bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Wound Complications After Percutaneous Posterior Pelvic Ring Fixation in Patients Who Undergo Pelvic Arterial Embolization
Authors: Namm Joshua D. , Obey Mitchel R. , Jo Sally , Berkes Marschall B. , McAndrew Christopher M. , Miller Anna N. 
Published: September 2020

Objective:
To report on the incidence of surgical wound complications after percutaneous posterior pelvic ring fixation in patients who have also undergone pelvic arterial embolization (PAE) and determine whether the risks outweigh the benefits.

Design:
Retrospective cohort study.

Setting:
Academic level 1 trauma center.

Patients:
Two hundred one consecutive patients who underwent percutaneous posterior pelvic fixation at our institution were included in this study. Of these, 27 patients underwent pelvic arterial embolization.

Intervention:
Percutaneous posterior pelvic fixation and pelvic arterial embolization.

Main Outcome Measurements:
Charts were reviewed for posterior percutaneous surgical wound complications including infection, dehiscence, seroma, tissue necrosis, and return to OR for debridement in all patients.

Results:
Of the 27 patients who received PAE, none developed posterior surgical wound complications. Of those who did not receive PAE, there was one posterior surgical wound complication documented. There were no cases of wound infection in either group.

Conclusion:
Pelvic arterial embolization can be a valuable intervention in treating hemodynamically unstable patients with pelvic ring injuries. Although even selective pelvic arterial embolization is not entirely benign, there seems to be minimal risk of wound complications when percutaneous posterior pelvic ring fixation is performed.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
White-Light Body Scanning Captures Three-Dimensional Shoulder Deformity After Displaced Diaphyseal Clavicle Fracture
Authors: DeBaun Malcolm R. , Lai Cara , Schultz Blake J. , Oquendo Yousi A. , Campbell Sean T. , Goodnough L. Henry , Bishop Julius A. , Gardner Michael J. 
Published: September 2020

Objective:
We sought to determine if white-light three-dimensional (3D) body scanning can identify clinically relevant shoulder girdle deformity after displaced diaphyseal clavicle fracture (DCF).

Methods:
Adult patients with DCF (OTA/AO 15A) were prospectively enrolled. Four subcutaneous osseous landmarks were used to measure shoulder girdle morphology of the injured and uninjured shoulder. Measurements were made both manually with a tape measure and digitally with a white-light 3D scanner. Bilateral radiographs were obtained, and clavicle length was recorded. Quick-Disabilities of the Arm, Shoulder, and Hand surveys were administered at injury and at 6 and 12 weeks.

Results:
Twenty-two patients were included in the study. At the initial visit, all patients had significant differences in deformity measurements between injured and uninjured shoulders as measured by 3D scanning. There was no difference between shoulders measured using manual measurements. At 6 and 12 weeks, shoulder asymmetry was significantly less in patients treated with surgery compared with nonoperative patients as measured by the 3D scanner alone. Clavicle shortening measured on 3D scanning had weak and moderate positive correlations to radiographs (R = 0.27) and manual measurements (R = 0.53), respectively. Patients treated with surgery had significant functional improvements by 6 weeks, and a similar improvement was not seen until 12 weeks in nonsurgical patients.

Conclusion:
White-light 3D scanning was able to identify and monitor clinically relevant shoulder girdle deformity after DCF. This tool may become a useful adjunct to clinical examination and radiographic assessment, when determining clinically relevant deformity thresholds. In the future, quantifying and understanding shoulder deformity may inform clinical decision making in these patients.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Impact of Substance Use and Abuse on Opioid Demand in Lower Extremity Fracture Surgery
Authors: Cunningham Daniel J. , LaRose Micaela A. , Gage Mark J. 
Published: September 2020

Objectives:
To describe the perioperative opioid demand in a large population of patients undergoing lower extremity fracture fixation and to evaluate mental disorders such as substance abuse as risk factors for increased use.

Design:
Retrospective, observational.

Setting:
National insurance claims database.

