bluuebunny/crossref_metadata_2025_split huggingface dataset:
Loose Body Versus Trochlear Biopsy Matrix-Induced Autologous Chondrocyte Implantation (MACI) MOCART Scores and IKDC Reported Outcomes in Pediatric Patients
Authors: Hill Zachary , Delman Connor , Shelton Trevor , Vander Voort Wyatt , Haus Brian 
Published: October 2022

Background:
Matrix-induced autologous chondrocyte implantation (MACI) has shown promising results in the treatment of osteochondral lesions of the knee. A recent study showed similar viability comparing chondrocytes harvested from the intercondylar notch compared to those harvested from osteochondral loose bodies. However, there is limited evidence assessing how these different biopsies perform clinically. The goal of this study was to compare both radiographic and patient-reported outcomes in patients with patellar and femoral osteochondral lesions treated with MACI using either a standard intercondylar notch biopsy or an osteochondral loose body biopsy.

Methods:
A retrospective study was performed on all pediatric autologous chondrocyte implantation procedures performed from 2014 to 2017 at a single institution. Patients were divided into 2 groups: one group had cartilage derived from a standard intercondylar notch biopsy (n=9) and the other group had cartilage derived from an osteochondral loose body found within the ipsilateral knee (n=10). At a minimum of 1-year postimplantation, magnetic resonance imagings of the operative knee were performed and the Magnetic Resonance Observation of Cartilage Repair Tissue Knee Score (MOCART 2.0) knee score was used to assess the integrity and quality of the cartilage repair tissue. Interclass correlation coefficients were calculated between the 2 groups. International Knee Documentation Committee (IKDC) outcome scores were determined at a minimum 2 years post-implantation.

Results:
The interclass correlation coefficient between three independent examiners for the MOCART scoring was excellent at 0.94. With regards to the MOCART score, the loose body group had an insignificant 17-point lower median score at 63 [interquartile range (IQR): 58 to 89] compared to the intercondylar group at 80 (IQR: 65 to 90) (P=0.15). There was no difference in IKDC scores with the loose body group having a median score of 82 (IQR: 65 to 95) and the intercondylar group having a median score of 84 (IQR: 53 to 99) (P=0.90).

Conclusion:
These results demonstrate that osteochondral loose bodies can be used as viable harvest site in MACI procedures with no difference in functional and radiographic outcomes at 2 years postimplantation. This may limit both short and long-term donor site morbidity.

Level of Evidence:
Level III—retrospective comparative study.
A Propensity Score-matched Analysis of Clinical Outcomes between Single- and Multi-level Intervertebral Decompression for Cervical Radiculopathy
Authors: Oshina Masahito , Kawamura Naohiro , Hara Nobuhiro , Higashikawa Akiro , Ono Takashi , Takeshita Yujiro , Azuma Seiichi , Fukushima Masayoshi , Iwai Hiroki , Kaneko Takeshi , Inanami Hirohiko , Oshima Yasushi 
Published: October 2022

Study Design.
Retrospective multicenter study with propensity score matching.

Objective.
To compare the clinical outcomes of single- and multi-level intervertebral decompression for cervical degenerative radiculopathy.

Summary of Background Data.
In patients with cervical radiculopathy, physical examination findings are sometimes inconsistent with imaging data. Multi-level decompression may be necessary for multiple foraminal stenosis. Additional decompression is more invasive yet expected to comprehensively decompress all suspected nerve root compression areas. However, the surgical outcomes of this approach compared to that of single-level decompression remain unknown.

Methods.
The data of patients with spinal surgery for pure cervical radiculopathy were collected. Patients were categorized into the single-level (SLDG) or multi-level (MLDG) intervertebral decompression group at C3/4/5/6/7/T1. Demographic data and patient-reported outcome (PRO) scores, including the Neck Disability Index (NDI) and numerical rating scale (NRS) scores for pain and numbness in the neck, upper back, and arms, were collected. The NDI improvement rates and changes in NRS scores were analyzed 1 year postoperatively at PRO evaluation. Propensity score matching was performed to compare both groups after adjusting for baseline characteristics, including the preoperative NDI and NRS scores.

Results.
Among the 357 patients in this study, SLDG and MLDG comprised 231 and 126 patients, respectively. Two groups (n=112, each) were created by propensity score matching. Compared to the MLDG, the SLDG had a higher postoperative NDI improvement rate (P=0.029) and lower postoperative arm numbness NRS score (P=0.037). Other outcomes tended to be more favorable in the SLDG than in the MLDG, yet no statistical significance was detected.

