and disease site. Characteristics of oncologists included gender and race/ethnicity. We used PSS ≥95 to make comparisons. The association between patient and physician characteristics were evaluated using the t test and χ2 test.

Results:
A total of 15,849 oncology patients were identified between 2011 and 2020. Survey respondents were predominantly female (53.2%), white (93.4%), between 50 and 70 years of age (55.3%), and living in an urban setting (63.6%). There were 303 oncologists with the majority being male (64.4%) and white (58.1%). Compared with white oncologists, Asian and Hispanic oncologists received lower PSS (P=0.001 and 0.0085, respectively). On subset analysis, these differences were significant among patients older than 50 years, living in rural counties, and reporting white or non-Hispanic race/ethnicity, or among patients of either gender (all P<0.05). Patients with genitourinary malignancies provided lower PSS for female oncologists (P=0.005).

Conclusions:
Asian and Hispanic oncologists were more likely to receive lower PSS. In addition, female oncologists treating genitourinary malignancies received lower PSS. Appropriate statistical adjustments are needed for PSS among oncologists to account for race, gender, and physician subspecialization to allow for equitable professional opportunities across demographics.
Usage Patterns of an mHealth Symptom Monitoring App Among Adolescents With Acute Mild Traumatic Brain Injuries
Authors: Schmidt Matthew , Babcock Lynn , Kurowski Brad G. , Cassedy Amy , Sidol Craig , Wade Shari L. 
Published: February 2022

Objective:
To understand usage patterns of SMART (Self-Monitoring Activity Regulation and Relaxation Treatment) mHealth app among adolescents with acute mild traumatic brain injuries (mTBIs) and to identify individual characteristics that influenced app usage.

Methods:

Setting:
Emergency departments of tertiary care children's medical center.

Participants:
Children aged 11 to 18 years with mTBI in the past 2 weeks, English-speaking, no evidence of severe TBI, and no preexisting neurological impairment.

Design:
Nested cohort of the intervention arm of a randomized clinical trial (n = 34).

mHealth App Intervention:
SMART was a month-long educational program on mTBI designed to promote self-monitoring and management of recovery. SMART included digital symptom and activity self-monitoring surveys, feedback on symptom changes, and 8 modules providing psychoeducation, strategies for symptom management, and training in active problem solving.

Main Measures:
App usage time, navigation, and interaction data were automatically collected. Usage involved inputting symptom ratings/activities and reviewing modules. Patterns of symptom/activity reporting and completion of learning modules data were analyzed. Predictors of app utilization, including individual characteristics, resilience (Connor-Davidson Resilience Scale), and coping (Coping Strategies Inventory-Short Form), were analyzed using Spearman correlations.

Results:
Participants completed symptom monitoring an average of 9 days over the month. Participants completed an average of 1.87 learning modules out of 7. Parent income and education, comorbid attention-deficit/hyperactivity disorder (ADHD), and emotional engagement coping style predicted symptom monitoring. Parental income, comorbid ADHD, and greater reliance on emotional engagement coping predicted module completion.

Significant Adverse Events:
None.

Conclusion:
Adolescents of higher socioeconomic status and those who manage their emotions using active engagement spent more time on both components of the SMART program.
PREDICTORS OF RETINAL PIGMENT EPITHELIUM TEAR DEVELOPMENT AFTER TREATMENT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION USING SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Yasuhara Satoshi , Miyata Manabu , Ooto Sotaro , Tamura Hiroshi , Ueda-Arakawa Naoko , Uji Akihito , Muraoka Yuki , Miyake Masahiro , Takahashi Ayako , Wakazono Tomotaka , Yamashiro Kenji , Tsujikawa Akitaka 
Published: February 2022

Purpose:
The purpose of this study was to investigate the predictors of retinal pigment epithelium (RPE) tear development after treatment for neovascular age-related macular degeneration using swept source optical coherence tomography angiography.

