bluuebunny/crossref_metadata_2025 huggingface dataset:
ERASE: a novel surface reconditioning strategy for single-molecule experiments
Authors: Broadwater D W Bo , Altman Roger B , Blanchard Scott C , Kim Harold D
Published: November 2018

While surface-based single-molecule experiments have revolutionized our understanding of biology and biomolecules, the workflow in preparing for such experiments, especially surface cleaning and functionalization, remains labor-intensive and time-consuming. Even worse, meticulously assembled flow channels can be used only once for most experiments. A reusable surface would thus dramatically increase productivity and efficiency of single-molecule experiments. In this paper, we report a novel surface reconditioning strategy termed ERASE (Epitaxial Removal Aided by Strand Exchange) that allows a single flow cell to be used for vast repetition of single-molecule experiments. In this method, biomolecules immobilized to the surface through a nucleic acid duplex are liberated when a competing DNA strand disrupts the duplex via toehold-mediated strand displacement. We demonstrate the wide-range applicability of this method with various common surface preparation techniques, fluorescent dyes, and biomolecules including the bacterial ribosome. Beyond time and cost savings, we also show ERASE can assort molecules based on a nucleic acid barcode sequence, thus allowing experiments on different molecules in parallel. Our method increases the utility of prepared surfaces and is a significant improvement to the current single-use paradigm.
Comparison of high glomerular filtration rate thresholds for identifying hyperfiltration
Authors: Chakkera Harini A , Denic Aleksandar , Kremers Walter K , Stegall Mark D , Larson Joseph J , Ravipati Harish , Taler Sandra J , Lieske John C , Lerman Lilach O , Augustine Joshua J , Rule Andrew D
Published: November 2018

Background

High glomerular filtration rate (GFR) is often used as a surrogate for single-nephron hyperfiltration. Our objective was to determine the definition for high GFR that best reflects clinical and structural characteristics of hyperfiltration.

Methods

We studied living kidney donors at the Mayo Clinic and Cleveland Clinic. Potential donors underwent evaluations that included measured GFR (mGFR) by iothalamate clearance and estimated GFR (eGFR) by the serum creatinine–based Chronic Kidney Disease-Epidemiology collaboration (CKD-EPI) equation. High GFR was defined by the 95th percentile for each method (mGFR or eGFR) using either overall or age-specific thresholds. High mGFR was defined as both corrected and uncorrected for body surface area. The association of high GFR by each definition with clinical characteristics and radiologic findings (kidney volume) was assessed. In the subset that donated, the association of high GFR with kidney biopsy findings (nephron number and glomerular volume) and single-nephron GFR was assessed.

Results

We studied 3317 potential donors, including 2125 actual donors. The overall 95th percentile for corrected mGFR was 134 mL/min/1.73 m2 and for eGFR was 118 mL/min/1.73 m2. The age-based threshold for uncorrected mGFR was 198 mL/min − 0.943×Age, for corrected mGFR it was 164 mL/min/1.73 m2 − 0.730×Age and for eGFR it was 146 mL/min/1.73 m2 − 0.813×Age. High age-based uncorrected mGFR had the strongest associations with higher single-nephron GFR, larger glomerular volume, larger kidney volume, male gender, higher body mass index and higher 24-h urine albumin, but also had the strongest association with high nephron number. A high age-height-gender–based uncorrected mGFR definition performed almost as well but had a weaker association with nephron number and did not associate with male gender.

Conclusions

High age-based uncorrected mGFR showed the most consistent associations reflective of hyperfiltration. However, high age-based uncorrected mGFR has limited clinical utility because it does not distinguish between hyperfiltration and high nephron number.
Brauer equivalent number fields and the geometry of quaternionic Shimura varieties
Authors: Linowitz Benjamin
Published: November 2018

Two number fields are said to be Brauer equivalent if there is an isomorphism between their Brauer groups that commutes with restriction. In this paper, we prove a variety of number theoretic results about Brauer equivalent number fields (for example, they must have the same signature). These results are then applied to the geometry of certain arithmetic locally symmetric spaces. As an example, we construct incommensurable arithmetic locally symmetric spaces containing exactly the same set of proper immersed totally geodesic surfaces.
Association of author’s financial conflict of interest with characteristics and outcome of rheumatoid arthritis randomized controlled trials
Authors: Khan Nasim Ahmed , Nguyen Chau L , Khawar Talha , Spencer Horace , Torralba Karina D
Published: November 2018

Objective

To examine the prevalence, types and temporal trends of reported financial conflicts of interest (FCOIs) among authors of drug therapy randomized controlled trials (RCTs) for RA and their association with study outcomes.

Methods

We identified original, non–phase 1, parallel-group, drug therapy RA RCTs published in the years 2002–03, 2006–07, and 2010–11. Two investigators independently obtained trial characteristics data. Authors’ FCOIs were classified as honoraria/consultation fees receipt, employee status, research grant, and stock ownership. Multivariable logistic regression was performed to identify whether FCOIs were independently associated with study outcome.

