Top 100 Most Cited Articles in Mohs Micrographic Surgery: A Bibliometric Analysis.

BACKGROUND: Bibliometric analysis is a scientific method that can derive insights into major publications' trends within a field. Currently, no bibliometric study has been conducted for Mohs micrographic surgery (MMS). OBJECTIVE: To characterize the most frequently cited articles in MMS. METHODS: Web of Science was used to identify the 100 most cited publications on MMS between 1970 and 2022. Articles were analyzed by title, authorship, institution, journal, year, citation frequency, originating country, funding, citation index, Altmetric score, impact factor, Eigenfactor score, and article influence score. RESULTS: Since January 2023, the top 100 articles had 9,096 total citations, ranging from 47 to 304. The top cited publication was "Mohs surgery is the treatment of choice for recurrent (previously treated) basal-cell carcinoma" in 1989. The top contributing organization was Harvard University (17%) and top contributing authors were Brodland, DJ (12%) and Zitelli, JA (11%). The year 2005 accounted for most of the articles (12%). Most articles were from the Journal of the American Academy of Dermatology (32%) and Dermatologic Surgery (27%). The United States contributed to 76% of the top articles. CONCLUSION: This bibliometric analysis offers researchers a detailed overview of important MMS publications and provides useful data into current findings steering MMS research and practice.

Ophthalmology procedure trends in the United States during the COVID-19 pandemic.

PURPOSE: To evaluate the relationship between the COVID-19 pandemic and ophthalmic procedural volume. METHODS: A retrospective cohort study using TriNetX, a federated electronic health record's research network was done. Monthly Current Procedural Terminology-specific volumes per healthcare organization were clustered chronologically to calculate average volumes into 3-month seasons to calculate average procedural volumes. An aggregate of the total pandemic period (March 2020-August 2021) was compared to corresponding figures in pre-pandemic timeframes. RESULTS: Intravitreal injections were the most prevalent procedure in this time period with 320,106 occurrences. Phacoemulsification cataract surgery was the second most prevalent (N = 176,095) procedure. From March 2020 to August 2021, a mean pandemic volume of 266.7 (SD = 15) was observed, a 5% decrease (p < 0.05) in procedures compared to the pre-pandemic mean of 280.8 (SD = 26.1). Spring 2020 exhibited the sharpest seasonal decrease in procedural volume (- 88%). The largest count of statistically significant increases in procedure volume was in Spring 2021 (+ 18%). The aggregate mean volume per HCO showed significant decreases for 11 out of 17 procedures in the 12 month March 2020-February 2021 timeframe and significant decreases for 10 out of 17 procedures over the 18-month March 2020-August 2021 pandemic period. CONCLUSIONS: This study highlights the relative inverse relationship between COVID-19 cases and ophthalmic procedure volume in America. Quantifying ophthalmic procedure trends is important in retrospectively assessing surgical disruptions and prospectively accommodating delayed surgeries. Furthermore, awareness of these trends could help ophthalmologists prepare should similar disruptions occur in the setting of future pandemics or national disasters.

Merkel Cell Carcinoma: A Bibliometric Analysis of the Top 100 Cited Publications.

BACKGROUND: Bibliometric studies provide a quantitative statistical analysis of the published literature within a field of interest and allow for easy identification of the major contributing authors, funding sources, and publication trends within the field. To date, no bibliometric studies have been performed pertaining to Merkel cell carcinoma (MCC). OBJECTIVE: To identify the 100 most frequently cited articles in MCC through a bibliometric analysis of the literature. METHODS: Web of science was queried to determine the 100 most frequently cited MCC publications published between the years 1970 and 2019. Articles were listed by title, authors and their affiliated institutions, journal title and type, year of publication, country of origin, funding sources, and citation frequency. RESULTS: Among the 100 most frequently cited MCC publications, articles were cited between 67 and 589 times with a mean of 136.3 times. Articles were cited between 2.0 and 98.2 times per year since publication with a mean of 11.3 times per year. 67% of the articles were published in oncology journals; 33% and 10% of the articles in dermatology and surgery journals, respectively. The most represented journal was Cancer (12%). Paul Nghiem was the most frequently identified author (18%). 36% of the top 100 articles were published out of the University of Washington. The most frequent funding agency was the National Institutes of Health (77%). CONCLUSION: Through this bibliometric analysis, researchers can easily identify key publications pertaining to MCC, which may in turn enhance their approach to understanding and practicing evidence-based medicine regarding MCC.