Methods:
This prospective study included 152 treatment-naïve eyes with neovascular age-related macular degeneration without high myopia that were followed up for 1 year after treatment. Eligible eyes were classified into eyes with or without RPE tear development. They were matched in a 1:2 ratio. The areas of choroidal neovascularization (CNV) and RPE detachment (pigment epithelial detachment [PED]) were measured from optical coherence tomography angiography and OCT en face images, respectively. The optical coherence tomography angiography–specific parameters representing CNV status were analyzed.

Results:
Eight (5.3%) of the 152 eyes developed RPE tears (RPE tear group). After matching, 16 eyes without RPE tears were analyzed (non-RPE tear group). The ratio of the CNV/PED area was lower in the RPE tear group than that in the non-RPE tear group (P = 0.007). The PED area was broader (P = 0.008), and PED height was greater in the RPE tear group (P = 0.04). Optical coherence tomography angiography–specific parameters did not differ between the two groups.

Conclusion:
Neovascular age-related macular degeneration with pretreatment broad PED, high PED, and small CNV area relative to the PED area has a high risk of RPE tear development after therapy. However, CNV status may not have an association.
ENDOGENOUS ENDOPHTHALMITIS DUE TO STREPTOCOCCUS ANGINOSUS IN A HEALTHY, YOUNG WOMAN
Authors: Lin Jonathan B. , Eliott Dean , Sobrin Lucia , Stryjewski Tomasz P. 
Published: February 2022

Purpose:
The purpose of this study was to present a case of indolent endogenous endophthalmitis in a young, seemingly healthy woman.

Methods:
This study is a retrospective case report.

Results:
A 25-year-old woman with no significant medical history presented with vision loss in the left eye over the course of 1 month. Examination showed vitritis and a white–yellow lesion overlying the macula and optic nerve in the left eye. Initial laboratory testing for infectious and inflammatory causes was unrevealing. A diagnostic vitrectomy was performed, and the patient was found to have presumed endogenous endophthalmitis due to Streptococcus anginosus, an extremely uncommon bacterium. Subsequent workup did not reveal evidence of bacteremia, endocarditis, or orbital infection. This case is unique because, unlike the three previously reported cases of S. anginosus endophthalmitis, this patient was seemingly healthy, never had an elevated white blood cell count, never had documented bacteremia, had a normal echocardiogram, and had normal orbital findings on magnetic resonance imaging and computed tomography scans. Further questioning revealed a remote history of facial cellulitis and possible sinusitis treated with oral antibiotics, which are the presumed etiology.

Conclusion:

Streptococcus anginosus endophthalmitis can occur in young, seemingly healthy patients. Endogenous endophthalmitis should be considered in the differential diagnosis even without systemic comorbidities or other risk factors. Detailed questioning about medical history and thorough review of systems, including nonocular symptoms, are essential.
VOGT–KOYANAGI–HARADA DISEASE-LIKE UVEITIS IN A PATIENT WITH ADVANCED MELANOMA TREATED BY SEQUENTIAL ADMINISTRATION OF NIVOLUMAB AND DABRAFENIB/TRAMETINIB THERAPY
Authors: Madoe Aline , Schauwvlieghe Pieter-Paul , Jacob Julie 
Published: February 2022

Purpose:
To describe a case of bilateral Vogt–Koyanagi–Harada (VKH)-like uveitis during treatment with dabrafenib and trametinib and three months after discontinuation of nivolumab for malignant melanoma, and discuss the possible (synergistic) role(s) of mitogen-activated protein kinase (MAPK) inhibitors and immune checkpoint inhibitors in its pathophysiology.

Methods:
Retrospective case report with fluorescein angiography and optical coherence tomography.

Results:
A 55-year old patient with metastatic melanoma presented with a complaint of gradually worsening blurry vision in the right eye during treatment with dabrafenib and trametinib, three months after discontinuation of nivolumab. Based on the clinical examination, optical coherence tomography and fluorescein angiography findings, and a thorough laboratory work-up, he was diagnosed with a bilateral VKH-like uveitis without extraocular manifestations. The uveitis responded well to oral corticosteroids.

