bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hip Reconstruction in Nonambulatory Children With Cerebral Palsy: Identifying Risk Factors Associated With Postoperative Complications and Prolonged Length of Stay
Authors: Shea Jodie , Nunally Kianna D. , Miller Patricia E. , Difazio Rachel , Matheney Travis H. , Snyder Brian , Shore Benjamin J. 
Published: August 2020

Background:
The purpose of this study is to examine the relationship between preoperative comorbidities, surgical complications, and length of stay (LOS) after hip reconstruction in nonambulatory children with cerebral palsy (CP).

Methods:
This single-center retrospective cohort study included 127 patients undergoing hip surgery between 2007 and 2016 who were diagnosed with CP (GMFCS IV/V). The cohort was 54% Gross Motor Function Classification System (GMFCS) V with an average age at surgery of 9 years (range, 3-19 y). Preoperative comorbidities included: presence of a gastrostomy tube, respiratory difficulty requiring positive-pressure ventilation or tracheostomy, history of seizures, and nonverbal status. Complications were dichotomized into major and minor complications according to severity. Multivariable general linear modeling was used to identify factors associated with complications and prolonged LOS.

Results:
The median LOS in the hospital was 6 days (intequartile range, 5-9 d). The majority of procedures (72%) involved both the femur and acetabulum and 82% of surgeries were performed bilaterally. Patients who experienced a major complication were mostly GMFCS level V and were more likely to spend time in intensive care unit than postanesthetic care unit (P=0.001). Multivariable analysis for a major complication determined that the addition of each comorbid risk fact increased the odds of developing a major complication by 2.6 times (odds ratio, 2.64; 95% confidence interval, 1.56-4.47; P<0.001) regardless of GMFCS level. Multivariable analysis for prolonged LOS determined that major complications (P<0.001), bilaterality (P=0.01), age (P=0.02), female sex (P=0.01), and GMFCS V (P<0.001) were all factors that increased LOS. Migration percentage, acetabular index odds ratio, and pelvic obliquity were not associated with prolonged LOS or the presence of a major complication.

Conclusions:
From our analysis, the authors found that a patient’s premorbid comorbidities were more predictive of the likelihood of sustaining a major complication than their GMFCS level. Identifying high-risk patients preoperatively may help reduce complications and LOS, which ultimately will improve the quality of care the authors deliver to nonambulatory children with CP undergoing hip reconstruction surgery.

Level of Evidence:
Level III—retrospective cohort study.
What Should I Wear to Clinic? A National Survey of Pediatric Orthopaedic Patients and Parents
Authors: Bauer Jennifer M. , Welling Sebastian E. , Ross Kirsten E. , Mackenzie W. G. Stuart , Larson Jill E. , Leshikar Holly , Strauss Nicole M. 
Published: August 2020

Background:
A number of factors have been shown to affect how surgeons are subjectively viewed, including their appearance in clinic. Patient preference for pediatric orthopaedic surgeon attire has not previously been studied, nor has its influence on initial perception of the surgeon.

Methods:
At 5 pediatric regional sites across the United States, parents and patients presenting to the pediatric orthopaedic clinic were given anonymous surveys showing 8 photos of surgeons in different clinical dress including in business or scrub dress, each with or without white coat (WC). Subjects reported their demographics, single preferred photo, rated characteristics of the surgeons in each photo on a 5-point Likert scale, and answered specific questions on scrubs and WCs. The first consecutively completed 100 parent and 100 patient surveys were included from each site.

Results:
One thousand surveys were collected from patients (500) and parents (500). The majority felt a surgeon’s clinical dress would not affect how they are cared for (83%), and that it was ok to wear scrubs in clinic (90%). Overall, WC was preferred to those without no matter the age, but there was no difference between scrub and business choices. Of those stating a preference, woman in business and WC (24%) and woman in scrubs and WC (21%) were most selected, with the only geographic difference being the midwest’s preference for man in business and WC. Females were more likely to prefer women photographs (P<0.0001).

Conclusions:
In general, pediatric orthopaedic patients and parents do not have a strong specific preference toward what their surgeon wears to clinic, including whether or not we are dressed in scrubs, but some initial biases exist. When asked to choose, the traditional WC worn over any attire is preferred, and female patients and parents uncover a preference for a surgeon of their own sex.

