bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Expandable Interbody Devices in Lumbar Fusion
Authors: Jenkins Nathaniel W. , Parrish James M. , Khechen Benjamin , Block Andrew M. , Lalehzarian Simon P. , Brundage Thomas , Hrynewycz Nadia , Iyer Sravisht , Singh Kern 
Published: February 2020

Study Design:
This was a systematic review.

Objective:
The objective of this study was to review radiographic, clinical, and surgical outcomes of expandable interbody device implantation following lumbar fusion.

Summary of Background Data:
Few studies have evaluated postsurgical outcomes of expandable implants following lumbar interbody fusion.

Methods:
A systematic review was performed to identify studies investigating expandable intervertebral body devices in lumbar fusion. Radiographic parameters, fusion assessments, patient-reported outcomes (PROs), complications, and revision data were recorded. A comparison of expandable and static devices was performed using a meta-analysis.

Results:
Eleven articles were included. Postoperative improvements for each radiographic parameters for expandable versus static device implantation ranged from: lumbar lordosis, +2.0 to +5.0 degrees (expandable) versus +1.0 to +4.4 degrees (static); segmental lordosis, +1.0 to +5.2 degrees (expandable) versus+1.1 to +2.3 degrees (static); disk height, +0.82 to +4.8 mm (expandable) versus +0.26 to +6.9 mm (static); foraminal height, +0.13 to +2.8 mm (expandable) versus and +0.05 to +3.0 mm (static). Fusion rates ranged from 72.1% at 6 months to 100% at terminal follow-up. Preoperative to final follow-up improvement for the various PROs assessed were: Oswestry Disability Index, −15.4 to −56.3 (expandable) versus −13.6 to −26.3 (static); Visual Analog Scale (VAS) Back, −3.2 to −6.0 (expandable) versus −3.1 to −4.1 (static); and VAS Leg, −2.9 to −7.1 (expandable) −3.0 versus −4.8 (static). Static cages had a reported complication rate ranging from 6.0% to 16.1% and a subsidence rate of 6.0%. Expandable cages had a reported complication rate that ranged from 0.0.% to 10.0% and a subsidence rate of 5.5%–10.0%. A meta-analysis demonstrated a statistically significant difference in the PRO Oswestry Disability Index, but not VAS Back, VAS Leg, or radiographic outcomes (disk height or foraminal height).

Conclusion:
There is no clear evidence for the use of expandable interbody devices over static devices.
Carbon Monoxide Exerts Functional Neuroprotection After Cardiac Arrest Using Extracorporeal Resuscitation in Pigs
Authors: Wollborn Jakob , Steiger Christoph , Doostkam Soroush , Schallner Nils , Schroeter Nils , Kari Fabian A. , Meinel Lorenz , Buerkle Hartmut , Schick Martin A. , Goebel Ulrich 
Published: February 2020

Objectives:
Neurologic damage following cardiac arrest remains a major burden for modern resuscitation medicine. Cardiopulmonary resuscitation with extracorporeal circulatory support holds the potential to reduce morbidity and mortality. Furthermore, the endogenous gasotransmitter carbon monoxide attracts attention in reducing cerebral injury. We hypothesize that extracorporeal resuscitation with additional carbon monoxide application reduces neurologic damage.

Design:
Randomized, controlled animal study.

Setting:
University research laboratory.

Subjects:
Landrace-hybrid pigs.

Interventions:
In a porcine model, carbon monoxide was added using a novel extracorporeal releasing system after resuscitation from cardiac arrest.

Measurements and Main Results:
As markers of cerebral function, neuromonitoring modalities (somatosensory-evoked potentials, cerebral oximetry, and transcranial Doppler ultrasound) were used. Histopathologic damage and molecular markers (caspase-3 activity and heme oxygenase-1 expression) were analyzed. Cerebral oximetry showed fast rise in regional oxygen saturation after carbon monoxide treatment at 0.5 hours compared with extracorporeal resuscitation alone (regional cerebral oxygen saturation, 73% ± 3% vs 52% ± 8%; p < 0.05). Median nerve somatosensory-evoked potentials showed improved activity upon carbon monoxide treatment, whereas post–cardiac arrest cerebral perfusion differences were diminished. Histopathologic damage scores were reduced compared with customary resuscitation strategies (hippocampus: sham, 0.4 ± 0.2; cardiopulmonary resuscitation, 1.7 ± 0.4; extracorporeal cardiopulmonary resuscitation, 2.3 ± 0.2; extracorporeal cardiopulmonary resuscitation with carbon monoxide application [CO-E-CPR], 0.9 ± 0.3; p < 0.05). Furthermore, ionized calcium-binding adaptor molecule 1 staining revealed reduced damage patterns upon carbon monoxide treatment. Caspase-3 activity (cardiopulmonary resuscitation, 426 ± 169 pg/mL; extracorporeal cardiopulmonary resuscitation, 240 ± 61 pg/mL; CO-E-CPR, 89 ± 26 pg/mL; p < 0.05) and heme oxygenase-1 (sham, 1 ± 0.1; cardiopulmonary resuscitation, 2.5 ± 0.4; extracorporeal cardiopulmonary resuscitation, 2.4 ± 0.2; CO-E-CPR, 1.4 ± 0.2; p < 0.05) expression were reduced after carbon monoxide exposure.

