bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic Cement-Coated Interlocked Intramedullary Nails for the Treatment of Infected Nonunion After Intramedullary Nailing
Authors: Zalikha Abdul K. , Sayeed Zain , Stine Sasha A. , Bray Ryan , Vaidya Rahul 
Published: July 2022

Objective:
To evaluate outcomes using an interlocking antibiotic cement-coated nail and culture-specific systematic antibiotics in the treatment of infected nonunion after intramedullary nailing.

Design:
Retrospective observational cohort study.

Setting:
Urban level I trauma center.

Patients/Participants:
Forty-one nonconsecutive patients who presented to a level I trauma center who underwent interlocked antibiotic nailing for treatment of infected nonunion status after primary intramedullary nailing.

Outcomes:
Eradication of infection, radiographic union by 2-year follow-up.

Results:
Antibiotic nailing successfully eradicated infection and led to fracture healing in 35 patients (85.4%), while 6 patients (14.6%) had persistent infection and required further surgical treatment. Of the 6 patients who required further treatment, 5 eventually went on to heal with fracture union and eradication of their infection, while 1 required a salvage procedure. Of the 5 patients who eventually went on to heal, 4 of them healed with repeat antibiotic or intramedullary nails, while 1 required segmental resection and bone grafting before healing.

Conclusions:
This study suggests that the proposed interlocked antibiotic nailing technique is a viable therapeutic option to eradicate infected nonunion and support fracture healing.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Usefulness of Source Images of Magnetic Resonance Myelograms and Partial Laminectomy for Interlaminar Endoscopic Lumbar Discectomy at L5-S1
Authors: Yun Dong-Ju , Lee Sang-Ho 
Published: July 2022

Abstract:
The primary objective of this study was to assess the clinical and radiologic outcomes and introduce the technical notes from 10 patients who underwent interlaminar endoscopic lumbar discectomy (IELD) at L5-S1 using the source images of magnetic resonance (MR) myelograms and performing partial laminectomy. A biportal endoscopic system was used to perform partial laminectomy, followed by fragmentectomy and subtotal discectomy using a uniportal endoscopic system. The source images of MR myelograms were used to identify the anatomical relationship between the herniated disc material, L5 and S1 nerve roots, the thecal sac, and L5 lamina. Preoperative leg and back visual analog scale scores were greatly improved immediately and after 3 months and 6 months postoperatively. Fragmentectomy and subtotal discectomy became easier after performing a partial laminectomy in all IELD cases at L5-S1. The source images of MR myelograms and partial laminectomy is useful for IELD at L5-S1.

Level of Evidence:
Level IV.
What PROMIS Scores Correlate With Severe Disability in Cervical Spine Surgery?
Authors: Barber Lauren A. , Steinhaus Michael , Lafage Renaud , Ross Thomas , Lafage Virginie , Kim Han Jo , Iyer Sravisht 
Published: July 2022

Study Design:
Institutional Review Board-approved prospective cohort study.

Objectives:
To establish a conversion between Neck Disability Index (NDI) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI).

Summary of Background Data:
As the National Institutes of Health (NIH) PROMIS is a global outcome measure, it can be difficult to interpret the clinical implications in patients with cervical spine surgery. To determine how a disease-specific legacy instrument (NDI) correlates with PROMIS PI and define levels of substantial and minimal disability, we developed a formula to convert NDI scores to PROMIS PI.

Materials and Methods:
Adult patients undergoing cervical spine surgery at a single institution from 2016 to 2018 were prospectively enrolled. Patients undergoing surgery for instability due to trauma were excluded. Preoperative questionnaires, demographic data, presenting complaint (radiculopathy, myelopathy, myeloradiculopathy), and procedural data were recorded. Patients were included if they had completed the NDI and PROMIS PI. Correlation and regression analyses were performed.

Results:
One hundred ninety-six patients met inclusion criteria. The average age was 56.9±12.9 years. The mean NDI score was 68.6±38 and PROMIS PI was 60.9±7.3. The PROMIS PI was strongly correlated with the NDI (r=0.76, P<0.001). Linear regression analysis revealed the following formula:

Conclusions:
We performed a regression analysis allowing for the conversion of PROMIS PI scores with NDI. In keeping with the previous studies, our analysis showed that PROMIS PI was most strongly correlated to NDI. A PROMIS PI score >66 was correlated to substantial disability (NDI=50), whereas a PROMIS PI score <59 was correlated to minimal relative impairment (NDI=28). These results provide important reference, as PROMIS reporting becomes more widespread in the literature.
Large Varicose Vein Closure: A Comprehensive Review
Authors: Almukhtar Rawaa M. , Goldman Mitchel P. 
Published: July 2022

BACKGROUND
Treatment of chronic venous disease and varicose veins has significant psychosocial and economic impact. The great saphenous vein is a common vein to develop incompetence and reflux and, therefore, been the focus of therapy for many years.