Using infodemiology metrics to assess patient demand for oculoplastic surgeons in the United States: insights from Google Search Trends.

PURPOSE: The aim of this study was to compare state-by-state concentrations of oculoplastic surgeons against patient demand using Google Search Trends data, in order to identify potential areas of unmet need. METHODS: Google Trends data from 2004 to 2019 was collected to determine relative search volumes for the keyword "blepharoplasty" in each US state and the District of Columbia. Oculoplastic surgeon density was calculated by dividing the number of active American Society of Plastic and Reconstructive Surgeons members in 2019 by the State Census Bureau population estimates. Relative search volume values were divided by the local concentration of surgeons, and results were normalized between 0 and 100 to obtain a relative demand index for each state. RESULTS: Oculoplastic surgeon density varied widely across the country. The greatest concentrations of surgeons per 100,000 people were in D.C. (0.708) and Rhode Island (0.378), while the lowest were in Montana, New Mexico, North Dakota, South Dakota, and Wyoming (all 0). Relative search volumes were tightly distributed, ranging between 100 (Hawaii) and 45 (Vermont). The highest relative demand was found in low surgeon density states, such as Hawaii, Montana, New Mexico, North Dakota, South Dakota, and Wyoming. The lowest relative demand was found in DC (5), Rhode Island (12), and Utah (12). CONCLUSIONS: Our results revealed vast disparities in surgical concentrations across the US and highlighted a number of areas with a relative undersupply of oculoplastic surgeons. Further investigation is necessary to examine the underlying factors impacting the supply and distribution of oculoplastic surgeons.

Short term outcomes of COVID-19 in lupus: Propensity score matched analysis from a nationwide multi-centric research network.

OBJECTIVES: To determine the severity and outcome of COVID-19 among individuals with lupus as compared to controls. The secondary objective was to identify the risk association of sex, race, presence of nephritis, and use of various immunomodulators with COVID-19 outcomes. METHODS: Retrospective data of individuals with lupus with and without COVID-19 between January 2020 to May 2021 was retrieved from the TriNetX. A one-to-one matched COVID-19 positive control was selected using propensity score(PS) matching. We assessed several outcomes, including all-cause mortality, hospitalisation, intensive care unit (ICU) admission, mechanical ventilation, severe COVID, acute kidney injury (AKI), Haemodialysis, acute respiratory distress syndrome (ARDS), ischemic stroke, venous thromboembolism (VTE) and sepsis were assessed. RESULTS: We identified 2140 SLE patients with COVID-19, 29,853 SLE without COVID-19 and 732,291controls. Mortality within 30 days of COVID-19 diagnosis was comparable among SLE and controls [RR-1.26; 95%CI-0.85,1.8]. SLE with COVID-19 had a higher risk of hospitalisation [RR-1.28; 95% CI 1.14-1.44], ICU admission [RR-1.35; 95% CI 1.01-1.83], mechanical ventilation [RR- 1.58 95% CI 1.07-2.33], stroke [RR-2.18; 95% CI 1.32,3.60], VTE [RR-2.22; 95% CI 1.57-03.12] and sepsis [RR-1.37; 95% CI 1.06-1.78].Individuals with SLE who contracted COVID-19 had higher mortality, hospitalisation, ICU admission, mechanical ventilation, AKI, VTE and sepsis (p < 0.001) compared to SLE without COVID-19. Males with SLE had a higher risk of AKI [RR-2.05; 95% CI 1.27-3.31] than females. Lupus nephritis was associated with higher risk of hospitalisation [RR-1.36; 95% CI 1.05-1.76], AKI [RR-2.32; 95% CI 1.50-3.59] and sepsis [RR-2.07; 95% CI-1.12-3.83]. CONCLUSION: The mortality of individuals with SLE due to COVID-19 is comparable to the general population but with higher risks of hospitalisation, ICU admission, mechanical ventilation, stroke, VTE and sepsis. The presence of nephritis increases the risk of AKI, thus probably increasing hospitalisation and sepsis.