Conclusion.
In patients with cervical radiculopathy, the surgical outcomes of the SLDG showed better improvement in clinical outcomes than those of the MLDG. Numbness remained on the distal (arms) rather than the central (neck and upper back) areas in patients receiving multi-level decompression.
Subacute Posttraumatic Ascending Myelopathy
Authors: Coleman-Bock Jacob , Bäcker Henrik C. , Johnson Michael A. , Turner Peter , Cunningham John 
Published: October 2022

Study Design:
Case report and literature review.

Objection:
Aim of this study was to summarize the current evidence base behind subacute posttraumatic ascending myelopathy (SPAM) including the epidemiology, presentation, diagnosis, prognosis, and etiology.

Summary of Background Data:
SPAM is a rare, potentially fatal disorder which is not attributable to ongoing mechanical instability, syrinx formation, or iatrogenic causes.

Methods:
A systematic literature search on SPAM was performed on Medline, Ovid, Cochrane, Embase, and PubMed databases between 1969 and 2021. Cases were reviewed and the findings summarized. Further evidence was reviewed to support the hypothesis that disruption of cerebrospinal fluid (CSF) circulation is the underlying etiology of the condition.

Results:
It is estimated to occur in 0.4%–0.7% of spinal cord injuries and may have a mortality of up to 10%. The most likely etiology disruption of CSF circulation leading to further damage to the spinal cord presumably through pressure mediated effects such as a reduction in cellular perfusion.

Conclusion:
There is effectively no treatment of this condition, however, with interest developing in monitoring of CSF pressures during spinal cord injury this may help confirm the etiology, and allow the suggestion of therapies such as drains or expansion duraplasty to reduce spinal cord pressures.

Level of Evidence:
Level II—case report and systematic review.
Proximal tubular dysfunction related to tenofovir in people living with HIV/AIDS: a pharmacogenetic study
Authors: Soares Rita De Cassia Albuquerque , De Araújo Paulo Sérgio Ramos , Brandão Lucas André Cavalcanti , Coelho Antônio Victor Campos , Lima Kledoaldo , De Melo Heloisa Ramos Lacerda 
Published: October 2022

Objectives
The purpose of this case-control study was to verify the association between single nucleotide polymorphisms (SNPs) in genes encoding drug transporters related to tenofovir disoproxil fumarate (TDF) and proximal renal tubular dysfunction (PRTD), and the association between PRTD and clinical characteristics.

Methods
The ‘cases’ met the diagnostic criteria for PRTD, determined by the presence of two or more of the following abnormalities: non-diabetic glycosuria, metabolic acidosis, increased uric acid and phosphorus excretion, decreased tubular phosphorus reabsorption and β2-microglobulinuria. We analyzed eight SNPs in ABCC2, ABCC4, ABCC10 and SLC28A2 genes. Genotyping was performed using real-time PCR.

Results
Of the 204 people living with HIV, 38 (18.6%) met the criteria for diagnosis of PRTD and 131 were male (64.2%), with a mean age of 49 years and a history of previous antiretroviral therapy for an average of 5 years. In the multivariate analysis, older individuals, TDF use, protease inhibitor, antihypertensives and anticonvulsants were associated with a risk of developing PRTD. Increased excretion of β2microglobulin was associated with the A/G genotype of rsCC8187710 from ABCC2 (P = 0.003) and the following genotypes of ABCC4 SNPs: A/G from rs1059751 (P = 0.023), G/G from rs1059751 (P = 0.030) and C/C of rs3742106 (P = 0.041). The increase in the fraction of excreted phosphorus was associated with the C/T genotype of SNCC rsP40037 from ABCC2 (P = 0.0041).

Conclusions
The results indicate an important relationship between SNPs associated with these markers and changes in proximal renal tubule function, and thus support their use as biomarkers for the early detection of PRTD risk.
Prediction of Visual Acuity in Patients With Microbial Keratitis
Authors: Woodward Maria A. , Niziol Leslie M. , Ballouz Dena , Lu Ming-Chen , Kang Linda , Thibodeau Alexa , Singh Karandeep 
Published: October 2022

Purpose:
The purpose of this study was to predict visual acuity (VA) 90 days after presentation for patients with microbial keratitis (MK) from data at the initial clinical ophthalmic encounter.