Results

A total of 146 eligible RCTs were identified. Of these, 83 (58.4%) RCTs had at least one author with an FCOI [employee status: 63 (43.2%), honoraria/consultation fees receipt: 49 (33.6%), research grant: 30 (20.5%), and stock ownership: 28 (19.2%)]. A remarkable temporal increase in reporting of honoraria/consultation fees receipt, research grant, and stock ownership was seen. The reporting of any FCOI itself was not associated with positive outcome [50/73 (68.5%) with author FCOI vs 36/52 (69.2%) without author FCOI, P = 0.93]. However, honoraria/consulting fees receipt was independently associated with increased likelihood of a positive outcome [adjusted odds ratio (95% CI) of 3.24 (1.06–9.88)]. In general, trials with FCOIs were significantly more likely to be multicentre, have larger enrolment, use biologic or a small molecule as the experimental intervention, and have better reporting of some methodological quality measures.

Conclusion

FCOI reporting in RA drug RCT authors is common and temporally increasing. Receipt of honoraria/consulting fees was independently associated with a positive study outcome.
Identification of Common Thalamocortical Dysconnectivity in Four Major Psychiatric Disorders
Authors: Tu Pei-Chi , Bai Ya Mei , Li Cheng-Ta , Chen Mu-Hong , Lin Wei-Chen , Chang Wan-Chen , Su Tung-Ping
Published: November 2018

Background

Recent genetic and imaging analyses of large datasets suggested that common biological substrates exist across psychiatric diagnoses. Functional connectivity (FC) abnormalities of thalamocortical circuits were consistently found in patients with schizophrenia but have been less studied in other major psychiatric disorders. This study aimed to examine thalamocortical FC in 4 major psychiatric disorders to identify the common connectivity abnormalities across major psychiatric disorders.

Methods

This study recruited 100 patients with schizophrenia, 100 patients with bipolar I disorder, 88 patients with bipolar II disorder, 100 patients with major depressive disorder, and 160 healthy controls (HCs). Each participant underwent resting functional magnetic resonance imaging. The thalamus was used to derive FC maps, and group comparisons were made between each patient group and HCs using an independent-sample t test. Conjunction analysis was used to identify the common thalamocortical abnormalities among these 4 psychiatric disorders.

Results

The 4 groups of patients shared a similar pattern of thalamocortical dysconnectivity characterized by a decrease in thalamocortical FC with the dorsal anterior cingulate, anterior prefrontal cortex and inferior parietal cortex. The groups also showed an increase in FC with the postcentral gyrus, precentral gyrus, superior temporal cortex, and lateral occipital areas. Further network analysis demonstrated that the frontoparietal regions showing hypoconnectivity belonged to the salience network.

Conclusion

Our findings provide FC evidence that supports the common network hypothesis by identifying common thalamocortical dysconnectivities across 4 major psychiatric disorders. The network analysis also supports the cardinal role of salience network abnormalities in major psychiatric disorders.
Auditory and Visual Oddball Stimulus Processing Deficits in Schizophrenia and the Psychosis Risk Syndrome: Forecasting Psychosis Risk With P300
Authors: Hamilton Holly K , Woods Scott W , Roach Brian J , Llerena Katiah , McGlashan Thomas H , Srihari Vinod H , Ford Judith M , Mathalon Daniel H
Published: November 2018

Identification of neurophysiological abnormalities associated with schizophrenia that predate and predict psychosis onset may improve clinical prediction in the psychosis risk syndrome (PRS) and help elucidate the pathogenesis of schizophrenia. Amplitude reduction of the P300 event-related potential component reflects attention-mediated processing deficits and is among the most replicated biological findings in schizophrenia, making it a candidate biomarker of psychosis risk. The relative extent to which deficits in P300 amplitudes elicited by auditory and visual oddball stimuli precede psychosis onset during the PRS and predict transition to psychosis, however, remains unclear. Forty-three individuals meeting PRS criteria, 19 schizophrenia patients, and 43 healthy control (HC) participants completed baseline electroencephalography recording during separate auditory and visual oddball tasks. Two subcomponents of P300 were measured: P3b, elicited by infrequent target stimuli, and P3a, elicited by infrequent nontarget novel stimuli. Auditory and visual target P3b and novel P3a amplitudes were reduced in PRS and schizophrenia participants relative to HC participants. In addition, baseline auditory and visual target P3b, but not novel P3a, amplitudes were reduced in 15 PRS participants who later converted to psychosis, relative to 18 PRS non-converters who were followed for at least 22 months. Furthermore, target P3b amplitudes predicted time to psychosis onset among PRS participants. These results suggest that P300 amplitude deficits across auditory and visual modalities emerge early in the schizophrenia illness course and precede onset of full psychosis. Moreover, target P3b may represent an important neurophysiological vulnerability marker of the imminence of risk for psychosis.
Confronting barriers to improve healthcare literacy and cultural competency in disparate populations
Authors: Polster Debra S.
Published: November 2018

Positive patient outcomes depend on clear communication. Understanding healthcare literacy, cultural competency, and health disparities/inequalities is essential for providing empathetic care to patients and their family members. Guidelines to provide culturally competent care may enhance the patient experience and improve healthcare provider communication.
Ventriculoperitoneal shunts
Authors: Vacca Vincent M.
Published: November 2018

A ventriculoperitoneal shunt (VPS) is the most common type of implanted cerebrospinal fluid shunt system. Nurses may care for patients who have undergone shunt placement or revision. This article discusses the indications for VPS placement in adults, possible complications, and nursing care for patients following a shunt placement procedure.
Leadership Development in Postgraduate Medical Education: A Systematic Review of the Literature
Authors: Sultan Nabil , Torti Jacqueline , Haddara Wael , Inayat Ali , Inayat Hamza , Lingard Lorelei
Published: November 2018

Purpose

To evaluate and interpret evidence relevant to leadership curricula in postgraduate medical education (PGME) to better understand leadership development in residency training.