Level of Evidence:
Level III.
Universal Screening for COVID-19 in Children Undergoing Orthopaedic Surgery: A Multicenter Report
Authors: Blumberg Todd J. , Adler Adam C. , Lin Elaina E. , Fazal Faris Z. , Talwar Divya , Ellingsen Kyle , Chandrakantan Arvind , Chen Jingyang , Shah Apurva S. 
Published: August 2020

Background:
The COVID-19 pandemic has substantially altered the typical process around performing surgery to ensure protection of health care workers, patients, and their families. One safety precaution has been the implementation of universal preoperative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examines the results of universal screening on children undergoing orthopaedic surgery.

Methods:
This is a retrospective cohort study evaluating the incidence and symptomatology of COVID-19 in all patients presenting for orthopaedic surgery at 3 pediatric tertiary care children’s hospitals during the COVID-19 pandemic (March to June 2020). All patients underwent universal screening with a nasopharyngeal swab to detect presence of SARS-CoV-2. Bivariate and multivariate logistic regression analysis was performed to identify risk factors for positive COVID-19 screening.

Results:
In total, 1198 patients underwent preoperative screening across all 3 institutions and 7 (0.58%) had detection of SARS-CoV-2. The majority of patients (1/7, 86%) were asymptomatic. Patients that tested positive were significantly more likely to be Hispanic (P=0.046) and had greater number of medical comorbidities (P=0.013), as scored on the American Society of Anesthesiologists (ASA) physical status score. A known COVID-19 positive contact was found to be a significant risk factor in the multivariate analysis (P=0.004).

Conclusions:
Early results of universal preoperative screening for COVID-19 demonstrates a low incidence and high rate of asymptomatic patients. Health care professionals, especially those at higher risk for the virus, should be aware of the challenges related to screening based solely on symptoms or travel history and consider universal screening for patients undergoing elective surgery.

Level of Evidence:
Level II.
A Novel Spacer Device for Treatment of Perimegaprosthetic Infections in Bone Tumor Surgeries Around the Knee
Authors: Kliushin Nikolay M. , Stepanjan Artak B. , Subramanyam Koushik N. , Sudnitsyn Anatoliy S. , Mundargi Abhishek V. 
Published: August 2020

Background:
Megaprosthesis constitutes the mainstay of limb salvage after bone tumor surgery, and the rate of perimegaprosthetic infection is relatively high. Although the ideal management of perimegaprosthetic infection is 2-stage revision, the ideal antibiotic spacer device is lacking.

Methods:
We designed a novel spacer device unique to this situation. It is a modular device made of titanium with variable size of the components. This customizes the spacer specific to the situation on the basis of the length of medullary canal and the size of the defect. Antibiotic-impregnated bone cement introduced into the medullary canal on both sides and at the site of the defect provides excellent stability and ability to weight-bear. Modularity ensures that components can be easily assembled and removed at the time of revision surgery. As a proof of concept, we used this spacer in 2 patients with perimegaprosthetic infection as a bridge between debridement and definitive reconstruction.

Results:
Both patients were young male individuals with multiple episodes of perimegaprosthetic infection in the past. Debridement resulted in defect of 24 and 28 cm, respectively. Both of them had spacer application along with antibiotic bone cement. Infection could be well controlled, and patients could be made to fully weight-bear with the spacer. Successful revision prostheses could be implanted 12 and 18 months from index surgery with no relapse of infection at 2-year follow-up.

Conclusion:
We recommend this novel spacer device to ensure stability and functionality in 2-stage revision surgeries of infected megaprostheses.
Combined Anteversion Technique for the Modified Hardinge Approach in Cementless Total Hip Arthroplasty
Authors: Suksathien Yingyong , Tippimanchai Thanut 
Published: August 2020

Objective:
To define the combined anteversion (CA) angle in the modified Hardinge approach, which created an impingement-free range of motion (ROM) and prevented dislocation.

Materials and Methods:
The femoral stem was prepared first, the anteversion of the femoral stem was determined and recorded. The target angle for acetabular cup abduction was 40 degrees in all cases. Cup anteversion angle was targeted individually close to but not exceed the native acetabular anteversion angle in each case. The hip joint was tested for impingement-free ROM and stability intraoperatively.

