Evaluating the Evidence: Scientometric Analysis of Highly Cited Neurofibromatosis 1 Publications.

The study of Neurofibromatosis 1 (NF1) is progressing rapidly. This study aimed to identify historical trends in publications focusing on NF1, to find the top 100 most cited publications on this topic, and to evaluate their level of evidence. This study identifies historical trends in publication regarding NF1 with the aim of providing readers useful information about the areas of research being performed, an educational guide to facilitate novice researchers in conducting effective evidence-based medical research, and unique insight into developments and trends of NF 1 research. This study also evaluates the evidence of highly cited papers on NF1. A search of all databases and journals accessible within Elsevier's Scopus was performed on June 27th, 2020, using combinations of the Boolean queries "Neurofibromatosis 1," "Von Recklinghausen," and "NF1," which yielded 13,599 documents. The top 100 most-cited papers were identified, analyzed, and evaluated for level of evidence. Evidence was assessed using the GRADE guidelines. The top 100 most-cited articles span years 1963-2010 and are published in 50 different journals. The average number of citations per publication was 366.5 (range 189-1527). The most cited article is "Neurofibromatosis: Conference Statement" (Stumpf et al., 1988). In this study, the top 100 most-cited works in NF1 are identified, characterized, and analyzed. This study will serve as a historical point of reference for future research, a jumping point for those unfamiliar with the topic, and an educational foundation for future NF1 specialists and researchers.

Corneal Neurotization in the Setting of Facial Paralysis: A Comprehensive Review of Surgical Techniques.

ABSTRACT: Neurotrophic keratopathy is characterized by decreased corneal sensitivity, decreased reflex tearing, and poor corneal healing resulting in corneal injury. Without proper sensory innervation, the cornea undergoes continuous epithelial injury, ulceration, infection and eventually results in vision loss. In situations where patients have concomitant facial paralysis, such as after resection of a large vestibular schwannoma, the ocular health is further impaired by paralytic lagophthalmos with decreased eye closure and blink reflex, decreased tearing, and potential lower eyelid malposition. In patients with a dual nerve injury, the ocular surface is in significant danger, as there is increased environmental exposure in conjunction with the inability to sense damage when it occurs. Immediate recognition and care of the eye are critical for maintaining ocular health and preventing irreversible vision loss. The first modern corneal neurotization procedure was described in 2009. The ultimate goal in corneal neurotization is to establish sub-basal plexus regeneration via transferring a healthy nerve to the corneo-limbal region. Corneal neurotization can be achieved either via a direct transfer of healthy nerve (direct approach) or via nerve graft interpositions (indirect approach). This is an emerging concept in the treatment of neurotrophic/exposure keratitis and over the past decade multiple direct and indirect approaches have been described in the attempt to restore corneal sensation and to prevent the devastating outcomes of neurotrophic keratitis. Knowledge of these techniques, their advantages, and disadvantages is required for proper management of patients suffering from neurotrophic keratitis in the setting of facial paralysis.

A Century in Review: Medicolegal Implications of Facial Nerve Paralysis.

Importance: It is important to recognize factors that may mitigate the risk of a potential lawsuit and increase knowledge and awareness of physicians. Objective: To evaluate and characterize facial nerve paralysis litigation claims and related potential causes. Design, Setting, and Participants: These data were extracted from the two main computerized legal databases: WestLaw and LexisNexis. The data were queried on April 2, 2020. The records from 1919 to 2020 were obtained from a population-based setting. A total of 186 cases were included. Data were gathered for all alleged cases of facial nerve paralysis. Main Outcomes and Measures: There was a continuous rise in the amount of malpractice payments with the highest mean amount being in the past decade. Results: From 1919 to 2020, a total of 186 malpractice cases for facial nerve damage were identified. A total amount of $89,178,857.99 was rewarded to plaintiffs in 66 cases. The mean amount of paid malpractice claim was $1,351,194.80. Improper performance/treatment was the most common reason for alleged litigation (n = 97). This was followed by misdiagnosis/delayed diagnosis (n = 47), and failure of informed consent (n = 34). The highest number of malpractice claims with a total of 53 cases was from 1991 to 2000. The highest mean amount per payment was in the past decade (2011-2020) with a mean of $3,841,052.68. Conclusions and Relevance: Over the past century, improper performance/procedure, delayed/misdiagnosis, and failure of informed consent were the most common reasons for litigations related to facial nerve paralysis.

Synergistic Growth in Number of Diagnostic and Interventional Radiology Matches at Pennsylvania State College of Medicine After 2016.

In 2016, when interventional radiology (IR) separated from diagnostic radiology (DR), the future implications were unknown. The goal of this study is to investigate trends in DR and IR matches at Penn State College of Medicine (PSCOM) from 2011-2020, particularly before and after 2016. This retrospective study generated descriptive statistics and paired t-tests, finding a statistically significant difference in mean number of DR and IR matches before and after 2016. More specifically, the number of DR matches increased from 3.8 to 6.4 (p = 0.0004) and IR matches increased from 0 to 2 (p = 0.03). These trends suggest a synergistic growth in both specialties.