Method

The authors conducted a systematic review of peer-reviewed, English-language articles from four databases published between 1980 and May 2, 2017 that describe specific interventions aimed at leadership development. They characterized the educational setting, curricular format, learner level, instructor type, pedagogical methods, conceptual leadership framework (including intervention domain), and evaluation outcomes. They used Kirkpatrick effectiveness scores and Best Evidence in Medical Education (BEME) Quality of Evidence scores to assess the quality of the interventions.

Results

Twenty-one articles met inclusion criteria. The classroom setting was the most common educational setting (described in 17 articles). Most curricula (described in 13 articles) were isolated, with all curricula ranging from three hours to five years. The most common instructor type was clinical faculty (13 articles). The most commonly used pedagogical method was small group/discussion, followed by didactic teaching (described in, respectively, 15 and 14 articles). Study authors evaluated both pre/post surveys of participant perceptions (n = 7) and just postintervention surveys (n = 10). The average Kirkpatrick Effectiveness score was 1.0. The average BEME Quality of Evidence score was 2.

Conclusions

The results revealed that interventions for developing leadership during PGME lack grounding conceptual leadership frameworks, provide poor evaluation outcomes, and focus primarily on cognitive leadership domains. Medical educators should design future leadership interventions grounded in established conceptual frameworks and pursue a comprehensive approach that includes character development and emotional intelligence.
Medical Student Deaths by Suicide: The Importance of Transparency
Authors: Laitman Benjamin M. , Muller David
Published: November 2018

In this Invited Commentary, the authors present a call to action regarding the paucity of data related to medical student deaths by suicide. They review the limited literature on medical student suicide and suggest that no comprehensive study has ever occurred. They believe that the available data are too limited to conclude what the rate of death by suicide is among medical students compared with their age-matched peers. The authors speculate that the lack of accurate data may be related both to reluctance on the part of schools to report deaths by suicide and to the failure of national organizations like the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and Liaison Committee on Medical Education to mandate reporting. The authors believe that without reliable data, the medical education community will never be able to determine whether any trends or predictors are connected to medical student death by suicide and that, as a result, intervening in a meaningful way will remain impossible. The authors call on the national organizing bodies of medical education to mandate reporting of deaths by suicide, and to create and maintain a database for tracking and studying these events. They advocate for public access to unidentified data, linking medical schools to the number of deaths by suicide, as another method of creating accountability and influencing medical school behavior in addressing this tragic phenomenon.
Centro SOL: A Community–Academic Partnership to Care for Undocumented Immigrants in an Emerging Latino Area
Authors: Polk Sarah , DeCamp Lisa R. , Guerrero Vázquez Mónica , Kline Kathryn , Andrade Adriana , Cook Barbara , Cheng Tina , Page Kathleen R.
Published: November 2018

Problem

From 2000 to 2014, the Latino population in Baltimore city, an emerging Latino settlement area, experienced rapid growth. Many of these individuals are undocumented and not eligible for coverage. Academic medical centers often lead the way in addressing the health needs of undocumented immigrants; however, examples from emerging immigrant areas are limited.

Approach

In October 2013, Johns Hopkins Medicine clinicians established the Center for Salud/Health and Opportunities for Latinos (Centro SOL) to better address the health needs of Baltimore’s growing Latino community. Centro SOL’s mission focuses on four core activities: clinical services; advocacy and community engagement efforts; pipeline/education opportunities; and research consultations. Progress is measured through a scorecard reviewed annually by Centro SOL leadership.

Outcomes

Centro SOL’s program has expanded health care access for undocumented immigrants, patient safety and quality of service/care programs for patients with limited English proficiency, and pipeline opportunities for Latino youth. In 2017, 2,763 uninsured patients received primary or specialty care and 290 people received group therapy to address stress-related conditions. In addition, 49 Latino students (ranging from high school to postgraduate students) received mentorship at Centro SOL.

Next Steps

In the next five years, Centro SOL plans to expand the pipeline for Latinos interested in health professions fields and to further improve access to health services for Latino families through both advocacy efforts and enhanced clinical services.
Is It Time to Be More Explicit About the Purpose of a Hospital Admission?
Authors: Goldszmidt Mark , Faden Lisa , Baranova Katherina
Published: November 2018

Purpose

Patient care suffers when teaching teams fail to achieve a shared understanding of problems to be addressed during a hospital admission. In academic contexts where attending physicians take turns supervising, practice variability may contribute to undermining this shared understanding. Exploring variability around what constitutes the purpose of the hospital admission was the focus of this study.