OBJECTIVE
To review the published medical literature relating to large varicose vein closure and provide a guide for closure techniques' efficacy and safety.

METHODS
A comprehensive search of the English language literature was performed up to and including December 2021. All references pertaining to large varicose vein closure were reviewed.

RESULTS
There are multiple safe and effective minimally invasive methods to achieve occlusion of incompetent great saphenous vein, the most widely used of which is endovenous thermal ablation. Other nonthermal, tumescent, and nontumescent methods can also be used.

CONCLUSION
Proper knowledge of vein anatomy, ultrasound, and vein closure procedures is needed to ensure safe and effective outcomes.
Socioeconomic Status Affects Pre- and Postoperative Two-point Discrimination in Patients with Carpal Tunnel Syndrome
Authors: Prabhakar Gautham , Ghali Abdullah , Momtaz David , Rose Ryan 
Published: July 2022

Background:
Carpal tunnel release is a life-changing procedure within hand surgery. Multiple factors may have an impact on the outcome following surgery.

Methods:
In this retrospective cohort study, we reviewed all patients who underwent carpal tunnel release in our institutional database from 2018 to 2020. We included patients with a minimum of 6-week follow-up. Patient demographics were identified, including insurance status and comorbidities. Patients were categorized as “improved” or “not improved” based on two-point test differences. Results were analyzed using the Fisher exact test. We ran a logistic regression model to analyze the relationship between income status (operationalized by having Medicaid/Carelink) and preoperative scores, and inferential statistics were computed with appropriate t tests.

Results:
Of the 125 patients who met the inclusion criteria, 47 (37.6%) had Medicaid or Carelink, and 79 (62.4%) had commercial insurance. Medicaid/ Carelink patients presented with worse two-point discrimination on initial presentation (P < 0.001). Compared to commercial insurance, Medicaid/Carelink patients were less likely to show improvement in postoperative two-point discrimination (P < 0.001). Male patients were also less likely to show improvement. Race, ethnicity, medical comorbidities, and age were not shown to have a significant effect on improvement in two-point discrimination.

Conclusions:
Although medical comorbidities did not have a significant effect on postoperative two-point, patients with low-income status (Medicaid/Carelink) may have a less predictable outcome. These socioeconomic considerations are critical in appropriately risk stratifying surgical candidates, and counseling patients in whom tactile acuity may be less predictable.
Cardiorespiratory Optimal Point Is a Submaximal Exercise Test Variable and a Predictor of Mortality Risk
Authors: Peterman James E. , Harber Matthew P. , Fleenor Bradley S. , Whaley Mitchell H. , Araújo Claudio G. , Kaminsky Leonard A. 
Published: July 2022

Purpose:
The cardiorespiratory optimal point (COP) is the minimum ventilatory equivalent for oxygen. The COP can be determined during a submaximal incremental exercise test. Reflecting the optimal interaction between the respiratory and cardiovascular systems, COP may have prognostic utility. The aim of this investigation was to determine the relationship between COP and all-cause mortality in a cohort of apparently healthy adults.

Methods:
The sample included 3160 apparently healthy adults (46% females) with a mean age of 44.0 ± 12.5 yr who performed a cardiopulmonary exercise test. Cox proportional hazards models were performed to assess the relationship between COP and mortality risk. Prognostic peak oxygen uptake (V˙o
2peak) and COP models were compared using the concordance index.

Results:
There were 558 deaths (31% females) over a follow-up period of 23.0 ± 11.9 yr. For males, all Cox proportional hazards models, including the model adjusted for traditional risk factors and V˙o
2peak, had a positive association with risk for mortality (P < .05). For females, only the unadjusted COP model was associated with risk for mortality (P < .05). The concordance index values indicated that unadjusted COP models had lower discrimination compared with unadjusted V˙o
2peak models (P < .05) and V˙o
2peak did not complement COP models (P ≥ .13).