Conclusions:
Carbon monoxide application during extracorporeal resuscitation reduces injury patterns in neuromonitoring and decreases histopathologic cerebral damage by reducing apoptosis. This may lay the basis for further clinical translation of this highly salutary substance.
Lung cancer aggressiveness in an intermittent hypoxia murine model of postmenopausal sleep apnea
Authors: Torres Marta , Martinez-Garcia Miguel Ángel , Campos-Rodriguez Francisco , Gozal David , Montserrat Josep M. , Navajas Daniel , Farré Ramon , Almendros Isaac 
Published: February 2020

Abstract

Objective:
Intermittent hypoxia (IH)—a hallmark of obstructive sleep apnea (OSA)—enhances lung cancer progression in mice via altered host immune responses that are also age and sex-dependent. However, the interactions of menopause with IH on tumor malignant properties remain unexplored. Here, we aimed to investigate lung cancer outcomes in the context of ovariectomy (OVX)-induced menopause in a murine model of OSA.

Methods:
Thirty-four female mice (C57BL/6, 12-week-old) were subjected to bilateral OVX or to Sham intervention. Six months after surgery, mice were pre-exposed to either IH or room air (RA) for 2 weeks. Then, 105 lung carcinoma (LLC1) cells were injected subcutaneously in the left flank, with IH or RA exposures continued for 4 weeks. Tumor weight, tumor invasion, and spontaneous lung metastases were assessed. Tumor-associated macrophages (TAMs) were isolated and subjected to flow cytometry polarity evaluation along with assessment of TAMs modulation of LLC1 proliferation in vitro. To determine the effect of IH and OVX on each experimental variable, a two-way analysis of variance was performed.

Results:
IH and OVX promoted a similar increase in tumor growth (∼2-fold; P = 0.05 and ∼1.74-fold; P < 0.05, respectively), and OVX-IH further increased it. Regarding lung metastasis, the concurrence of OVX in mice exposed to IH enhanced the number of metastases (23.7 ± 8.0) in comparison to those without OVX (7.9 ± 2.8; P < 0.05). The pro-tumoral phenotype of TAMS, assessed as M2/M1 ratio, was increased in OVX (0.06 ± 0.01; P < 0.01) and IH (0.06 ± 0.01; P < 0.01) compared with sham/RA conditions (0.14 ± 0.03). The co-culture of TAMS with naive LLC1 cells enhanced their proliferation only under IH.

Conclusion:
In female mice, both the IH that is characteristically present in OSA and OVX as a menopause model emerge as independent contributors that promote lung cancer aggressiveness and seemingly operate through alterations in the host immune response.
Common transcriptional signatures of neuropathic pain
Authors: Pokhilko Alexandra , Nash Anthony , Cader M. Zameel 
Published: February 2020

Abstarct
The dorsal root ganglia (DRG) are key structures in nociception and chronic pain disorders. Several gene expression studies of DRG in preclinical pain models have been performed, but it is unclear if consistent gene changes are identifiable. We, therefore, compared several recent RNA-Seq data sets on the whole DRG in rodent models of nerve injury. Contrary to previous findings, we show hundreds of common differentially expressed genes and high positive correlation between studies, despite model and species differences. We also find, in contrast to previous studies, that 60% of the common rodent gene response after injury is likely to occur in nociceptors of the DRG. Substantial expression changes are observed at a 1-week time-point, with smaller changes in the same genes at a later 3- to 4-week time-point. However, a subset of genes shows a similar magnitude of changes at both early and late time-points, suggesting their potential involvement in the maintenance of chronic pain. These genes are centred around suppression of endogenous opioid signalling. Reversal of this suppression could allow endogenous and exogenous opioids to exert their analgesic functions and may be an important strategy for treating chronic pain disorders. Currently used drugs, such as amitriptyline and duloxetine, do not seem to appropriately modulate many of the critical pain genes and indeed may transcriptionally suppress endogenous opioid signalling further.
Tumor lysis syndrome as a risk factor for very early mortality in HIV-associated non-Hodgkin’s lymphoma: A 10-year single-center experience
Authors: Chang Yea-Yuan , Chang Chih-Hao , Ku Wen-Wei , Gau Jyh-Pyng , Yu Yuan-Bin 
Published: February 2020