Method

Constructivist grounded theory was used to inform data collection and analysis of this two-phase study, conducted in London and Hamilton, Ontario, Canada, in 2012. In phase 1, interviews with 24 attending physicians from 2 academic health centers were conducted. Phase 2 involved analyzing 18 audio-recorded admission case review discussions in relation to the emergent theory from phase 1. Participants for phase 2 were 7 different attendings, 7 medical students, and 5 junior residents.

Results

Three dominant perspectives around the purpose of an admission were identified. The most focused perspective characterized the purpose as making patients ready for discharge. By contrast, the most comprehensive perspective characterized admission as an opportunity to identify ways to improve overall patient health status. The third perspective was in-between—treating acute issues while monitoring pertinent chronic conditions. All attendings expressed a sense of discharge pressure but responded with different strategies. Attendings rarely explicitly discussed their perspectives as part of case review.

Conclusions

These extremes of practice and lack of overt dialogue are concerning. Potential effects include mixed messages to trainees and missed opportunities for dialogue and debate around what can and should be achieved during a hospital admission.
A Multicountry Updated Assessment of the Economic Impact of Fetal Alcohol Spectrum Disorder: Costs for Children and Adults
Authors: Greenmyer Jacob R. , Klug Marilyn G. , Kambeitz Cassondra , Popova Svetlana , Burd Larry
Published: November 2018

Aim:

To conduct a systematic review and quantitative analysis of the world literature on the economic impact of fetal alcohol spectrum disorder (FASD).

Methods:

A comprehensive literature review was conducted using multiple electronic databases and reference materials.

Results:

Thirty-two studies from 4 countries met the inclusion criteria (United States [n = 20], Canada [n = 9], Sweden [n = 2], and New Zealand [n = 1]). The studies reported the economic impact of FASD on health care, special education, residential care, criminal justice system, productivity losses due to morbidity and premature mortality, productivity losses of caregivers of children with FASD, and intangible costs. The economic estimates vary considerably due to the different methodologies used by different studies. The mean annual cost for children with FASD was estimated to be $22,810 and for adults $24,308. Residential costs for children with FASD were 4-fold greater than for adults with FASD. The costs of lost productivity for adults were 6.3-fold greater than for children.

Conclusions:

The data on the economic burden of FASD are scarce, and the existing estimates likely underestimate the full economic impact of this disorder on the affected individuals, their caregivers, and society. However, the current research is sufficient to demonstrate that FASD is a serious public health problem associated with tremendous economic burden.
The Best Interests of Infants and Families During Palliative Care at the End of Life
Authors: Sieg Susan E. , Bradshaw Wanda T. , Blake Stephanie
Published: November 2018

Background:

Palliative care is an integral element of care provision in neonatal intensive care units (NICUs). Healthcare providers working in NICUs are likely to provide palliative care at some point in their career.

Purpose:

This article examines what neonatal palliative care entails, how parents perceive healthcare providers' actions, what they potentially need at the end of their infant's life, and what bereavement interventions are most supportive for parents.

Search Strategy:

We conducted a search of full-text articles published in English in PubMed and CINAHL using the following key words: “NICU bereavement care,” “end-of-life care,” “infant loss,” and “palliative care.”

Findings:

Healthcare providers should consider alleviation of the infant's pain and suffering when discussing whether to provide or continue aggressive medical interventions. The timing of these discussions is important. Parents appear to be most comforted by compassionate, caring healthcare providers who show competence and knowledge in the provision of medical/nursing and palliative care.

Implications for Practice:

Healthcare providers working in NICUs require specific training in bereavement/palliative care for infants. Families facing the death of their infant must receive support from qualified providers both during and after that death. Furthermore, the infant's quality of life must be considered when discussing withholding or withdrawing care.

Implications for Research:

There is a need for further research investigating the specific types of training required by healthcare providers in NICU settings who are providing bereavement/palliative care to neonates, in order to best support the families' needs in these situations.
Pediatric trigger thumb caused by a flexor tendon sheath ganglion
Authors: Murgai Rajan R. , Lightdale-Miric Nina
Published: November 2018

Pediatric trigger thumb is a common reason for toddlers to present to a pediatric orthopaedic surgeon. There is controversy over the precise etiology and optimal treatment method. Current accepted diagnostic and treatment algorithms in children have not varied based on etiology. This report describes the clinical presentation and care of a 3-year-old child with pediatric trigger thumb and surgical findings of a large flexor tendon sheath ganglion at the level of the annular pulley with no apparent nodule within the FPL. The potential implications for consideration of etiology in current diagnostic and treatment guidelines are discussed.
Discrepancies Between Patient and Surgeon Expectations of Surgery for Sciatica
Authors: Rehman Yasir , Syed Muzammil , Wiercioch Wojtek , Rehman Nadia , Drew Brian , Cenic Aleksa , Reddy Kesava , Murty Naresh , Kucher Edward , Dunlop Brett , Guyatt Gordon H. , Busse Jason W. , Schwartz Lisa , Vanstone Meredith
Published: November 2018

Study Design.

Qualitative study.

Objective.

The objective of this study was to compare the perceptions of patients and surgeons regarding the risks and benefits of lumbar decompressive surgery for sciatica following a consultation meeting.