Results:
There were 120 cases with a mean age of 58.7 years (29 to 91, 14.1) and the mean follow-up of 21.8 months (18 to 37). The mean native acetabular anteversion angle was 11.9 degrees (3 to 28 degrees, 5.1). The mean femoral stem anteversion angle was 13.7 degrees (2 to 35 degrees, 7.7) and the mean acetabular cup anteversion angle was 10.2 degrees (−4 to 21 degrees, 3.6). The mean CA angle was 24.2 degrees (9 to 48 degrees, 7.9). The CA angle was within 10 to 40 degrees for 114 of 120 cases (95%). The acetabular cup anteversion angle was within the Lewinnek safe zone for 113 of 120 cases (94.2%). The mean femoral anteversion angle for male and female individuals was 12.16 degrees (2 to 30 degrees, 6.75) and 14.62 degrees (2 to 35 degrees, 8.17) respectively, there was no significant difference (P=0.094). The mean CA angle for male and female individuals was 23.21 degrees (15 to 42 degrees, 6.37) and 24.72 degrees (9 to 48 degrees, 8.6), respectively, which was not significantly different (P=0.310). There was no dislocation.

Conclusions:
The mean CA angle in the modified Hardinge approach was 24.2 degrees and the effective CA angle for impingement-free ROM and preventing dislocation was between 10 and 40 degrees.
Pulmonary deportation of hydatidiform mole: a 12-year, single tertiary center experience in China
Authors: Dai Yu-Xin , Xiang Yang , Feng Feng-Zhi , Ren Tong , Yang Jun-Jun , Zhao Jun , Wan Xi-Run 
Published: August 2020

Abstract

Background
Pulmonary deportation of hydatidiform mole is an exceedingly rare entity. The underlying mechanisms and proper management strategies remain unclear based on sporadic case reports over the past six decades. This study aimed to investigate the clinical features and rational treatment of patients with benign molar pregnancies with pulmonary deportation based on our experience.

Methods
Medical records of 20 cases of hydatidiform mole with pulmonary deportation were retrospectively reviewed at Peking Union Medical College Hospital from November 2006 to May 2019. The detailed information of all patients was recorded and analyzed. Patients were divided into different groups according to their characteristics and Mann-Whitney U test was used to compare the duration to achieve a normal β-human chorionic gonadotrophin (β-hCG) level after the first evacuation among groups.

Results
Initial pulmonary computed tomography scans showed suspected bilateral, left and right chest deportation of hydatidiform mole in 12, four, and four patients, respectively, with the maximum nodular diameter ranging from 0.6 to 1.2 cm. Ten patients achieved lesion resolution while the remaining ten patients achieved decreases in the size of their pulmonary lesions. The median duration to achieve a normal β-hCG level after the first evacuation was 15.5 (13.0, 21.9) weeks. There was no significant difference in the duration to achieve a normal β-hCG level after the first evacuation between two groups based on age (≥40 years vs. < 40 years: 15.8 [12.2, 21.5] weeks vs. 15.5 [12.9, 23.0] weeks, Z = 0.094, P = 0.925), type of antecedent mole (partial mole vs. complete mole: 15.2 [12.5, 27.4] weeks vs. 15.9 [12.9, 21.5] weeks, Z = 0.165, P = 0.869), distribution of pulmonary nodules (bilateral lungs vs. unilateral lung: 15.2 [12.8, 22.5] weeks vs. 15.9 [13.2, 22.2] weeks, Z = 0.386, P = 0.700), maximum size of pulmonary nodules (>0.5 cm vs. ≤0.5 cm: 13.0 [11.3, 17.2] weeks vs. 16.0 [14.5, 23.8] weeks, Z = 1.815, P = 0.070), and number of uterine evacuations (once vs. twice or three times: 15.0 [13.0, 16.3] weeks vs. 16.0 [12.8, 23.9] weeks, Z = 0.832, P = 0.405). The post-molar cohort was followed up for 17 to 139 months, and no gestational trophoblastic neoplasia was observed.