Methods:
Patients with MK were identified in the electronic health record between August 2012 and February 2021. Random forest (RF) models were used to predict 90-day VA < 20/40 [visual impairment (VI)]. Predictors evaluated included age, sex, initial VA, and information documented in notes at presentation. Model diagnostics are reported with 95% confidence intervals (CIs) for area under the curve (AUC), misclassification rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results:
One thousand seven hundred ninety-one patients were identified. The presenting logMAR VA was on average 0.86 (Snellen equivalent and standard deviation = 20/144 ± 12.6 lines) in the affected or worse eye, and 43.6% with VI. VI at 90-day follow-up was present in the affected eye or worse eye for 26.9% of patients. The RF model for predicting 90-day VI had an AUC of 95% (CI: 93%–97%) and a misclassification rate of 9% (7%–12%). The percent sensitivity, specificity, PPV, and NPV were 86% (80%–91%), 92% (89%–95%), 81% (74%–86%), and 95% (92%–97%), respectively. Older age, worse presenting VA, and more mentions of “penetrating keratoplasty” and “bandage contact lens” were associated with increased probability of 90-day VI, whereas more mentions of “quiet” were associated with decreased probability of 90-day VI.

Conclusions:
RF modeling yielded good sensitivity and specificity to predict VI at 90 days which could guide clinicians about the risk of poor vision outcomes for patients with MK.
COVID-19 and Eye Banking: Ongoing Impacts of the Pandemic
Authors: Ballouz Dena , Issa Rafik , Sawant Onkar B. , Hurlbert Susan , Titus Michael S. , Zhou Yunshu , Musch David C. , Majmudar Parag A. , Kumar Ashok , Mian Shahzad I. 
Published: October 2022

Purpose:
The purpose of this study was to assess the impact of ongoing waves of the COVID-19 pandemic and resulting guidelines on the corneal donor pool with resumption of clinical operations.

Methods:
A retrospective analysis of donors deemed eligible for corneal transplantation at an eye bank from July 1, 2020, through December 31, 2021. Donors ineligible due to meeting Eye Bank Association of America (EBAA) COVID-19 guidelines or a positive postmortem COVID-19 testing were examined. The correlation between COVID-19 rule outs and state COVID positivity was calculated. The number of scheduled surgeries, suitable corneas, imports, and international exports was compared with a pre-COVID period. Postmortem testing was reduced for the final 5 months of the study, and numbers were compared before and after the policy change.

Results:
2.85% of referrals to the eye bank were ruled out because of EBAA guidelines. 3.2% of postmortem tests were positive or indeterminate resulting in an ineligible tissue donor (0.42% of referrals). Over the 18-month period, there was a 4.30% shortage of suitable corneas compared with transplantation procedures. There was a significant correlation between postmortem testing and state COVID-19 positivity (r = 0.37, P <0.01), but not with EBAA guidelines (r = 0.19, P = 0.07). When postmortem testing was reduced, significantly more corneas were exported internationally.

Conclusions:
Although corneal transplant procedures were back to normal levels, there was a shortage of suitable corneal tissue. The discontinuation of postmortem testing was associated with a significant increase in international exports of corneal donor tissue.
Light adjustable intraocular lenses: an updated platform for cataract surgery
Authors: Moshirfar Majid , Martin Daniel J. , Jensen Jenna L. , Payne Carter J. 
Published: October 2022

Purpose of review
Light adjustable intraocular lenses (LALs) are a relatively new platform for cataract surgery that is shifting the paradigm for intraocular lens placement following cataract removal.

Recent findings
LALs may have additional utility in patients with prior refractive surgery and complex ocular conditions, as they give the surgeon greater latitude in preoperative intraocular power calculations to meet postoperative refractive goals.

Summary
Further study of best candidates for LALs is warranted. Current best candidates are patients who can comply with treatment and have decreased accuracy in calculating the preoperative intraocular power requirement.
Improving research personnel’s hand hygiene adherence in the pediatric acute care setting during the COVID-19 pandemic: a quality improvement initiative
Authors: Dissanayake Ashini , MacLellan Abigale , Doan Quynh , Sabhaney Vikram , Virk Punit 
Published: October 2022

Introduction:
Hand hygiene is critical in preventing the spread of healthcare-associated infections. Routine hand hygiene surveillance and education are common for clinical staff in pediatric acute care settings. However, nonclinical staff, including research personnel, are often excluded from these programs and therefore represent a gap in ongoing infection control efforts. This project aimed to evaluate the impact of evidence-based interventions on improving hand hygiene adherence among research personnel in the pediatric emergency department to meet provincial targets set for clinical staff.