Summary of Background Data.

Evidence regarding pain improvement in patients following lumbar decompressive surgery for sciatica is inconsistent. Given this inconsistency, patients choosing to undergo lumbar decompressive surgery must accept the risks associated with the surgery despite uncertainty regarding benefits. This raises questions as to the nature of informed decision-making for patients choosing to undergo surgery for sciatica.

Methods.

We undertook a qualitative descriptive study with 12 adult lumbar decompressive surgery candidates and six of their spine surgeons and analyzed data using inductive content analysis.

Results.

Our analysis revealed that most patients were satisfied with the consultation despite limited understanding of lumbar decompressive surgery. We found discrepancies between patients’ preoperative expectations and understanding of information provided by surgeons and what surgeons believed they had conveyed. Surgeons and patients disagreed on how much information is needed about postsurgical activity modifications and long-term outcomes to make a decision about whether or not to undergo surgery, with patients desiring more information. As a result, for most patients, the decision-making process extended beyond the information provided by surgeons and incorporated information from family members, friends, family doctors, and the internet.

Conclusion.

Our results highlight misunderstandings between patients and surgeons, particularly in regard to prognosis and activity modifications. Since this information is important for patients choosing whether to undergo a surgical intervention, our study provides guidance to improve informed decisions about sciatica and, potentially, other elective surgeries.

Level of Evidence: 4
An Insight Into the Health-Related Quality of Life of Adolescent Idiopathic Scoliosis Patients Who Are Braced, Observed, and Previously Braced
Authors: Cheung Prudence Wing Hang , Wong Carlos King Ho , Cheung Jason Pui Yin
Published: November 2018

Study Design.

Prospective cross-sectional study.

Objective.

To determine the health-related quality of life (HRQoL) of adolescent idiopathic scoliosis (AIS) patients undergoing bracing, previously braced and observation only.

Summary of Background Data.

HRQoL is an important treatment outcome measure for AIS. A poor HRQoL may also negatively influence the success of bracing by reducing the likelihood of good brace compliance. Yet, the HRQoL thresholds for patients undergoing observation only, brace treatment or previous brace treatment is not well understood.

Methods.

Chinese AIS patients with refined Scoliosis Research Society 22-item (SRS-22r) Questionnaire and 5-level EQ-5D (EQ-5D-5L) Questionnaire scores were consecutively recruited for this cross-sectional study. Patients were grouped based on their treatment modality (observation only, bracing, previously braced, and postoperatively). Coronal and sagittal Cobb angles, degree of apical vertebral rotation, and curve type were studied. Spearman correlation test, independent t test, and one-way analysis of variance (ANOVA) with Tukey Post-hoc test were performed for statistical analysis.

Results.

A total of 652 AIS patients with mean age of 14.8 ± 1.9 years and mean Cobb angle of 18.6° ± 10.0° was studied. The respective mean SRS-22r total scores for bracing, observation, and previously braced groups were 4.20, 4.54, and 4.42, and mean EQ-5D-5L scores were 0.87, 0.95, and 0.92. The total and domain scores were correlated with coronal Cobb angles (P < 0.001) while only EQ-5D-5L correlated with sagittal Cobb angles (P < 0.001). Curves greater than 40° had worse HRQoL (P < 0.001). Currently braced patients had significantly worse HRQoL than those under observation, as indicated by lower EQ-5D-5L (0.08) and SRS-22r (0.35) scores (P < 0.001 to P < 0.05). Previously braced patients had better HRQoL than currently braced patients, with 0.05 higher EQ-5D-5L score (P < 0.001), and 0.23 higher SRS-22r score (P < 0.001). However, currently braced patients were more satisfied with treatment (1.94 difference; P < 0.001) than previously braced. There were no gross differences between patients previously braced and undergoing observation only.

Conclusion.

The negative impact of bracing on HRQoL is only transient as previously braced patients have superior HRQoL. It appears as though the EQ-5D-5L scores are more sensitive to changes in the sagittal profile as compared with SRS-22r. Our study highlights the differences in HRQoL between patients only being observed, undergoing bracing or previous brace treatment and the importance of monitoring HRQoL throughout follow-up. Further longitudinal studies may help determine the timing and threshold of HRQoL changes during the entire duration of bracing as well as after brace weaning.

Level of Evidence: 2
Predictors of Extended Length of Hospital Stay in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Segmental Instrumented Fusion
Authors: Sultan Assem A. , Berger Ryan J. , Cantrell William A. , Samuel Linsen T. , Ramanathan Deepak , Churchill Jessica , Minkara Anas A. , Golubovsky Joshua , Bachour Salam , Pasadyn Selena , Karnuta Jaret M. , Tamer Pierre , Kuivila Thomas E. , Gurd David P. , Goodwin Ryan C.
Published: November 2018

Study Design.

Retrospective cohort study.

Objective.

The aims of this study were to (1) compare patient and procedure-specific characteristics among those who had short versus long hospital stays and (2) identify independent risk factors that may correlate with extended length of hospital stay (LOS) in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior segmental instrumented fusion (PSIF).

Summary of Background Data.