Conclusions
No surgeries other than uterine evacuation and no chemotherapy regimens are recommended for such patients if they achieve satisfactory decreases in the level of hCG and gradual decrease or disappearance of pulmonary deportation nodules. Patients should be informed about the necessity of long-term follow-up. More collaborative international studies on this exceedingly rare condition may guide decisions regarding optimal management strategies.
Surgical left atrial appendage occlusion in patients with atrial fibrillation undergoing mechanical heart valve replacement
Authors: Zheng Ye , Rao Chen-Fei , Chen Si-Peng , He Li , Hou Jian-Feng , Zheng Zhe 
Published: August 2020

AbstractBackgroundSurgical left atrial appendage occlusion (SLAAO) may be associated with a lower risk of thromboembolism in patients with atrial fibrillation undergoing cardiac surgery. However, evidence regarding the effectiveness of SLAAO in patients undergoing mechanical heart valve replacement (MHVR) is lacking. Therefore, we aimed to evaluate the association between SLAAO and the cardiovascular outcomes in patients with atrial fibrillation undergoing MHVR.MethodsWe retrospectively analyzed data for 497 patients with atrial fibrillation; 27.6% of the patients underwent SLAAO, and the remainder of the patients did not (No-SLAAO group). The primary outcome was a composite of ischemic stroke, systemic embolism, and all-cause mortality. Cumulative event-free survival rates were estimated using Kaplan-Meier curves, and we performed multivariate Cox analyses to evaluate the association between SLAAO and outcomes. We used one-to-one propensity score matching to balance patients’ baseline characteristics, and analyzed 120 matching pairs.ResultsFive patients died within 30 days postoperatively, and there were no significant differences between the two groups regarding in-hospital complications (allP > 0.05). After a median follow-up of 14 months, 14 primary events occurred. Kaplan-Meier curves showed no difference in the cumulative incidence of freedom from the primary outcome (log-rankP = 0.830), hemorrhagic events (log-rankP = 0.870), and the secondary outcome (log-rankP = 0.730), between the two groups. Multivariable Cox proportional hazards regression analysis showed no association between SLAAO and any outcome (allP > 0.05). After propensity score matching, cardiopulmonary bypass time and aortic cross-clamp time, and the postoperative length of stay were significantly longer in the SLAAO group (allP < 0.05); results were similar to the unadjusted analyses.ConclusionsConcomitant SLAAO and MHVR was associated with longer length of stay, and cardiopulmonary bypass time and aortic cross-clamp time, but was not associated with additional protective effects against thromboembolic events and mortality during the 14-month follow-up.
Molecular Alterations in Vaginal Melanomas: Report of 4 Cases and Literature Review
Authors: Moran Jakob M. T. , Fujimoto Masakazu , Iwahashi Yoshifumi , Cornejo Kristine M. , Hoang Mai P. 
Published: August 2020

Abstract:
Melanomas of the female gynecological tract comprise approximately 18% of mucosal melanomas, a rare subtype of melanoma. Within the female genital tract, 70% of primary melanomas of the gynecological tract are from the vulva with the remainder occurring in the vagina and rarely, in the cervix. We investigate molecular alterations by next-generation sequencing-based molecular tests targeting 99 cancer genes and translocation/fusion assays in 4 and 3 vaginal melanomas, respectively. The ages of the 4 patients range from 65 to 90 years. Postmenopausal bleeding was the most common presenting symptom. Tumor size ranged from 0.5 to 6.6 cm. KIT L576P mutation was documented in case 1, whereas TP53 mutation was seen in cases 2 and 3 (L130F and Y163C). Case 2 also harbored NF2 E204Q and ATRX D1719H mutations. A number of gene copy alterations were noted in case 4, which included GNA11 loss, MYC gain, RET loss, SMO loss, SUFU loss, and TSC2 loss. No gene fusion was detected in any of the 3 tested cases. In conclusion, in addition to KIT, TP53, and ATRX mutations, which have been previously reported, our cases harbor NF2 mutation and multiple gene copy alterations that have not previously been documented in vaginal melanomas. These findings highlight the potential role of targeted therapy in this rare melanoma subtype.
Preliminary Impact of an Adapted Emotion Regulation Intervention for Adolescents with Overweight and Obesity Attempting to Lose Weight
Authors: Hadley Wendy , Houck Christopher , Barker David , Wickham Brittany , Bogner Jaclyn , Jelalian Elissa 
Published: August 2020

ABSTRACT:

Objective:
This study examines the acceptability, feasibility, and preliminary impact of a program (HealthTRAC) combining 2 efficacious interventions (one targeting emotion regulation [TRAC] and the other a standardized behavioral weight management intervention [SBWC]) to improve weight management outcomes among a sample of adolescents with overweight and obesity.