Public interest in rheumatic diseases and rheumatologist in the United States during the COVID-19 pandemic: evidence from Google Trends.

To evaluate the public interest in rheumatic diseases during the coronavirus disease 2019 (COVID-19) pandemic. Google Trends was queried to analyze search trends in the United States for numerous rheumatic diseases and also the interest in a rheumatologist. Three 8-week periods in 2020 ((March 15-May 9), (May 10-July 4), and (July 5-August 29)) were compared to similar periods of the prior 4 years (2016-2019). Compared to a similar time period between 2016 and 2019, a significant decrease was found in the relative search volume for more than half of the search terms during the initial March 15-May 9, 2020 period. However, this trend appeared to reverse during the July 5-August 29, 2020 period where the relative volume for nearly half of the search terms were not statistically significant compared to similar periods of the prior 4 years. In addition, this period showed a significant increase in relative volume for the terms: Axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren's syndrome, antiphospholipid syndrome, scleroderma, Kawasaki disease, Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis, and rheumatologist. There was a significant decrease in relative search volume for many rheumatic diseases between March 15 and May 9, 2020 when compared to similar periods during the prior 4 years. However, the trends reversed after the initial period ended. There was an increase in relative search for the term "rheumatologist" between July and August 2020 suggesting the need for rheumatologists during the COVID-19 pandemic. Policymakers and healthcare providers should address the informational demands on rheumatic diseases and needs for rheumatologists by the general public during pandemics like COVID-19.

Modular construction of multi-subunit protein complexes using engineered tags and microbial transglutaminase.

Motivations for the hierarchical assembly of protein complexes are diverse spanning biosensing, biomedical and bioreactor applications. The assembly processes should be simple, scalable, versatile, and biologically benign to minimize loss of component parts. A "plug and play" methodology comprising a generic linking apparatus may enable rapid design and optimization. One application that desires these qualities is metabolon construction wherein multiple enzymes are organized in defined pathways to mediate biochemical flux. Here, we propose a modular design by incorporation of crosslinking-compliant amino acid tags comprised of lysine or glutamine residues at the N- or C-termini of the to-be-assembled proteins. These amino acid tags enable covalent crosslinking using microbial transglutaminase (mTG). Modularity is demonstrated where stoichiometries and relative positions of enzymes and other functional proteins are altered. Construction of multifunctional complexes is demonstrated by crosslinking domains of different function and origin. Namely, we built a two-subunit quorum sensing (QS) biosynthetic metabolon on solid supports and altered stoichiometries of the limiting constituents to increase the overall rate of reaction. To display functionality beyond biosynthesis, we constructed a molecular communication 'device' (antibody binding Protein G-QS complex) to target bacterial cells and demonstrated tailored QS responses among targeted bacteria. We propose that this approach, solid phase mTG-mediated linkage of biological components, can be used for assembly within many environments including microreactors or lab-on-a-chip systems. Because the methodology is general, we envision construction of multi-functional protein complexes in a 'plug and play' fashion for a variety of biosensing and synthetic biology applications.

Characteristics of Litigations Involving Contact Dermatitis: An Exploratory Analysis.