Conclusions:
Cardiorespiratory optimal point is related to all-cause mortality in males but not females. These findings suggest that a determination of COP can have prognostic utility in apparently healthy males aged 18-85 yr, which may be relevant when a maximal exercise test is not feasible or desirable.
Epidemiology of ectopia lentis and outcomes after surgery in a Danish population
Authors: Rasul Asrin , Roos Laura , Groth Kristian , Riise Per , Bach-Holm Daniella , Kessel Line 
Published: July 2022

Purpose:
To describe the causes of ectopia lentis (EL) and the outcomes after surgery in a Danish population.

Setting:
The Eye Clinic Rigshospitalet and Kennedy Center in Copenhagen.

Design:
Retrospective cohort study.

Methods:
Medical records of patients with nontraumatic EL born after 1980 and seen at the Eye Clinic Rigshospitalet and Kennedy Center from 1983 to 2019 were reviewed. Clinical information regarding family history, comorbidities, genetic workup, ophthalmological examinations, and surgical history was retrieved.

Results:
72 patients (38 males), of whom 68 had bilateral EL (94.4%) were identified. Marfan syndrome (MFS) was found in 34 (47.2%) and biallelic variants in ADAMTSL4 in 4 (5.6%). Surgery was performed in 38 (52.8%) patients, 66 eyes, with a median age at the time of first eye surgery of 8.4 years (range 0.8 to 39.0 years) and a follow-up of 2.3 years (range 0 to 25.7 years). Intraocular lenses were implanted in 9 (23.7%) (11 eyes). Corrected distance visual acuity improved from 0.7 to 0.2 logMAR (median) in right eyes and from 0.7 to 0.3 logMAR in left eyes postoperatively. 21 patients (56.8%), 42 eyes, did not experience any surgery-related complications. 3 patients (3 eyes) experienced a perioperative tear in the posterior capsule. Temporary postoperative ocular hypertension was reported in 3 patients (7.9%) (3 eyes), and 2 patients (5.4%) (2 eyes) developed persistent ocular hypertension. There were no cases of postoperative retinal detachment.

Conclusions:
The main reason for EL was MFS. Surgery improved visual acuity, and postoperative ocular hypertension was the most common complication, whereas retinal detachment was not observed.
Pancreatic head sparing surgery for solid pseudopapillary tumor in patients with agenesis of the dorsal pancreas
Authors: Shyr Bor-Shiuan , Wang Shin-E , Chen Shih-Chin , Shyr Yi-Ming , Shyr Bor-Uei 
Published: July 2022

Background:
This study aimed to clarify the feasibility and justification of pancreatic head sparing (PHS) enucleation for patients with agenesis of the dorsal pancreas (ADP) associated with a solid pseudopapillary tumor (SPT).

Methods:
Data of the SPT patients with and without ADP, including clinical presentations, surgical options, and surgical and survival outcomes, were recruited for comparison.

Results:
A total of 31 patients with SPTs were included, three of whom displayed ADP and underwent PHS enucleation. Surgical complications were comparable between the groups. Overall, the 5- and 10-year disease-free survival rates were 100% and 90%, respectively. The 20- and 25-year overall survival rates were 100% and 66.7%, respectively. Only one patient (3.2%) developed tumor recurrence 7.3 years after pancreatectomy for an SPT with lymph node involvement, and the patient survived 24.5 years after the initial operation. No tumor recurrence occurred in any patient with ADP after PHS enucleation.

Conclusion:
PHS enucleation seems to be feasible and justifiable for SPT patients with ADP in terms of surgical and survival outcomes, and this approach could be recommended to avoid pancreatic insufficiency.
What Makes a Trauma Patient “Pediatric”? Survey of Providers' Admission Decision Making for Pediatric Trauma Patients
Authors: Fakhry Samir M. , Berg Gina M. , Wilson Nina Y. , Slivinski Andrea , Morse Jennifer L. , Shen Yan , Wyse Ransom J. , Garland Jeneva M. , Worthley Aaron , Brady Jessica L. , Franklin Kelli , Dunne James R. , Turner Jennifer , Rhodes Heather , Palladino Kelsey , Watts Dorraine D. 
Published: July 2022

Background:
Only a fraction of pediatric trauma patients are treated in pediatric-specific facilities, leaving the remaining to be seen in centers that must decide to admit the patient to a pediatric or adult unit. Thus, there may be inconsistencies in pediatric trauma admission practices among trauma centers.

Objective:
Describe current practices in admission decision making for pediatric patients.