Methods:
We used a Plan-Do-Study-Act approach to carry out a peer-driven, multimodal hand hygiene improvement strategy involving education, surveillance, and feedback targeted to research assistants working in a pediatric emergency department. Two anonymous peer evaluators observed hand hygiene practices in several specific instances (eg, before/after patient interactions) and determined adherence a priori.

Results:
In an open sample of clinical research assistants (Ntotal = 22), hand hygiene adherence increased from 12.5% to 89.1% over 11 months. Increases in adherence were particularly notable before entering the patient environment compared to exiting.

Conclusions:
Hand hygiene interventions targeting research personnel show potential success in acute care. Further quality improvement initiatives in larger research personnel samples must robustly evaluate the framework’s effectiveness.
Simultaneous Le Fort III and Le Fort I Osteotomy: Surgical Outcomes and Clinical Parameters
Authors: Yue Olivia Y. , Kalra Aneesh , Eisemann Bradley S. , Grayson Barry H. , McCarthy Joseph G. , Flores Roberto L. , Staffenberg David A. , Rodriguez Eduardo D. , Shetye Pradip R. 
Published: October 2022

Introduction:
Simultaneous Le Fort III/I (LF III/I) osteotomies are often performed when a differential advancement of the upper and lower midface is needed. This study aims to evaluate midface position preoperative and 1 week postoperative in patients with severe midface hypoplasia. In addition, this study aims to compare the planned surgical movements to the actual postoperative movements.

Materials and Methods:
A retrospective review was conducted using cephalometry for patients treated with a simultaneous LF III/I osteotomy at a single institution. Osteotomies were performed during 1980-2018 on skeletally mature patients with a craniofacial syndrome, with clinical and radiographic follow-up available.

Results:
Twelve patients met the inclusion criteria with a mean age of 20.2±6.4 years. Treatment resulted in statistically significant anterior movements related to Orbitale, anterior nasal spine, A Point, and the upper incisor tip, and inferior movements related to anterior nasal spine, A Point, upper and lower incisor tips, B point, and pogonion. Stability after 1 year showed only statistically significant changes at ANB. The predictable error for planned movements versus actual movements was greater in the vertical plane than the horizontal plane.

Conclusions:
A simultaneous LF III/I osteotomy significantly improved the midface position and occlusal relationship in syndromic patients with midface hypoplasia in a predictable manner. Further multicenter studies with larger sample sizes are needed to validate the conclusions.
Coronary Artery Bypass Surgery Among Medicare Beneficiaries in Health Professional Shortage Areas
Authors: Stewart James W. , Kunnath Nicholas , Dimick Justin B. , Pagani Francis D. , Ailawadi Gorav , Ibrahim Andrew M. 
Published: October 2022

Objective:Health professional shortage areas (HPSAs) were created by the Health Resources and Services Administration to identify communities with a shortage of clinical providers. For medical conditions, these designations are associated with worse outcomes. However, far less is known about patients undergoing high-complexity surgical procedures, such as coronary artery bypass grafting (CABG).Background:The aim was to compare postoperative surgical outcomes of high-complexity surgery in beneficiaries living in HPSA versus non-HPSA designated areas.Methods:This study is a retrospective cohort review of Medicare beneficiaries who underwent CABG between 2014 and 2018. The authors compared risk-adjusted 30-day mortality, complication, reoperation, and readmission rates for beneficiaries living in a designated HPSA versus non-HPSA using a multivariable logistic regression model accounting for patient (eg, age, sex, comorbidities, surgery year) and hospital characteristics (eg, patient-to-nurse ratio, teaching status). Patient travel burden was measured based on the time and distance required to travel from the beneficiary’s home zip code to the hospital zip code.Results:Of the 370,532 Medicare beneficiaries who underwent CABG, 30,881 (8.3%) lived in a HPSA. Beneficiaries in HPSAs were found to experience comparable 30-day mortality (3.50% vs. 3.65%,P<0.001), complication (32.67% vs. 33.54%,P<0.001), reoperation (1.58% vs. 1.66%,P<0.001), and readmission (14.72% vs. 14.86%,P<0.001) rates. Beneficiaries experienced greater mean travel times (91.2 vs. 64.0 minutes,P<0.001) and mean travel distances (85.0 vs. 59.3 miles,P<0.001).Conclusions:Medicare beneficiaries living in designated HPSA experienced comparable surgical outcomes after CABG surgery but a significantly greater travel burden. The greater travel burden experienced by patients living in designated shortage areas to obtain comparable surgical care for complex procedures demonstrates important tradeoffs between access and quality.
Serum Calcitonin Gene-Related Peptide Is Elevated in Patients With Migraine and Ophthalmoplegia
Authors: Takkar Aastha , Kumar K. V. Anil , Katoch Deeksha , Singh Paramjeet , Minz Ranjana , Anand Shashi , Kathirvel Soundappan , Ravishankar K. , Lal Vivek , Caplan Louis R. 
Published: October 2022