Reducing the LOS and identifying risk factors associated with extended admission have become increasingly relevant to healthcare policy makers. There is currently limited research identifying risk factors that correlate with extended stay in patients undergoing PSIF for AIS.

Methods.

A single-institution, longitudinally maintained database was queried to identify 407 patients who met specific inclusion and exclusion criteria. Based on the distribution and median LOS in the cohort (4 days), patients were divided into those who had long versus short LOS. In both groups, patient demographics, comorbidities, preoperative scoliosis curve measurements, surgery-related characteristics, and complications were analyzed. A univariate and multivariate regression analysis was then conducted to identify independent risk factors associated with extended LOS.

Results.

Patients who had extended LOS tended to be women (84.6% vs. 75%, P = 0.01), had more levels fused (9 ± 2 vs. 7 ± 2 levels, P < 0.001), had more major postoperative complications (0.8% vs. 7.4%, P = 0.002), had more blood loss during surgery (723 ± 548 vs. 488 ± 341 cm3, P < 0.001), and received less epidural analgesia for pain control (69% vs. 89%, P < 0.001). Except for higher thoracic kyphosis, long LOS patients did not have worse preoperative radiographic curve parameters. Multivariate logistic analysis identified female sex, having ≥9 ± 2 levels of fusion, operative blood loss, major postoperative complications, lack of epidural analgesia, and higher thoracic kyphosis as independent risk factors correlating for extended LOS.

Conclusion.

Independent risk factors identified by this study may be used to recognize patients with AIS at risk of prolonged hospital stay.

Level of Evidence: 3
A Morphometric Study on Subaxial Cervical Pedicles of Thai People
Authors: Mahiphot Jarupon , Iamsaard Sitthichai , Sawatpanich Tarinee , Sae-Jung Surachai , Khamanarong Kimaporn
Published: November 2018

Study Design.

This study investigated the subaxial cervical pedicles from C3 to C7 to provide information for accurately transpedicular screw fixation in this region.

Objective.

This study was evaluated the morphology of the subaxial cervical pedicle to determine the size and trajectory of screw fixation.

Summary of Background Data.

Cervical vertebrae are an important structure to protect the neurovascular structure. The cervical spine surgery using screw fixation is an effective method to treat the cervical spine instability. There have been many research morphological data of subaxial cervical vertebrae. However, no studies have reports on dried cervical vertebrae of Thai's people.

Methods.

The measurement was conducted in 130 dried cervical vertebrae (C3–C7), including 61 males and 69 females. The measurement parameters were pedicle width (PW), pedicle length (PL), pedicle height (PH), pedicle axis length (PAL), pedicle transverse angle (PTA), and pedicle sagittal angle (PSA), which determined using ImageJ software.

Results.

The results of morphological data of C3 to C7 was found that the mean of PW, PL, PH, PAL, PTA, and PSA that obtained from male were significantly higher than female excepted for PL (C7) and PTA (C3, C5). Except for the C6 PW, C3 PL, C4 to C5 to C7 PTA, and C4 PSA, there were no significant differences of these parameters between male and female.

Conclusion.

The appropriate pedicle screw size is 4.0 mm for C3 and C4, and 4.5 mm for C5 to C7. The results of this study are the useful information for cervical spine fixation while prevent the vascular and neurological injuries from the large screw causing pedicle breakage.

Level of Evidence: 3
Bone Graft Substitutes in Single- or Double-Level Anterior Cervical Discectomy and Fusion
Authors: Stark Jessica R. , Hsieh Joseph , Waller Dorothy
Published: November 2018

Study Design.

Systematic review

Objective.

To undertake a systematic review of published literature to evaluate efficacy of bone graft substitutes on radiographic and clinical outcomes in single- or double-level anterior cervical discectomy and fusion (ACDF) for degenerative disease.

Summary of Background Data.

ACDF is one of the most common spinal surgeries completed in the United States. Today bone graft substitutes including ceramic-based synthetic bone grafts, allografts, bone morphogenetic proteins (BMPs), mesenchymal stem cells, and bone marrow aspirate are widely used to enhance fusions; even though the efficacy of these substitutes is poorly defined. Critical evaluation of these products is necessary to optimize radiographic and clinical outcomes for ACDF in degenerative disease.

Methods.

A systematic literature review of 22 published articles was conducted. All articles reported results on patients who underwent a single- or double-level ACDF performed using a bone graft substitute and reported results on radiographic fusion rates at least 6 months after surgery.

Results.

All studies using BMP showed 100% fusion rate despite length of the study or whether additional bone graft substitutes were used. Use of only ceramic-based synthetics had the lowest fusion rate, 80.5%. Use of only mesenchymal stem cells resulted in an average fusion rate of 87.7%. When used alone, allograft resulted in an average fusion rate of 87.3%. This was significantly influenced by one outlier, Kim et al, which when removed, increased the fusion rate to 93.5%. Clinical outcomes were improved postoperatively irrespective of the graft used, although dysphagia was significantly greater in studies using BMP (P < 0.001).

Conclusion.

Allograft alone has the lowest cost with similar fusion rates and clinical outcomes compared to other bone graft substitutes. Physicians should consider this when choosing to use bone graft substitutes for routine ACDFs.