Background: Contact dermatitis (CD) is one of the most common skin disorders, occurring in >20% of patients worldwide. Estimated cost burden for CD in the United States approaches $1 billion annually. Objective: To describe characteristics of litigation among patients with CD. Methods: Westlaw legal database for U.S. lawsuits was queried for lawsuits between the years 1983 and 2021 containing the keywords "dermatitis or eczema." Each lawsuit associated with CD was analyzed by plaintiff demographics, verdict, prosecution reason, payouts, and allergen implicated. Results: Of 98 cases, 61 met the inclusion criteria. Verdicts issued favored plaintiffs (42.6%) more than defendants (32.8%) with the remaining cases decided through settlements. If payout occurred, the mean was $246,310 (standard deviation [SD] = $798,536), the median was $20,000 (Q1 = $8,500, Q3 = $88,725, interquartile range = $80,225). The top reason for litigation was toxic exposure (n = 38, 62.2%), and common contact allergens associated with lawsuits were latex (n = 4, 20%), surgical tape (n = 4, 20%), and beauty products (n = 4, 20%). Conclusion: Common allergens associated with lawsuits include latex, surgical tape, and beauty products. Most CD cases adjudicated in the United States since 1983 are associated with toxic exposures.

Patient Demand for Urologists in the United States: A Google Trends Analysis.

INTRODUCTION: We sought to quantify patient demand for urologists on a state-by-state basis in the United States. METHODS: Google Trends data were analyzed from 2004-2019 to determine average relative search volume for the term "urologist" in each state. The 2019 American Urological Association Census was used to determine the number of practicing urologists per state. A per capita concentration of urologists was calculated by dividing the number of providers by the estimated population in each state as reported by the 2019 Census Bureau. Relative search volume values were then divided by the concentration of urologists to estimate a physician demand index for each state scaled 0-100. RESULTS: The physician demand index was highest in Mississippi (100), Nevada (89), New Mexico (87), Texas (82), and Oklahoma (78). The concentration of urologists per 10,000 people was greatest in New Hampshire (0.537), New York (0.529), and Massachusetts (0.514), and lowest in Utah (0.268), New Mexico (0.248), and Nevada (0.234). Relative search volume was highest in New Jersey (100.00), Louisiana (91.67), and Alabama (87.67), and lowest in Wisconsin (31.17), Oregon (29.17), and North Dakota (28.50). CONCLUSIONS: The findings of this study suggest that demand is greatest in the Southern and Intermountain regions of the United States. Facing a shortage in the urology workforce, these data may aid physicians and policy makers in focusing interventions. These findings may further aid in future job allocation and practice distribution.

Quantifying the Impact of COVID-19 on Hand and Wrist Surgery Procedural Volume: A National Analysis of 381,046 Cases.

Purpose: To quantify and describe the impact of the COVID-19 pandemic on procedural volume trends in hand and wrist surgery from 2020 to early 2022 at multiple centers. Methods: In this retrospective comparative study, a real-time, national, federated research database was used to identify patients of interest from 56 health care organizations across the United States. Patients were queried from March 1, 2018, to February 28, 2022. Current Procedural Terminology codes were chosen using the Accreditation Council for Graduate Medical Education's hand fellowship procedure requirements. Results: Common hand and wrist surgeries exhibited substantial fluctuations in procedural volume per health care organization during the COVID-19 pandemic. Time periods with considerable procedural volume decreases corresponded with surges in increased COVID-19 caseloads and emergence of COVID-19 variants. Periods of procedural volume increase occurred in the summer of 2020 and immediately following distribution of the COVID-19 vaccine to the public. Fixation of metacarpal fracture, fixation of phalangeal fracture, tendon transfer, flexor tendon repair, and extensor tendon repair consistently showed decreased volumes over the study period. In contrast, ulnar nerve decompression was the only procedure to experience a statistically significant increase in volume over an entire year (2021, +19.2%, P < .001), as compared to before the pandemic. Conclusions: Major milestones of the COVID-19 pandemic correlated with fluctuations in the number of hand and wrist procedures performed across the United States. Future studies should seek to evaluate the impact of patient backlogs and individual procedure fluctuations on financial impacts, patient outcomes, and orthopedic trainee experience. Type of study/level of evidence: Economic/Decision Analysis IV.