Conclusion:
Vogt–Koyanagi–Harada-like uveitis is a rare adverse effect of MAPK inhibitors and immune checkpoint inhibitors. Similar pathogenetic mechanisms including a drug-induced autoimmunity targeted against benign and malignant melanocytes may underlie MAPK inhibitor-induced and immune checkpoint inhibitors-induced VKH-like uveitis. In our report, the patient developed a VKH-like uveitis during MAPK inhibition therapy, four months after discontinuation of nivolumab. It is difficult to delineate whether MAPK inhibition alone was responsible for this adverse effect, or whether, on the contrary, potentiation occurred as a result of immune modulation by previous treatment with an immune checkpoint inhibitor. Further cases are needed to further clarify this latter hypothesis.
SPONTANEOUS FORMATION AND RESOLUTION OF A LAMELLAR HOLE IN A PATIENT SUCCESSFULLY TREATED FOR DIABETIC MACULAR EDEMA WITH A FLUOCINOLONE ACETONIDE IMPLANT
Authors: Shah Saumya M. , Bakri Sophie J. 
Published: February 2022

Purpose:
The purpose of this study was to report a case of spontaneous formation and resolution of a lamellar macular hole in a patient with diabetic macular edema treated with steroid implants.

Methods:
This study is a case report.

Results:
A 53-year-old man presented with blurry vision and was found to have diabetic macular edema that remained refractory to treatment despite multiple short-term intravitreal steroid implants. He was eventually treated with an intravitreal fluocinolone acetonide implant and was subsequently noted to have developed a lamellar macular hole that then resolved spontaneously without any additional therapy.

Conclusion:
There can be spontaneous formation and resolution of lamellar holes in the treatment of diabetic macular edema because of reorganization of the inner retinal layers, without significant impact on visual acuity. To the best of our knowledge, this finding has not been previously reported.
Bacterial and Fungal Gut Dysbiosis and Clostridium difficile in COVID-19
Authors: Linares-García Laura , Cárdenas-Barragán María E. , Hernández-Ceballos Winston , Pérez-Solano Carlos S. , Morales-Guzmán Alizon S. , Miller Danielle S. , Schmulson Max 
Published: February 2022

Background:
Gastrointestinal symptoms are common in Coronavirus Disease 2019 (COVID-19), related to infection of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) of intestinal cells through the angiotensin converting enzyme 2 (ACE2) receptor in the brush border. Also, patients are treated with multiple antibiotics. Therefore, an increase in gut dysbiosis and in the prevalence of Clostridium difficile infection (CDI) is expected in patients with COVID-19.

Methods:
A PubMed search was conducted using the terms “gut microbiota,” “gut mycobiota,” “dysbiosis” AND “COVID-19”; “Clostridium difficile,” “Clostridioides difficile” AND “COVID-19”; “probiotics,” “bacteriotherapy AND COVID-19.” Only case series, observational and experimental studies were included.

Results:
A total of 384 papers were retrieved and 21 fulfilled selection criteria. Later, a new paper was identified, thus 22 papers were reviewed. Main findings: (1) gut bacterial dysbiosis has been found in fecal samples of COVID-19 patients, with enrichment of opportunistic organisms and decrease of beneficial commensals such as Faecalibacterium prausnitizii. Dysbiosis is related to inflammatory markers and illness severity. (2) There is evidence for abnormal gut barrier and bacterial translocation with a negative impact in the lungs. (3) Fungal dysbiosis correlating with pulmonary mycobiota, has also been found. (4) There is controversy in the CDI rates among COVID-19 patients versus controls and pandemic versus prepandemic era. (5) There is no available evidence yet to support bacteriotherapy in COVID-19. (6) Fecal microbiota transplantation (FMT) has been proposed for COVID-19, although there is no evidence to support it. Also, FMT can be safely used during the pandemic for CDI if strict screening protocols for donors and fecal product are implemented.