Methods:
An email survey was distributed to members of three professional organizations: The American Association for the Surgery of Trauma, Society of Trauma Nurses, and Pediatric Trauma Society. The survey contained questions regarding pediatric age cutoffs, institutional placement decisions, and scenario-based assessments to determine mitigating placement factors.

Results:
There were 313 survey responses representing freestanding children's hospitals (114, 36.4%); children's hospitals within general hospitals (107, 34.2%), and adult centers (not a children's hospital; 90, 28.8%). The mean age cutoff for pediatric admission was 16.6 years. The most reported cutoff ages were 18 years (77, 25.6%) and 15 years (76, 25.2%). The most common rationales for the age cutoffs were “institutional experience/tradition” (139, 44.4%) and “physician preference” (89, 28.4%).

Conclusion:
There was no single widely accepted age cutoff that distinguished pediatric from adult trauma patients for admission placement. There was significant variability between and within the types of facilities, with noted ambiguity in the definition of a “pediatric” patient. Thresholds appear to be based primarily on subjective criteria such as traditions or preferences rather than scientific data. Institutions should strive for objective, evidence-based policies for determining the appropriate placement of pediatric patients.
Clinical Prediction Rule Validation for Ambulation Outcome After Traumatic Spinal Cord Injury in a Spanish Population
Authors: García-Rudolph Alejandro , Wright Mark Andrew , Benito Jesus , Vidal Joan , Tormos Josep Maria , Opisso Eloy , Murillo Narda 
Published: July 2022

BACKGROUND:
Predicting the ability to walk after traumatic spinal cord injury is of utmost importance in the clinical setting. Nevertheless, only a small fraction of predictive models are evaluated on their performance by other authors using external data. The Dutch Clinical Prediction Rule for long-term walking ability was developed and validated using neurological assessments performed within 15 days postinjury. However, in reality, this assessment is most often performed between 11 and 55 days. When considering a longer time from injury to neurological assessments, the Dutch Clinical Prediction Rule has only been externally validated for patients after non–traumatic spinal cord injury.

OBJECTIVE:
We aimed to validate the Dutch Clinical Prediction Rule with neurological assessment performed within 3–90 days after traumatic spinal cord injury, using (a) the Dutch Clinical Prediction Rule logistic regression coefficients (Equation 1); (b) the Dutch Clinical Prediction Rule weighted coefficients (Equation 2); and (c) the reestimated (using a Spanish population) weighted coefficients (Equation 3).

METHODS:
We conducted a retrospective (STROBE-compliant) study involving 298 adults with traumatic spinal cord injury admitted to a hospital between 2010 and 2019 in Spain. The Spinal Cord Independence Measure item-12 was used for walking assessment.

RESULTS:
Using Equation 1, the model yielded 86.2% overall classification accuracy, 94.5% sensitivity, and 83.4% specificity (area under the curve [AUC] = 0.939, 95% confidence interval [CI]: 0.915–0.965; p < .001).
Using Equation 2 yielded 86.2% overall classification accuracy, 93.2% sensitivity, and 83.9% specificity (AUC = 0.9392, 95% CI: 0.914–0.964; p < .001).
Using Equation 3 yielded 86.9% overall classification accuracy, 68.9% sensitivity, and 92.8% specificity (AUC = 0.939, 95% CI: 0.914–0.964; p < .001).

CONCLUSIONS:
This study validates the Dutch Clinical Prediction Rule in a Spanish traumatic spinal cord injury population with assessments performed up to 90 days postinjury with similar performance, using the original coefficients and including a reestimation of the coefficients.
Autoimmune progesterone dermatitis: a retrospective case series
Authors: Aghazadeh Nessa , Berry Nicholas A. , Torgerson Rochelle R. , Park Miguel A. , Davis Dawn Marie R. 
Published: July 2022

Background:
Autoimmune progesterone dermatitis (APD) is a rare hypersensitivity disorder characterized by recurring dermatologic manifestations during the luteal phase of the menstrual cycle in women. Well-defined clinical and diagnostic criteria, outcomes measurements, and standard treatments are lacking.

Methods:
We performed a single-institution retrospective review of adult patients (older than 20 years at the time of diagnosis) with APD.