Background:
Despite the effectiveness of combination antiretroviral therapy, persons living with human immunodeficiency virus (PLWHIV) remain at a high risk of developing non-Hodgkin lymphoma (NHL). We aimed to analyze the demographics and outcomes of the HIV-associated NHLs.

Methods:
Between 2005 and 2014, PLWHIV with NHLs were retrospectively enrolled at a tertiary referral center. Characteristics and survival were reviewed and analyzed.

Results:
Twenty-two HIV-associated NHLs were identified, with a median follow-up of 14 months (range, 0.1-139.7), including eight diffuse large B-cell lymphomas (DLBCLs), eight primary central nervous system lymphomas (PCNSLs), and six Burkitt’s lymphomas (BLs). Nine patients (40.9%) were diagnosed with NHLs and HIV infection concurrently. The prognosis of DLBCL patients tended to be better prognosis than that of BL and PCNSL patients (median overall survival: not reached vs. 3.5 months, p = 0.056). Very early mortality (death within 14 days after NHL diagnosis) was noted in five patients (22.7%), and tumor lysis syndrome (TLS) is a predictive factor for very early mortality among PLWHIV (hazard ratio:11.3, 95% confidence interval: 1.1–114.4, p = 0.04).

Conclusion:
Management of the early treatment phase of HIV-associated NHLs remains a major challenge. Careful intervention to patients with TLS might be the key to improve treatment outcomes.
Human global and population-specific genetic susceptibility to Mycobacterium tuberculosis infection and disease
Authors: Möller Marlo , Kinnear Craig J. 
Published: February 2020

Purpose of review
Multiple lines of evidence support a role of the host genetic component in Mycobacterium tuberculosis infection and disease progression. However, genomic studies of tuberculosis susceptibility have been disappointing compared with that of other complex disorders. Recently the field has explored alternative strategies to facilitate locus discovery. Results emanating from these efforts during the last 18 months are addressed in this review.

Recent findings
There has been a renewed focus on the refinement of phenotypic definitions of infection and disease as well as on age-related, sex-specific and population-specific effects. Genome-wide association studies have yielded candidate genes but the findings have not always been transferable to all population groups. Candidate gene association studies remain popular as it is used for GWAS replication and is affordable, particularly in lower and middle-income countries. Pharmacogenetic studies involving tuberculosis drugs may locate variants that can be cost-effectively genotyped to identify individuals at risk of developing adverse events during treatment.

Summary
Additional GWAS and candidate gene association studies of crudely defined study participants are unlikely to make further important contributions to the TB susceptibility field. Instead refined phenotyping will allow the elucidation of genetic mechanisms contributing to infection and disease in distinct populations and the calculation of polygenic risk scores.
Electrochemotherapy in the head and neck area: an addition to the treatment armamentarium
Authors: de Bree Remco , Wessel Irene 
Published: February 2020

Purpose of review
Electrochemotherapy (ECT) is increasingly used in different settings in head and neck cancer patients when conventional treatment options are not available.

Recent findings
Recent improvements of electroporation and ECT include new advanced electrode probes, the combination with intratumorally injected supraphysiological doses of calcium and an update of the standard operating procedures.

Summary
ECT is a treatment modality that combines administration of a chemotherapeutic drug, for example, bleomycin, with electroporation therapy (EPT). EPT uses brief, high-intensity, pulsed electrical currents to enhance the uptake of cytotoxic drugs by producing a transient increase in cell wall permeability. ECT increases the effect of cytostatic drugs, is independent on histology of the lesion, enables treatment to previously treated areas, preserves healthy tissue, has no significant side effects (low-dose chemotherapy) and enables repeated treatments. ECT can be combined with other treatment modalities and is an addition to the current treatment options of head and neck cancer. ECT is not only able to palliate symptoms but can also provide complete responses and curation.
Changes in Lid Crease Measurements in Levator Advancement for Ptosis
Authors: Alkeswani Amena , Hataway Felicia , Westbrook Brian , Gulamani Shan , Collawn Sherry S. 
Published: February 2020