Examining the Influence of COVID-19 Infection and Pandemic Restrictions on the Risk of Corneal Transplant Rejection or Failure: A Multicenter Study.

PURPOSE: The purpose of this study was to evaluate two aims. The first was whether patients with a history of keratoplasty who developed COVID-19 were at a higher risk of corneal graft rejection or failure. The second was examining whether patients who underwent a new keratoplasty during the first 2 years of the pandemic from 2020-2022 were at a higher risk of the same outcomes compared to those undergoing keratoplasty from 2017-2019 before the pandemic. METHODS: A multicenter research network, TriNetX, was used to query for keratoplasty patients with or without a COVID-19 between January 2020 and July 2022. Additionally, the database was also queried to identify new keratoplasties performed from January 2020-July 2022 and compare it to keratoplasties performed during a similar pre-pandemic interval between 2017-2019. 1:1 Propensity Score Matching was utilized to adjust for confounders. Graft complication of either a rejection or failure was assessed within 120 day follow-up using the Cox proportional hazard model and survival analysis. RESULTS: A total of 21,991 patients with any keratoplasty history were identified from January 2020-July 2022, of which 8.8% were diagnosed with COVID-19. Matching revealed two balanced cohorts of 1,927 patients where no significant difference in risk of corneal graft rejection or failure among groups ((aHR [95% CI] = 0.76 [0.43,1.34]; p = .244)). Comparing first-time keratoplasties performed in a pandemic period of January 2020-July 2022 to a corresponding pre-pandemic interval from 2017-2019 also similarly revealed no differences in graft rejection or failure in matched analysis (aHR = 0.937[0.75, 1.17], p = .339). CONCLUSIONS: This study found no significant increase in the risk of graft rejection or failure in patients with a prior keratoplasty history following COVID-19 diagnosis nor in any patients who had a new keratoplasty done during 2020-2022 when compared to a similar pre-pandemic interval.

Patient Demand for Ophthalmologists in the United States: A Google Trends Analysis.

PURPOSE: To study geographic patterns in ophthalmologist supply and patient demand for services in the United States. METHODS: Google Trends data for the keywords "ophthalmology" and "ophthalmologist" between 2004 and 2019 were queried and normalized to determine relative search volumes (RSV) for each United States state. Ophthalmologist density was calculated by dividing the number of practicing ophthalmologists by the State Census Bureau population estimates. RSV values were divided by ophthalmologist density and normalized to calculate the relative demand index (RDI) for each state. The number of accredited ophthalmology programs per state was acquired through the Accreditation Council for Graduate Medical Education. RESULTS: Ophthalmologist concentration was highly heterogeneous across the country. The states with the highest concentration of ophthalmologist per 10,000 people were Washington, DC (1.42), Maryland (0.94), Massachusetts (0.87), and New York (0.86), while the lowest were Wyoming (0.19), Idaho (0.36), New Mexico (0.38), and Nevada (0.39). RSVs ranged from 36 (Alaska and North Dakota) to 100 (Michigan). The highest RDI was found in South Dakota (100), Delaware (84), Michigan (66), and Arizona (56). The lowest RDI was in Washington, DC (0), Hawaii (7), Oregon (8), and Montana (14). The highest number of ophthalmology residency programs were in New York (18), Texas (9), and California (9), whereas 12 states lacked residency programs altogether. CONCLUSIONS: In this study, we found a wide range in the geographic distribution of ophthalmologists and residency programs in the United States. States with the highest relative demand index may represent areas most at risk of unmet medical needs.

Impact of COVID-19 on Spinal Diagnosis and Procedural Volume in the United States.