Background:
There is ongoing debate about whether the oculomotor (III), trochlear (IV), or abducens (VI) nerve paresis in patients with migraine is directly attributable to migraine (ophthalmoplegic migraine [OM]) or is due to an inflammatory neuropathy (recurrent painful ophthalmoplegic neuropathy [RPON]). As migraine is associated with elevated serum calcitonin gene-related peptide (CGRP) levels, we studied serum CGRP levels among patients with OM/RPON to determine whether they are elevated during and between attacks. This is the first study assessing CGRP levels in the serum of patients with OM/RPON.

Methods:
The aim of this case–control study was to assess serum CGRP levels in patients with ophthalmoplegia and a headache consistent with migraine according to ICHD-3 criteria. Serum CGRP levels were measured during the ictal and interictal phases in 15 patients with OM/RPON and compared with age-matched and sex-matched controls without migraine (12 patients).

Results:
The median serum CGRP levels were significantly elevated (P = 0.021) during the ictal phase (37.2 [36.4, 43.6] ng/L) compared with controls (32.5 [30.1, 37.3] ng/L). Serum CGRP levels during the attack correlated with the total duration of ophthalmoplegia. A CGRP level of 35.5 ng/L in the ictal phase of the attack had a sensitivity of 86.7% and specificity of 75.0% in diagnosing a patient with OM/RPON.

Conclusion:
Elevated serum CGRP levels during the ictal phase of OM/RPON favor migraine as the underlying cause of episodic headache with ophthalmoplegia.
Intra-arterial Thrombolysis for Acute Retinal Ischemia: A Retrospective, Observational, Cohort Study
Authors: Gao Yuan , Zhao Wenbo , Wu Di , Feng Wayne , Grory Brain Mac , Guo Wenting , Zhang Dawei , Su Xinjie , Ji Xunming , Zhang Xuxiang 
Published: October 2022

Background:
To determine whether intra-arterial thrombolysis (IAT) within 16 hours after the onset of symptoms is feasible and associated with better visual outcomes in patients with acute retinal ischemia (ARI).

Methods:
The retrospective cohort study was performed from January 2014 to December 2021 in the Xuanwu Hospital of Capital Medical University. Patients with ARI who initially presented visual acuity of 20/100 or worse were screened in the study. Visual end points were evaluated at one week and at final visit after treatment. Serious adverse events were recorded during operation and within 1 week after IAT treatment.

Results:
The amount of clinically significant visual improvement (≥0.3 logarithm of the minimum angle of resolution) in the IAT group was significantly higher than that in the conservative treatment group at one week after the treatment (47.8% vs 16.7%; P = 0.014) and at final visit (52.2% vs 20%; P = 0.014). After controlling confounding factors, ARI treatment was the only factor significantly associated with the amount of clinically significant visual improvement (OR, 4.364; 95 CI, 1.298–14.667; P = 0.017). A patient (4.3%) experienced retinal hemorrhage without symptom within 1 week after IAT treatment. No patients experienced new symptomatic cerebral infarction, intracranial hemorrhage, TIA, artery dissection, vascular perforation, and distal embolization during operation and within 1 week after IAT treatment.

Conclusions:
IAT may be associated with better visual improvement within 16 hours after the onset of symptoms. Besides, IAT is feasible and associated with a low risk of periprocedural complications for ARI. This study will aid in feasibility testing and sample size calculations in advance of future, fully-powered efficacy studies for ARI.