Level of Evidence: 4
The Importance of the Pedicle Diameters at the Proximal Thoracic Vertebrae for the Correction of Proximal Thoracic Curve in Asian Patients With Idiopathic Scoliosis
Authors: Lee Choon Sung , Cho Jae Hwan , Hwang Chang Ju , Lee Dong-Ho , Park Jae-Woo , Park Kun-Bo
Published: November 2018

Study Design.

A retrospective comparative radiographic study.

Objective.

The purpose of this study was to evaluate differences in the pedicle diameters of proximal thoracic vertebrae in relation to the severity of the proximal thoracic curve in Asian patients with idiopathic scoliosis.

Summary of Background Data.

A small pedicle diameter at the proximal thoracic vertebra has been reported in normal population, but the changes of pedicle diameter in patients with a proximal thoracic curve have not been properly evaluated.

Methods.

One hundred eighty-two patients with adolescent idiopathic scoliosis involving a greater than 10-degree proximal thoracic curve were analyzed. Sixty-nine and 113 patients had a structural and nonstructural proximal thoracic curve, respectively. The pedicle width was evaluated from T1 to T4 using a reconstructed computed tomography (CT) scan. The pedicle widths were compared between the convex and concave side, and between the structural and nonstructural proximal thoracic curve groups.

Results.

The pedicle widths at T3 (0.76 ± 0.92 mm) and T4 (0.50 ± 0.69 mm) on the concave side for the structural proximal thoracic curves were extremely narrow compared with those for the nonstructural proximal thoracic curves (T3,1.17 ± 0.84 mm; T4,0.82 ± 0.72 mm) (P = 0.002, 0.003, respectively). However, the T2 pedicle width was comparable on the concave side in both groups (2.44 ± 0.94 mm for the nonstructural and 2.32 ± 0.97 mm for the structural proximal thoracic curve, P = 0.430).

Conclusion.

A pedicle screw insertion at the T3 or T4 vertebra on the concave side is not always possible in cases of a structural proximal thoracic curve; however, the pedicle width of the T2 vertebra is very wide and safe for the standard pedicle screw insertion. These results should be considered when the surgeon decides the upper instrumented vertebra or the correction method for the structural proximal thoracic curve.

Level of Evidence: 3
The Changing Position of the Center of Mass of the Thorax During Growth in Relation to Pre-existent Vertebral Rotation
Authors: de Reuver Steven , Brink Rob C. , Homans Jelle F. , Kruyt Moyo C. , van Stralen Marijn , Schlösser Tom P.C. , Castelein René M.
Published: November 2018

Study Design.

Cross-sectional.

Objective.

The aim of this study was to analyze the thoracic center of mass (COM) position of children at different ages and evaluate its relation with the previously reported pre-existent rotational pattern of the normal spine.

Summary of Background Data.

The normal, nonscoliotic thoracic spine is known to have a rotational pattern that changes direction during growth, a transition from left-sided toward right-sided rotation with increasing age. This matches the changing curve convexity seen when idiopathic scoliosis develops at different ages. Furthermore, the direction of pre-existent rotation was shown to be related to organ orientation; in situs inversus the rotation is opposite to situs solitus.

Methods.

Computed tomography (CT) scans of the thorax of infantile (0–4 years, n = 40), juvenile (4–10 years, n = 53), and adolescent (10–18 years, n = 62) children without spinal pathology were included from an existing database. The location of the COM inside the thorax was calculated based on Hounsfield-units, representing tissue mass. The COM offset was defined as the shortest distance to the midsagittal plane.

Results.

At the infantile age, the COM was 2.5 ± 2.1 mm on the right side, at juvenile age not significantly deviated, and at adolescent age 3.1 ± 2.3 mm on the left side of the midsagittal plane. The mean COM offset correlated linearly with age (r = 0.77, P < 0.001).

Conclusion.

The COM shifts from slightly on the right side of the thorax at the infantile age, to neutral at juvenile age, to the left at adolescent age. This corresponds to the earlier demonstrated change in direction of pre-existent rotation in the normal spine with age, as well as with the well-known changing direction, from left to right, of thoracic curve convexity in scoliosis at different ages.

Level of Evidence: N/ A
Minimum Clinically Important Difference and Patient Acceptable Symptom State of Japanese Orthopaedic Association Score in Degenerative Cervical Myelopathy Patients
Authors: Kato So , Oshima Yasushi , Matsubayashi Yoshitaka , Taniguchi Yuki , Tanaka Sakae , Takeshita Katsushi
Published: November 2018

Study Design.

A retrospective analysis.

Objective.

The aim of this study was to elucidate the psychometric properties of the original Japanese Orthopaedic Association (JOA) score, including the minimum detectable change (MDC), minimum clinically important difference (MCID), and patient-accepted symptom state (PASS).

Summary of Background Data.

Despite the worldwide popularity of modified JOA score (mJOA), the original JOA score is still commonly used in East Asian countries, including Japan. However, unlike mJOA score, the psychometric properties of JOA score remain poorly understood.

Methods.