Patients/participants:
Twenty-three four hundred forty-one patients grouped by mental disorders such as depression, psychoses, alcohol abuse, tobacco abuse, drug abuse, and preoperative opioid filling undergoing operative treatment of lower extremity fractures (femoral shaft through ankle) between 2007 and 2017.

Intervention:
Operative treatment of lower extremity fractures.

Main Outcome Measures:
The primary outcome was filled opioid prescription volume converted to oxycodone 5-mg pill equivalents. Secondary outcomes included the number of filled prescriptions and the risk of obtaining 2 or more opioid prescriptions.

Results:
Of 23,441 patients, 16,618 (70.9%), 8862 (37.8%), and 18,084 (77.1%) filled opioid prescriptions within 1-month preop to 90-day postop, 3-month postop to 1-year postop, and 1-month preop to 1-year postop, respectively. On average, patients filled 104, 69, and 173 oxycodone 5-mg pills at those time intervals. Alcohol, tobacco, drug abuse, and preoperative opioid filling were associated with increased perioperative opioid demand. Psychoses had a small effect on opioid demand, and depression had no significant impact.

Conclusions:
This study reports the rate and volume of opioid prescription filling in patients undergoing lower extremity fracture surgery. Substance use and abuse were the main risk factors for increased perioperative opioid prescription filling. Providers should recognize these risk factors for increased use and be judicious when prescribing opioids. Enhanced patient education, increased nonopioid pain management strategies, and referral for substance use and abuse treatment may be helpful for these patients.

LEVEL OF EVIDENCE:
Level III. See Instructions for Authors for a complete description of levels of evidence.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Can Rapid Progression in Nonambulatory Cerebral Palsy Scoliosis Be Predicted Using Humeral Head Ossification?
Authors: Bram Joshua T. , Flynn John M. , Karkenny Alexa J. , Shah Ronit V. , Talwar Divya , Baldwin Keith D. 
Published: September 2020

Background:
Patients with cerebral palsy scoliosis (CPS) experience higher complication rates compared with idiopathic scoliosis and often present for surgery with larger curves. Prediction of an inflection point for rapid deformity progression has proven difficult. A proximal humerus-based skeletal maturity staging system (HS) has been recently validated and is commonly visible on the posteroanterior radiograph. The authors hypothesize that this system can be used to identify a period at which CPS may progress rapidly, perhaps facilitating discussion of timely surgical intervention.

Methods:
A retrospective review was conducted for nonambulatory pediatric patients with CPS who presented between 2009 and 2018 at our institution. All patients were considered for inclusion regardless of operative or nonoperative management. Patients who were skeletally mature at initial evaluation or had prior spine surgery were excluded. The authors analyzed radiographs in each HS available. Survival was calculated for cutoffs of 60 and 70 degrees (numbers found to increase intraoperative and postoperative complications for CPS).

Results:
Eighty-six patients with CPS were identified (54 male individuals). Major curves increased significantly between HS 1 and 2 (27.7 to 46.6 degrees, P=0.009) and HS 3 and 4 (53.1 to 67.9 degrees, P=0.023). The proportion of curves ≥70 degrees were significantly different between HS (P<0.001), with the greatest increase between HS 3 and 4 (24% to 51%; ≥70 degrees). The largest drop in the 60/70-degree survival curves was between HS 3 and 4. In a subanalysis, 69% of patients with curves ≥40 degrees but <70 degrees in stage 3 would progress ≥70 degrees by stage 4.

Conclusions:
Identifying a period of rapid curve progression may guide surgical planning before CPS curves become large, stiff, and more difficult to fix. Our findings suggest that humeral skeletal maturity staging is a valuable decision-making tool in neuromuscular scoliosis, with the HS 3 to 4 transition representing the time of the greatest risk of progression. Consider a surgical discussion or shortened follow-up interval for patients with CPS with curves ≥40 degrees who are HS 3.