Results:
Fourteen patients were included with mean age of clinical onset of 34.3 ± 7.7 (range 24-54) years. There was a delay of 3.9 ± 5.5 (range 0.4-20) years between the onset of disease symptoms and diagnosis. The onset of APD was after exposure to exogenous progesterone in 9 of 14 patients. Progesterone skin test was performed in 9 patients and 6 were positive. Patients frequently presented with urticaria (9/14, 64.3%) and dermatitis (4/14, 28.6%). Continuous combined oral contraceptives (4/14, 28.6%), gonadotropin-releasing hormone agonist (3/14, 21.4%), and hysterectomy with bilateral salpingo-oophorectomy (2/14, 14.3%) were the most common attempted treatments with reliable outcomes.

Conclusions:
APD is a rare disorder which lacks universal diagnostic measures and criteria, contributing to a significant delay in diagnosis. Large-scale multicenter studies are needed to develop accurate tests, establish diagnostic criteria, and define treatment outcomes.
The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents
Authors: Nowaskie Dustin Z. , Garcia-Dehbozorgi Sara , Cortez Jose L. 
Published: July 2022

Background:
Lesbian, gay, bisexual, and transgender (LGBT) people interface with dermatology providers for many reasons. Implementing culturally competent LGBT dermatologic care necessitates evaluating provider competency to identify where gaps remain.

Objectives:
To assess the LGBT cultural competency among U.S. dermatology residents.

Methods:
A self-reporting, cross-sectional survey was emailed to U.S. dermatology program coordinators (N = 143). LGBT patient exposure, LGBT educational hours, and LGBT cultural competency via the LGBT-Development of Clinical Skills Scale (with the subscales Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) were measured.

Results:
Dermatology residents (N = 119) across the United States completed the survey. They reported caring for less than 20 LGBT patients per year and receiving less than 75 minutes of LGBT education per year. They reported significantly higher Attitudinal Awareness than both Clinical Preparedness and Basic Knowledge; they reported significantly higher Basic Knowledge than Clinical Preparedness. They reported significantly less adequate clinical training and supervision, experience, and competence to assess transgender patients compared to lesbian, gay, and bisexual patients. In general, dermatology residents who reported more LGBT patients and LGBT education also reported higher LGBT cultural competency.

Limitations:
A larger national sample of U.S. dermatology residents is necessary for generalizability.

Conclusions:
Currently, there is a lack of LGBT education in U.S. dermatology residency curricula, which may delay addressing the health disparities that exist in this patient population. Due to such dearth of standardized LGBT education, dermatology residents likely do not feel adequately knowledgeable or prepared to address LGBT needs. Both LGBT education and LGBT patient experiences may help alleviate these shortcomings and help LGBT patients feel affirmed in their dermatologic care.
Comparing Outcomes and Billing Costs of Middle Cranial Fossa and Transmastoid Approaches for Otogenic Encephalocele and Cerebrospinal Fluid Leak Repair
Authors: Patel Tirth R. , Piracha Ali Z. , Roy Alexa S. , Byrne Richard , Jhaveri Miral , Michaelides Elias , Wiet R. Mark 
Published: July 2022

Objective
Comparison of outcomes and billing costs of patients treated at our institution using transmastoid (TM), middle cranial fossa (MCF), and combined approaches for repair of otogenic cerebrospinal fluid (CSF) leaks and encephaloceles.

Study Design
Retrospective cohort review.

Setting
Tertiary-care hospital.

Patients
Seventy-seven cases of otogenic CSF leaks or encephaloceles.

Interventions
Surgical repair of an otogenic encephalocele or CSF leak using either a TM, MCF, or combined approach.

Main Outcome Measures
Success of repair, length of operation, cost of operating room materials, postoperative need for intensive care, and postoperative length of stay.

Results
Forty cases (52%) were performed by the TM approach, 27 (35%) by MCF, and 10 (13%) by combined TM/MCF. Mean length of stay was not statistically different amongst TM patients (2.1 d), MCF patients (3.3 d), and combined TM/MCF patients (3.70; p = 0.112). Only 3/40 TM cases required intensive care during their admission while all MCF and combined TM/MCF approach cases were admitted to the intensive care unit for at least one night (p < 0.001). On follow-up, CSF leak recurred in 3/77 (4%) cases: 3/27 (11%) MCF, 0/40 TM, and 0/10 combined TM/MCF patients (p = 0.056). The mean cost of operating room materials charged to the patient was significantly greater in the MCF group ($9,883) than the TM group ($3,748; p = 0.001).

Conclusions
In carefully selected patients, the TM approach is an effective and less costly alternative to MCF approaches for repair of otogenic CSF leaks and encephaloceles.