Purpose
Although previous reports addressed the differences in marginal reflex distance 1 (MRD-1) measurements based on various techniques of levator advancement, eyelid crease measurements have not been studied as markers in perioperative planning. In addition to possible benefits in optimal results for improvement of visual field defects and functional impairment, recent work has suggested that eyelid crease is important in the perception of attractiveness. Therefore, the aims of this study were to determine the change in eyelid crease measurements in levator advancement and to further expand on numerical correlation of levator advancement in preoperative planning to avoid overcorrection or undercorrection.

Methods
The authors performed a retrospective analysis of preoperative and postoperative eye measurements in patients who underwent levator advancement for ptosis between August 2016 and April 2019. This study included 13 patients, all of whom had recorded preoperative and postoperative measurements of MRD-1, whereas 8 of 13 patients had additional preoperative and postoperative measurements of the mid pupil to crease and lateral limbus to crease at the level of mid pupil.

Results
All patients had increased in MRD-1, mid pupil to crease, and lateral limbus to crease measurements postoperatively. The average advancement of 4.8 mm led to an elevation of MRD-1 to 2.6 mm (n = 25) and an improvement in mid pupil to crease distance of 1.9 mm (n = 15) and lateral limbus to crease distance of 2.6 mm (n = 15). No cases of undercorrection or overcorrection were found. All patients reported satisfaction with the results, including improvement in function and quality of life. No infections, hematomas, or other complications were noted postoperatively in any of the patients.

Conclusions
Marginal reflex distance 1 is a consistently reliable planning tool in preoperative assessment of levator advancement, with beneficial patient outcomes including improvement of visual field defects caused by ptosis and satisfaction with cosmetic results. This study is the first to report use of crease measurements (mid pupil to crease and lateral limbus to crease), which may provide additional understanding to the aesthetic value of to the levator advancement.
Revisiting the Relationship Between Hospital Case Volume and Outcomes in Abdominally Based Free Flap Breast Reconstruction
Authors: Chattha Anmol , Chen Austin D. , Muste Justin , Cohen Justin B. , Lee Bernard T. , Lin Samuel J. 
Published: February 2020

Background
Increased operative volume has been associated with benefits in patient outcomes for a variety of surgical procedures. In autologous abdominally based breast reconstruction, however, there are few studies assessing the association between procedure volume and patient outcomes. The objectives of this study are to evaluate the associations between abdominal-based free flap breast reconstruction and patient outcomes.

Methods
The 2013–2014 Healthcare Cost and Utilization Project National Inpatient Sample was queried for all female patients with a diagnosis of breast cancer who underwent mastectomy and immediate abdominally based breast reconstruction (deep inferior epigastric perforator or transverse rectus abdominus muscle free flaps). Outcomes included occurrence of major or surgical site in-hospital complications, hospital cost, and length of stay (LOS). High-volume (HV) hospitals were defined as the 90th percentile of annual case volume or higher (>18 cases/y). Multivariate regressions and generalized linear modeling with gamma log-link function were performed to access the outcomes associated with HV hospitals.

Results
Overall, 7145 patients at 473 hospitals were studied; of these, 42.4% of patients were treated at HV hospitals. There were significant differences in unadjusted major complications (2.1% vs 4.3%; P < 0.001) and unadjusted surgical site complications (3.5% vs 6.1%; P < 0.001) between HV and non-HV hospitals. After adjustments for clinical and hospital characteristics, patients treated at HV hospitals were less likely to experience a major complication (odds ratio, 0.488; 95% confidence interval, 0.353–0.675; P < 0.001) or surgical site complication (odds ratio, 0.678; 95% confidence interval, 0.519–0.887; P = 0.005). There was no difference in inpatient cost between HV and non-HV hospitals ($26,822 vs $26,295; marginal cost, $528; P = 0.102); however, HV hospitals had a shorter LOS (4.31 vs 4.40 days; marginal LOS, −0.10 days; P = 0.005).