We retrospectively reviewed a consecutive series of laminoplasty for degenerative cervical myelopathy patients in a single academic institution. Pre- and postoperative JOA scores were collected, and the recovery rate was calculated. Anchor-based methods were used to determine the cut-off values by a receiver operating characteristic (ROC) curve analysis. The patients were also asked to answer an anchor question analyzing their postoperative health transition used for the MDC and another question assessing the patient satisfaction used for the MCID and PASS.

Results.

A total of 101 patients were included in the analysis. The mean preoperative JOA score was 10.3 [standard deviation (SD): 2.4), and the mean postoperative JOA score was 13.4 (SD: 2.5). The mean recovery rate was 44%. A total of 68% of the patients admitted that their health condition was at least “somewhat better” than their preoperative condition, and 66% were at least “somewhat satisfied” with the treatment results. On the basis of ROC curve analyses, the MDC and MCID for JOA score in degenerative cervical myelopathy patients were calculated to be 2.5. The PASS was estimated to be 14.5, and the MCID for JOA recovery rate was 52.8%.

Conclusion.

The MDC, MCID, and PASS for JOA score for degenerative cervical myelopathy patients were reported by anchor-based ROC curve analyses.

Level of Evidence: 4
Posterolateral Versus Transforaminal Interbody L4/5 Fusion
Authors: Gaffney Christian J. , Pinto Manuel R. , Buyuk Abdul F. , Garvey Timothy A. , Mueller Benjamin , Schwender James D. , Transfeldt Ensor E. , Tam Harrison K. , Dawson John M.
Published: November 2018

Study Design:

This is a retrospective cohort study.

Objective:

To compare posterolateral versus transforaminal interbody fusion (PLF vs. PLF+TLIF) of the L4/5 segment regarding rates of subsequent surgery, clinical and radiographic parameters, and patient satisfaction.

Summary of Background Data:

Surgical treatment of lumbar stenosis, decompression with or without fusion, is an efficacious treatment in select patients. Reoperation is thought to be a problem after lumbar fusion. Despite multiple studies, the fusion method that minimizes the need for subsequent surgery has yet to be determined.

Materials and Methods:

A retrospective cohort study was conducted on 89 patients who had an isolated L4/5 decompression and fusion, from January 2006 to 2012. All patients had stenosis and degenerative spondylolisthesis at the L4/5 level. All surgeries were performed at a single center, using either PLF (31 patients) or PLF+TLIF (58 patients) techniques. Preoperative and postoperative patient-reported outcome measures (Oswestry disability index, visual analog scale back pain, visual analog scale leg pain) and radiographic parameters (L4/5 lordosis and overall lumbar lordosis) were measured. Patient satisfaction was acquired via a questionnaire. Chart reviews and patient questionnaires were used to determine the incidence of subsequent lumbar surgery over a minimum follow-up of 5 years.

Results:

At an average of 8.7 years follow-up, 2 of 31 patients in the PLF group had subsequent lumbar surgery, compared with 16 of 58 patients in the PLF+TLIF group (6% vs. 28%; P=0.02). There were no significant differences between groups with respect to sex, age, body mass index, tobacco, perioperative measures, patient-reported outcomes, or radiographic parameters (P>0.05).

Conclusions:

Both PLF and PLF+TLIF are effective fusion methods for L4/5 stenosis and spondylolisthesis. In this study, patients treated with PLF were less likely to undergo a subsequent lumbar surgery. More research is needed to determine which factors influence whether PLF or PLF+TLIF should be used in these patients.

Level of Evidence:

Level III.
Percutaneous Vertebroplasty Does Not Increase the Incidence of New Fractures in Adjacent and Nonadjacent Vertebral Bodies
Authors: Yang Wencheng , Yang Jianyi , Liang Ming
Published: November 2018

Study Design:

This was a clinical retrospective study.

Objectives:

This retrospective study aimed to investigate the incidence of new vertebral compression fractures (NVCFs) and analyze the risk factors that influence the secondary fractures in adjacent and nonadjacent levels after percutaneous vertebroplasty (PVP) and conservative treatment (CT).

Summary of Background Data:

PVP is an effective procedure to alleviate the pain caused by osteoporotic vertebral compression fractures. NVCFs have been noted as a potential late sequela of the procedure. However, it remains unclear whether NVCFs are due to this augmentation or simply are the result of the natural progression of osteoporosis.

Methods:

A total of 290 patients who had undergone PVP and 270 patients who had undergone CT during the last 4 years were examined. They were followed-up on a monthly basis by telephone for >2 years. They were divided into 2 groups: NVCFs and non-NVCFs. The groups were statistically compared in terms of age, sex, body mass index, initial fracture levels, bone mineral density (BMD) score of the spine, original fracture levels, and new fracture levels.

Results:

After a mean follow-up of at least 24 months (range, 24−78 mo), 42 NVCFs occurred in 37 of 290 patients after PVP and 33 NVCFs in 30 of 270 patients after CT. Only BMD was significantly different between the groups. Lower BMD was a significant predictive factor for NVCFs.

Conclusions:

PVP did not increase the incidence of NVCFs, especially those adjacent to the treated vertebrae, following augmentation with PVP compared with CT. The most important risk factor for NVCFs was osteoporosis.