Level of Evidence:
Level II.
Depression Identified on the Mental Component Score of the Short Form-12 Affects Health Related Quality of Life After Lumbar Decompression Surgery
Authors: Divi Srikanth N. , Goyal Dhruv K.C. , Stull Justin D. , Morgenstern Monica , Galetta Matthew S. , Kaye I. David , Kurd Mark F. , Woods Barrett I. , Radcliff Kris E. , Rihn Jeffery A. , Anderson David Greg , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: September 2020

Study Design:
This was a retrospective comparative study.

Objective:
The goal of this study was to further elucidate the relationship between preoperative depression and patient-reported outcome measurements (PROMs) following lumbar decompression surgery.

Summary of Background Data:
The impact of preoperative depression on PROMs after lumbar decompression surgery is not well established.

Methods:
Patients undergoing lumbar decompression between 1 and 3 levels were retrospectively identified. Patients were split into 2 groups using a preoperative Mental Component Score (MCS)-12 threshold score of 45.6 or 35.0 to identify those with and without depressive symptoms. In addition, patients were also split based on a pre-existing diagnosis of depression in the medical chart. Absolute PROM scores, the recovery ratio and the percent of patients achieving minimum clinically important difference between groups were compared, and a multiple linear regression analysis was performed.

Results:
A total of 184 patients were included, with 125 (67.9%) in the MCS-12 >45.6 group and 59 (32.1%) in the MCS-12 ≤45.6 group. The MCS-12 ≤45.6 and MCS<35.0 group had worse baseline Oswestry Disability Index (ODI) (P<0.001 for both) and Visual Analogue Scale Leg (P=0.018 and 0.024, respectively) scores. The MCS ≤45.6 group had greater disability postoperatively in terms of SF-12 Physical Component Score (PCS-12) (39.1 vs. 43.1, P=0.015) and ODI (26.6 vs. 17.8, P=0.006). Using regression analysis, having a baseline MCS-12 scores ≤45.6 before surgical intervention was a significant predictor of worse improvement in terms of PCS-12 [β=−4.548 (−7.567 to −1.530), P=0.003] and ODI [β=8.234 (1.433, 15.035), P=0.010] scores than the MCS-12 >45.6 group.

Conclusion:
Although all patients showed improved in all PROMs after surgery, those with MCS-12 ≤45.6 showed less improvement in PCS-12 and ODI scores.
Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis
Authors: Nie Shao-Bo , Zhao Yan-Peng , Li Jian-Tao , Zhao Zhe , Zhang Zhuo , Zhang Li-Cheng , Tang Pei-Fu 
Published: September 2020

Abstract

Background
The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis.

Methods
Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site.

Results
The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively.

Conclusion
Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.
Intensive statin versus low-dose statin + ezetimibe treatment for fibrous cap thickness of coronary vulnerable plaques
Authors: Meng Pei-Na , Yin De-Lu , Lu Wen-Qi , Xu Tian , You Wei , Wu Zhi-Ming , Wu Xiang-Qi , Ye Fei 
Published: September 2020

Abstract

Background
Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinant of the propensity of a VP to rupture and is recognized as a key factor. The intensive use of statins is known to have the ability to increase FCT; however, there is a risk of additional adverse effects. However, lower dose statin with ezetimibe is known to be tolerable by patients. The present study aimed to investigate the effect of intensive statin vs. low-dose stain + ezetimibe therapy on FCT, as evaluated using optical coherence tomography.

Method
Patients who had VPs (minimum FCT <65 μm and lipid core >90°) and deferred from intervention in our single center from January 2014 to December 2018 were included in the trial. They were divided into the following two groups: intensive statin group (rosuvastatin 15–20 mg or atorvastatin 30–40 mg) and combination therapy group (rosuvastatin 5–10 mg or atorvastatin 10–20 mg + ezetimibe 10 mg). At the 12-month follow-up, we compared the change in the FCT (ΔFCT%) between the two groups and analyzed the association of ΔFCT% with risk factors. Fisher exact test was used for all categorical variables. Student's t test or Mann-Whitney U-test was used for analyzing the continuous data. The relationship between ΔFCT% and risk factors was analyzed using linear regression analysis.