Conclusions
Hospitals that perform a larger volume of immediate abdominal-based breast reconstructions after mastectomy, when compared with those that perform a lower volume of these procedures, seem to have an associated lower rate of major complications and a shorter LOS. However, these same HV centers demonstrate no decrease in costs. Further research is needed to understand how these HV centers can reduce hospital costs.
Lower hemoglobin concentration decreases time to death in severely anemic patients for whom blood transfusion is not an option
Authors: Guinn Nicole R. , Cooter Mary L. , Weiskopf Richard B. 
Published: February 2020

BACKGROUNDAnemia in patients who decline transfusion has been associated with increased morbidity and mortality. We hypothesized that the time to death decreases with increasing severity of anemia in patients for whom transfusion is not an option.METHODSWith institutional review board approval, a retrospective review of registered adult blood refusal patients with at least one hemoglobin (Hb) value of 12.0 g/dL or less during hospital admission at a single institution from January 2004 to September 2015 was performed. The association of nadir Hb category and time to death (all-cause 30-day mortality) was determined using Kaplan-Meier plots, log rank tests, and Cox proportional hazard models. We investigated if there was a nadir Hb level between the values of 5.0 and 6.0 g/dL at which mortality risk significantly increased and then categorized nadir Hb by the traditional cut points and the newly identified “critical” cut point.RESULTSThe study population included 1,011 patients. The Cox proportional hazard models showed a more than 50% increase in hazard of death per 1 g/dL decrease in Hb (adjusted hazard ratio [confidence interval], 1.55 [1.40–1.72];p< 0.001). A Hb value of 5.0 g/dL was identified as defining “critical anemia.” We found a strong association between anemia severity level and mortality (p< 0.001). Time to death was shorter (median, 2 days) in patients with critical anemia than in those having higher Hb (median time to death of 4 or 6 days, in severe or moderate anemia).CONCLUSIONIn anemic patients unable to be transfused, critical anemia was associated with a significantly and clinically important reduced time to death.LEVEL OF EVIDENCEPrognostic, level III.
Headache and Bilateral Optic Disc Edema as the Initial Manifestation of Vogt–Koyanagi–Harada Disease
Authors: Nichani Prem , Christakis Panos G. , Micieli Jonathan A. 
Published: February 2020

Abstract:
A 31-year-old healthy Asian man presented with new headaches and blurred vision. He was found to have bilateral optic disc edema (ODE) and peripapillary subretinal fluid and was initially investigated for causes of raised intracranial pressure. After referral to neuro-ophthalmology, he received a diagnosis of Vogt–Koyanagi–Harada (VKH) disease and his symptoms, ODE, and vision improved promptly with prednisone treatment. HLA typing was performed and returned positive for the HLA-DRB1*04 subtype. Although VKH disease usually presents with granulomatous uveitis or serous retinal detachments, ODE may manifest early in the disease course. Those with ODE in VKH disease are believed to be older and female, but this case demonstrates that these findings were also seen in a young man.
Establishing Clinically Significant Patient-reported Outcomes for Diverticular Disease – A Prospective Cohort Study
Authors: Khor Sara , Flum David R. , Strate Lisa L. , Hantouli Mariam N. , Harris Heather H. , Lavallee Danielle C. , Spiegel Brennan MR , Davidson Giana H. 
Published: February 2020

AbstractBackground & AimsDiverticular disease can undermine health-related quality of life (HRQoL). The diverticulitis quality of life (DV-QOL) instrument was designed and validated to measure the patient-reported burden of diverticular disease. However, in order for the DV-QOL to capture longitudinal outcomes, values reflecting meaningful improvement (i.e., minimal clinically important difference (MCID)) and the patient acceptable symptom state (PASS) need to be established. We sought to establish the MCID and PASS of the DV-QOL, and describe the characteristics of those with DV-QOL above the PASS threshold.MethodsWe performed a prospective cohort study of adults with diverticular disease from 7 centers in Washington and California (2016-2018). Patients were surveyed at baseline, then quarterly up to 30 months. To determine the PASS for DV-QOL, we used an anchor-based approach and performed receiver operating characteristic analyses using baseline data. A range of MCID values were calculated using distribution-based and anchor-based approaches.ResultsThe study included 177 patients (mean age 57, 43% female). A PASS threshold of 3.2/10 distinguished between those with and without HRQoL-impacting diverticulitis with acceptable accuracy (area under the curve (AUC) 0.76). A change of 2.2 points in the DV-QOL was the most appropriate MCID: above the measurement error and corresponding to patient perception of importance of change (AUC 0.70). Patients with DV-QOL≥PASS were more often male, younger, had Medicaid, less educated, and had more serious episodes of diverticulitis.ConclusionsOur study is the first to define MCID and PASS for DV-QOL. These thresholds are critical for measuring the impact of diverticular disease and the evaluation of treatment effectiveness.