Wahood, Waseem

Background: The eyebrows play an important role in emotional facial expressions, nonverbal communication, and facial esthetics. A comprehensive understanding of the mechanisms underlying eyebrow aging is vital in allowing plastic surgeons to appropriately address these age-related changes and to recreate an aesthetically desirable outcome for patients seeking brow rejuvenation. The aim of this study is to summarize the current literature on eyebrow height changes with aging. Methods: A comprehensive search was conducted across several databases to identify all published studies that reported changes of eyebrow position or height with aging, from 1946 to January 2019. Studies that reported eyebrow position at the level of medial canthus, mid-pupil, and lateral canthus were included in a meta-analysis. Results: A total of 346 articles were initially identified, of which 19 met our inclusion criteria. Of 3,634 patients who were identified, 2,237 (64%) were females and 1,274 (36%) were males. Eyebrow height showed significant increase with aging at the level of medial canthus (mean difference 1.4 mm; 95% CI: 0.22–2.59; P = 0.02), and the level of mid-pupil (mean difference 1.17 mm; 95% CI: 0.54–1.8; P = 0.0002). However, no significant difference was found at the level of lateral canthus (mean difference 0.19 mm; 95% CI: −0.87 to 1.25; P = 0.72). Conclusions: Based on the reviewed literature to date, the medial eyebrow height increases with age, whereas it remains stable at the level of the lateral canthus. These results should be considered when considering eyebrow rejuvenation.

Abstract Objective The primary objective of this proof-of-concept cross-sectional study was to identify a framework for appraising the learning-approaches of undergraduate medical students in a competency based medical curriculum and correlating the results with teaching-approaches, as well as academic performance. The study was pursued at MBRU, which is a medical school in the Middle East with an undergraduate entry medical program. Results Our framework was blueprinted using the Approaches and Study Skills Inventory for Students (ASSIST) questionnaire, to which we made some modifications such that the overall cogency of the questionnaire wasn’t affected. Initial results with modified ASSIST at MBRU showed that most of our students adopted Deep or Strategic-learning approaches. This observation is in line with other studies in the literature, which shows that modified ASSIST is a suitable tool for mapping generic learning approaches with teaching approaches. Further, based on the insights from our initial results following the implementation of modified ASSIST, we have considered specific pedagogical strategies, in practice at MBRU, which cater to the generic learning approaches of majority of our undergraduate medical students. These pedagogical approaches, A. Feynman’s Technique; and B. Blended learning strategies, if implemented suitably in a curriculum will transform “Surface-learners” to “Deep/Strategic-learners”.

Abstract BACKGROUND Degenerative spondylolisthesis is the displacement of one vertebral body over the adjacent one. While standing and flexion-extension X-rays are preferred for determining listhesis, magnetic resonance imaging (MRI) is often utilized to assess the compression of nerve root or spinal cord. OBJECTIVE To investigate the difference in radiographic measurements of spondylolisthesis between X-rays and MRI. METHODS We retrospectively reviewed the records and radiographic images of patients with a confirmed diagnosis of spondylolisthesis undergoing operation in 2016. Primary variable of interest was the degree of slippage as per the Meyerding method. Agreement between the 2 reviewers was assessed using the 2-way intraclass correlation coefficient (ICC) for slippage percentage and Cohen's Kappa for grade. Agreement of Meyerding grade between the 2 imaging techniques was assessed using Cohen's Kappa, while the slip percentage measured for each technique was compared using a Bland-Altman (BA) plot, mean difference (MD), and 1-way ICC. RESULTS A total of 255 cases were analyzed. ICC between the 2 reviewers was found to be 0.75 (95% confidence interval [CI] = 0.64-0.83, P < .001) for X-ray and 0.76 (95% CI = 0.66-0.83, P < .001) for MRI. Agreement between X-ray and MRI for grading of spondylolisthesis was found to be poor (kappa = 0.32, P < .001). BA plot between X-ray and MRI measurements revealed an MD of 4.4% (95% limits of agreement: –10.3% to 19.3%) with 5.16% observations outside the limits of agreement and 1-way ICC of 0.35 showing poor agreement. Conclusion Our results demonstrate the discrepancy of spondylolisthesis grade measurements between weight-bearing X-ray and nonweight-bearing MRI. Careful evaluation of both imaging technique is warranted to determine the final severity of pathology and tailoring of management plan.