Conclusions:
In COVID-19 there is bacterial and fungal dysbiosis that correlates with systemic and pulmonary inflammation, and illness severity. Further investigations are warranted to determine the efficacy of bacteriotherapy and FMT for modulating gut dysbiosis in COVID-19.
Recognizing vitamin A deficiency: special considerations in low-prevalence areas
Authors: Song Ailin , Mousa Hazem M. , Soifer Matias , Perez Victor L. 
Published: February 2022

Purpose of review
Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas.

Recent findings
Vitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in at-risk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD.

Summary
Even in well resourced countries, VAD should remain on the differential in patients with risk factors who present with relevant signs and symptoms. Early diagnosis and appropriate involvement of a multidisciplinary care team can help prevent morbidity and mortality associated with VAD.
Advantages of Proactive Therapeutic Drug Monitoring in a Prospective Cohort of Children With Inflammatory Bowel Disease Treated With Anti‐Tumour Necrosis Factor
Authors: Gasparetto Marco , Burgess Natasha , Naik Sandhia , Studart Dominic , Kadir Ahmed , Croft Nick , Sanderson Ian , Deb Protima 
Published: February 2022

ABSTRACTFew studies have addressed whether proactive therapeutic drug monitoring (TDM) results in improved clinical outcomes in children with inflammatory bowel disease (IBD) treated with anti‐tumour necrosis factor. The aim of this study was to investigate the impact of using proactive TDM in this patient group.Pilot single‐centre observational study to accrue data on patients managed with proactive TDM.More patients in the proactive TDM cohort were managed by escalating the infliximab (IFX) regime (P < 0.001). The need for switching to different biologics was significantly lower in this patient group (P < 0.001).The introduction of proactive TDM resulted in a significant reduction of patients requiring switch of their primary biologic. The results of this study are indicators that proactive TDM offers a better method of managing children with IBD on IFX therapy.
The Utility of Functional Luminal Imaging Probes Measurements to Diagnose Dysmotility and Their Relationship to Impaired Bolus Clearance
Authors: Rosen Rachel , Stayn Zachary , Garza Jose M. , DiFilippo Courtney , Cohen Alexandra , Kane Madeline , Wall Stephanie , Nurko Samuel 
Published: February 2022

ABSTRACTBackground:Functional luminal imaging probes (FLIP) have been used by multiple centers to assess esophagogastric junction (EGJ) function in patients at risk for esophageal obstruction but its role in diagnosing peristaltic disorders is less well studied. In particular, there are no studies comparing the sensitivity of FLIP to diagnose motility abnormalities and impaired bolus transit by high‐resolution esophageal manometry with impedance.Methods:We prospectively recruited 42 patients undergoing high‐resolution esophageal manometry with impedance (HRIM) who also underwent FLIP between 2018 and 2020. HRIM parameters were analyzed using Swallow Gateway software to determine peristaltic and lower esophageal sphincter pressure measurements as well as bolus flow parameters. FLIP tracings were analyzed for the presence of repetitive antegrade contractions (RACs), EGJ distensibility, and associated parameters.Results:Forty‐two patients were included (11 controls, 7 achalasia, 16 fundoplication, 8 dysmotility). The mean age of patients was 10.1 ± 0.9 years. There were significant differences in bolus flow parameters across diagnosis with longer bolus presence (BPT) in control patients compared with fundoplication and dysmotility patients. There was a significant correlation between EGJ diameter, EGJ distensibility and bolus flow time (BFT) for solid foods (r2 > 0.518, P < 0.02). The presence of RACs and EGJ relaxation during RACs was associated with a greater BFT and BPT across textures (P < 0.05). Forty‐two percentage of patients with absent RACs, however, had clear peristalsis by HRIM.Conclusions:The presence of RACs and EGJ relaxation by FLIP correlate with improved bolus flow. Patients with an absence of RACs need HRIM to confirm any diagnoses of dysmotility.