STUDY DESIGN: Retrospective analysis of a national database. OBJECTIVES: COVID-19 resulted in the widespread shifting of hospital resources to handle surging COVID-19 cases resulting in the postponement of surgeries, including numerous spine procedures. This study aimed to quantify the impact that COVID-19 had on the number of treated spinal conditions and diagnoses during the pandemic. METHODS: Using CPT and ICD-10 codes, TriNetX, a national database, was utilized to quantify spine procedures and diagnoses in patients >18 years of age. The period of March 2020-May 2021 was compared to a reference pre-pandemic period of March 2018-May 2019. Each time period was then stratified into four seasons of the year, and the mean average number of procedures per healthcare organization was compared. RESULTS: In total, 524,394 patient encounters from 53 healthcare organizations were included in the analysis. There were significant decreases in spine procedures and diagnoses during March-May 2020 compared to pre-pandemic levels. Measurable differences were noted for spine procedures during the winter of 2020-2021, including a decrease in lumbar laminectomy and anterior cervical arthrodesis. Comparing the pandemic period to the pre-pandemic period showed significant reductions in most spine procedures and treated diagnoses; however, there was an increase in open repair of thoracic fractures during this period. CONCLUSIONS: COVID-19 resulted in a widespread decrease in spinal diagnosis and treated conditions. An inverse relationship was observed between new COVID-19 cases and spine procedural volume. Recent increases in procedural volume from pre-pandemic levels are promising signs that the spine surgery community has narrowed the gap in unmet care produced by the pandemic.

Readability Analysis of the American Society of Ophthalmic Plastic & Reconstructive Surgery Patient Educational Brochures.

INTRODUCTION: Previous studies have shown patient education material (PEM) in ophthalmology has been written at levels exceeding appropriate reading levels. However, information for readability in the field of oculoplastics remains limited. The aim of this study was to evaluate the readability of patient educational brochures from the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS). METHODS: Patient educational brochures from ASOPRS were analyzed for readability. The body of text from all 18 ASOPRS patient brochures was analyzed by ten validated tests for English readability assessment: Flesch Reading Ease Test (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), New Dale-Chall Readability (NDC), FORCAST, Fry Graph Readability (FG), Raygor Readability Estimate (RRE), and New Fog Count (NFC). RESULTS: The mean (± SD) readability scores from the 18 ASOPRS patient brochures were 48 (4.3), 11.0 (0.8), 13.0 (0.7), 11.7 (0.8), 13.6 (0.9), 11.3 (0.8), 11.1 (0.5), 12.1 (1.5), 12.2 (1.0), and 10.6 (1.3) for FRE, FKGL, SMOG, CLI, GFI, NDC, FORCAST, FG, RRE, and NFC, respectively. All ten of the mean readability scores were above the recommended reading levels. CONCLUSIONS: These findings show that the average patient may have difficulty understanding educational information provided by ASOPRS patient brochures, thereby hindering their ability to make informed decisions on their healthcare. Revision with readability as a primary goal, with input from patients and caregivers, may be necessary to improve health literacy among patients who seek oculoplastic care.

COVID-19's impact on interest in gastrointestinal topics.

There has been a disparity in familiarity regarding the public interest in gastroenterology terminologies during the COVID-19 pandemic. This study aimed to understand the outcomes of the public's view on gastrointestinal topics and their potential social effects. This study is a comparative analysis of American Google Trends gastrointestinal terminology during the COVID-19 pandemic compared to a similar time frame (March 2018-February 2020) to determine how trends in the patient-seeking behavior of gastrointestinal terminology changed throughout the pandemic. The analysis discovered a substantial decrease in search volumes of gastrointestinal topics, more significantly in the first pandemic months. Later in the pandemic, search volumes trended toward pre-pandemic years in terms of public interest. In the case of gastrointestinal procedures, endoscopy and colonoscopies, they surpassed pre-pandemic interest levels statistically (p-values of 0.01 and 0.002). The public's decreased interest in gastrointestinal topics at the beginning of the COVID-19 pandemic may have adverse effects on the healthcare maintenance of patients who could have had a positive outcome in their gastrointestinal health with proper monitoring. Although gastrointestinal internet searches increased toward pre-pandemic levels as the seasons progressed, further research is needed to determine the social impact of decreased public interest.