Method:
Adolescents with overweight or obesity (N = 38), ages 13 to 17 years, were enrolled and randomized into either the SBWC or HealthTRAC. Data were collected at baseline (before intervention), at the end of the 16-week intervention (postintervention), and 4 months after completing the intervention (4 months). Assessments included adolescent self-reports of intervention acceptability and reported emotion regulation (ER) abilities and caregiver report of adolescent ER skills. Body mass index (BMI) was used to examine the impact on adolescent weight outcomes. Analyses of covariance controlling for baseline values were used to evaluate study outcomes.

Results:
Eighty-four percent (n = 32) of participants completed the immediate postintervention and 4-month follow-up assessments. Adolescents in both conditions reported high treatment satisfaction. Adolescents randomized to HealthTRAC demonstrated greater reductions in BMI relative to SBWC and reported greater use of emotion regulation skills. Finally, caregivers of adolescents randomized to HealthTRAC also reported greater improvements in emotion regulation abilities among their adolescents at the 4-month follow-up.

Conclusion:
Findings suggest that the HealthTRAC intervention was acceptable, feasible to deliver, and demonstrated a positive impact on BMI and emotion regulation abilities. These data suggest that ER is related to health decision-making and is relevant to most overweight/obese adolescents seeking to lose weight.
Maternal Consistency in Recalling Prenatal Experiences at 6 Months and 8 Years Postnatal
Authors: Ramos Amanda M. , Marceau Kristine , Neiderhiser Jenae M. , De Araujo-Greecher Marielena , Natsuaki Misaki N. , Leve Leslie D. 
Published: August 2020

ABSTRACT:

Objective:
Mothers are known to be reliable reporters of smoking during pregnancy, type of delivery, and birth weight when compared with medical records. Few studies have considered whether the timing of retrospective collection affects the mother's retrospective self-report. We examined the consistency of maternal retrospective recall of prenatal experiences, behaviors, and basic birth outcomes between 6 months and 8 years postpartum.

Method:
We examined 117 mothers (62% White, 44% living in a committed relationship, median high school education) from the Early Growth and Development Study (EGDS). EGDS is a longitudinal adoption study that includes birth mothers of children born between 2003 and 2009 who were involved in a domestic adoption. Using the modified life history calendar and a pregnancy screener, mothers reported on their prenatal health behaviors, prenatal substance use, and labor and delivery at 6 months and 8 years postpartum. Cohen κ was calculated to examine consistency, and χ2 tests were used to test differences by parity and maternal education.

Results:
Mothers' recall was very good for recall of the type of delivery and good for smoking during pregnancy, medicine used for labor induction, and specific medical problems (i.e., pre-eclampsia, sexually transmitted infections, and kidney infections). Recall consistency was poor for illicit drug use, specific prenatal tests performed (i.e., amniocentesis and emergency room visits), and using drugs other than an epidural during delivery.

Conclusion:
This study provides support for using retrospective collection of maternal self-report on some prenatal experiences up to 8 years postpartum and offers a potential way to more accurately collect self-reported prenatal experiences.
Non-hormonal mediators of uterine fibroid growth
Authors: Cetin Esra , Al-Hendy Ayman , Ciebiera Michał 
Published: August 2020

Purpose of review
Uterine fibroids are the most common benign neoplasms of the female reproductive tract and one of the major public health concerns. Although most women with uterine fibroids are asymptomatic, over 30% of them will present with varying symptoms. This review focuses on the role of non-hormonal mediators and pathways in uterine fibroid biology. Furthermore, it provides data regarding the most recent findings in the field of compounds, which use those non-hormonal pathways in the medical therapy of uterine fibroids.

Recent findings
Complex signaling pathway alterations are crucial for uterine fibroid development. The topic of the pathophysiology of uterine fibroids focuses mostly on steroids and other hormones. However, other very important pathways exist, and some of them are independent of hormones. Some of the most important pathways, which are non-hormonal, but in some cases still hormone-depended, include growth factors, cytokines and inflammation, Smad proteins, wingless type/β-catenin and others.

Summary
Much more is known about hormonal than about non-hormonal signaling in uterine fibroids. Growth factors, early life exposure and inflammation are key factors in uterine fibroid biology. Numerous agents depend on those pathways and may find their place in the current and future therapy of uterine fibroids.