Result
Total 53 patients were finally enrolled, including 26 patients who were in the intensive statin group and 27 who were in the combination therapy group. At the 12-month follow-up, the serum levels of total cholesterol (TC), total triglyceride, low-density lipoprotein (LDL-C), hypersensitive C-reactive protein (hs-CRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels were reduced in both the groups. The ΔTC%, ΔLDL-C%, and ΔLp-PLA2% were decreased further in the combination therapy group. FCT was increased in both the groups (combination treatment group vs. intensive statin group: 128.89 ± 7.64 vs. 110.19 ± 7.00 μm, t = −9.282, P < 0.001) at the 12-month follow-up. The increase in ΔFCT% was more in the combination therapy group (123.46% ± 14.05% vs. 91.14% ± 11.68%, t = −9.085, P < 0.001). Based on the multivariate linear regression analysis, only the serum Lp-PLA2 at the 12-month follow-up (B = −0.203, t = −2.701, P = 0.010), ΔTC% (B = −0.573, t = −2.048, P = 0.046), and Δhs-CRP% (B = −0.302, t = −2.963, P = 0.005) showed an independent association with ΔFCT%.

Conclusions
Low-dose statin combined with ezetimibe therapy maybe provide a profound and significant increase in FCT as compared to intensive statin monotherapy. The reductions in Lp-PLA2, ΔTC%, and Δhs-CRP% are independently associated with an increase in FCT.
Current status of surgical treatment of rectal cancer in China
Authors: Yang Yong , Wang Han-Yang , Chen Yong-Kang , Chen Jia-Jia , Song Can , Gu Jin 
Published: September 2020

Abstract
With the changing lifestyle and the acceleration of aging in the Chinese population, the incidence and mortality of colorectal cancer (CRC) have risen in the last decades. On the contrary, the incidence and mortality of CRC have continued to decline in the USA since the 1980s, which is mainly attributed to early screening and standardized diagnosis and treatment. Rectal cancer accounts for the largest proportion of CRC in China, and its treatment regimens are complex. At present, surgical treatment is still the most important treatment for rectal cancer. Since the first Chinese guideline for diagnosis and treatment of CRC was issued in 2010, the fourth version has been revised in 2020. These guidelines have greatly promoted the standardization and internationalization of CRC diagnosis and treatment in China. And with the development of comprehensive treatment methods such as neoadjuvant chemoradiotherapy, targeted therapy, and immunotherapy, the post-operative quality of life and prognosis of patients with rectal cancer have improved. We believe that the inflection point of the rising incidence and mortality of rectal cancer will appear in the near future in China. This article reviewed the current status and research progress on surgical therapy of rectal cancer in China.
Angiosarcoma of the Breast
Authors: Gutkin Paulina M. , Ganjoo Kristen N. , Lohman Marti , von Eyben Rie , Charville Gregory W. , Nazerali Rahim S. , Dirbas Frederick M. , Horst Kathleen C. 
Published: September 2020

Objective:
Angiosarcoma of the breast is rare and has a poor prognosis. We reviewed our institution’s experience with this disease to characterize presentation, identify management patterns, and report outcomes.

Methods:
Fifty-eight patients with nonmetastatic angiosarcoma were identified from 1998 to 2019 and retrospectively reviewed. Overall survival (OS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier analysis and log-rank test.

Results:
The median follow-up was 43.4 months (range: 1.8 to 203.3 mo). Twenty-four patients had primary angiosarcoma (PAS) and 34 patients had secondary angiosarcoma (SAS). Patients with PAS were significantly younger than those with SAS (P<0.0001). Mastectomy was the main surgical treatment in our cohort (n=47) and 3 underwent a lumpectomy. The multifocal disease was found in 5/23 patients with PAS and 11/35 patients with SAS. Twenty-eight patients received chemotherapy. Radiation was administered to 13 patients with PAS and 3 patients with SAS. Five-year OS was 73.7% for PAS and 63.5% for SAS. Local recurrence occurred in a greater proportion of patients with margins <5 mm than those with margins ≥5 mm. Chemotherapy did not impact RFS and was not associated with OS in PAS (P=0.35). Those with SAS treated with chemotherapy had significantly greater OS than those who did not receive chemotherapy (P=0.043). Radiation did not significantly influence RFS or OS.