Abstract BACKGROUND Use of large databases such as the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has become increasingly common in neurosurgical research. OBJECTIVE To perform a critical appraisal and evaluation of the methodological reporting for studies in neurosurgical literature that utilize the ACS-NSQIP database. METHODS We queried Ovid MEDLINE, EMBASE, and PubMed databases for all neurosurgical studies utilizing the ACS-NSQIP. We assessed each study according to number of criteria fulfilled with respect to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement, REporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) Statement, and Journal of American Medical Association–Surgical Section (JAMA-Surgery) Checklist. A separate analysis was conducted among papers published in core and noncore journals in neurosurgery according to Bradford's law. RESULTS A total of 117 studies were included. Median (interquartile range [IQR]) scores for number of fulfilled criteria for STROBE Statement, RECORD Statement, and JAMA-Surgery Checklist were 20 (IQR:19-21), 9 (IQR:8-9), and 6 (IQR:5-6), respectively. For STROBE Statement, RECORD Statement, and JAMA-Surgery Checklist, item 9 (potential sources of bias), item 13 (supplemental information), and item 9 (missing data/sensitivity analysis) had the highest number of studies with no fulfillment among all studies (56, 68, 50%), respectively. When comparing core journals vs noncore journals, no significant difference was found (STROBE, P = .94; RECORD, P = .24; JAMA-Surgery checklist, P = .60). CONCLUSION While we observed an overall satisfactory reporting of methodology, most studies lacked mention of potential sources of bias, data cleaning methods, supplemental information, and external validity. Given the pervasive role of national databases and registries for research and health care policy, the surgical community needs to ensure the credibility and quality of such studies that ultimately aim to improve the value of surgical care delivery to patients.

OBJECTIVETranspsoas lateral interbody fusion is one of the lateral minimally invasive approaches for lumbar spine surgery. Most surgeons insert the interbody cage laterally and then insert pedicle or cortical screw and rod instrumentation posteriorly. However, standalone cages have also been used to avoid posterior instrumentation. To the best of the authors’ knowledge, the literature on comparison of the two approaches is sparse.METHODSThe authors performed a systematic review and meta-analysis of the available literature on transpsoas lateral interbody fusion by an electronic search of the PubMed, EMBASE, and Scopus databases using PRISMA guidelines. They compared patients undergoing transpsoas standalone fusion (TP) with those undergoing transpsoas fusion with posterior instrumentation (TPP).RESULTSA total of 28 studies with 1462 patients were included. Three hundred and seventy-four patients underwent TPP, and 956 patients underwent TP. The mean patient age ranged from 45.7 to 68 years in the TP group, and 50 to 67.7 years in the TPP group. The incidence of reoperation was found to be higher for TP (0.08, 95% confidence interval [CI] 0.04–0.11) compared to TPP (0.03, 95% CI 0.01–0.06; p = 0.057). Similarly, the incidence of cage movement was found to be greater in TP (0.18, 95% CI 0.10–0.26) compared to TPP (0.03, 95% CI 0.00–0.05; p < 0.001). Oswestry Disability Index (ODI) and visual analog scale (VAS) scores and postoperative transient deficits were found to be comparable between the two groups.CONCLUSIONSThese results appear to suggest that addition of posterior instrumentation to transpsoas fusion is associated with decreased reoperations and cage movements. The results of previous systematic reviews and meta-analyses should be reevaluated in light of these results, which seem to suggest that higher reoperation and subsidence rates may be due to the use of the standalone technique.