Conclusions:
Five-year OS was higher than anticipated. Margins >5 mm appear important for local control. Patients with SAS, but not PAS, may achieve improved survival with chemotherapy. National trials using prespecified agents may be needed to identify an optimal chemotherapy regimen for women with SAS.
False-positive 1p/19q Testing Results in Gliomas
Authors: Alnahhas Iyad , Rayi Appaji , Thomas Diana , Ong Shirley , Giglio Pierre , Puduvalli Vinay 
Published: September 2020

Background:
The revised fourth edition of the World Health Organization Classification of Tumors of the Central Nervous System—published in 2016—established 1p19q codeletion as the molecular hallmark for the diagnosis of oligodendrogliomas. Fluorescence in situ hybridization (FISH) is currently the most commonly used modality for 1p19q testing. However, as with most laboratory testing, 1p19q FISH testing has a false-positive rate, potentially resulting in an erroneous diagnosis of oligodendroglioma with significant implications for the choice of therapy and prognosis.

Methods:
The authors describe a case series of 5 patients treated at the Ohio State University James Cancer Center to illustrate the problem of false-positive 1p19q FISH results.

Results:
In our case series, the authors present a spectrum of possibilities for conflicting 1p19q testing results and the clinical consequences. The authors present 4 cases that, in retrospect, are believed to have had a false 1p19q FISH results. One other case may represent a true transformation of oligodendroglioma to glioblastoma or a second malignancy. Neuro-oncologists should pay attention to additional molecular markers, namely ATRX, TP53, and MGMT methylation status, before discussing the pathology with the patient and formulating a treatment plan.

Conclusions:
Pathologists and neuro-oncologists should be aware of false-positive 1p19q FISH results as they can significantly change treatment and prognosis for glioma patients. Moreover, this issue should be taken into account when designing clinical trials specific to this disease cohort.
Histological Evaluation of the Relationships Between Distal Interphalangeal Psoriatic Arthritis and Nail Psoriasis: Correlations With Anatomical Studies of the Normal Nail Unit and the Main Radiological Data Concerning Distal Interphalangeal Psoriatic Arthritis
Authors: Perrin Christophe 
Published: September 2020

Abstract:
To determine whether distal interphalangeal joint psoriatic arthritis (DIP PsA) and nail psoriasis are anatomically linked, we studied 2 fingers taken from a cadaver presenting a typical cutaneous and nail psoriasis in the setting of a dactylitis limited to the fourth toe. This comprehensive study of the inflammatory pattern of DIP PsA is discussed in the context of the controversial theory of the nail as a musculoskeletal appendage. Both the extensor and flexor entheses were focally and quite markedly infiltrated by lymphocytes and showed variable fibrosis and neovascularization. In addition, some clusters of giant cells were seen. Synovial perivascular inflammation was focally relatively dense. Discrete periostitis and bone inflammation of the intertrabecular spaces were seen, maximally at the insertion of the extensor and flexor tendons. The retained superficial fibrocartilaginous and tendinous cuff separated the inflamed extensor enthesis from the surrounding connective tissues. The thick proximal periosteum constituted a barrier between the inflamed bone and the matrical hypoderm. The lateral sections showed inflammation at 3 levels as follows: the enthesis of the interosseous ligament and collateral ligament, periosteum, and nail epithelium. In the 3 specimens, the inflammatory foci involving entheses and nails were prominent and never contiguous. This suggests that DIP PsA is not merely an extensor enthesitis and that the nail unit remains a microanatomical structure independent from the extensor enthesis, even with severe DIP PsA.