bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Mobile Phone-Based Support on Exclusive Breastfeeding and Infant Growth in Nigeria: A Randomized Controlled Trial
Authors: Ogaji Daprim S , Arthur Adaku O , George Innocent 
Published: August 2020

AbstractBackgroundThis study examined whether mobile phone-based support improve the rates, duration of exclusive breastfeeding (EBF) as well as infant growth patterns in Nigeria.MethodsA 6-month prospective randomized controlled trial with 75 participants assigned to receive ‘usual care’ or ‘mobile phone-based support in addition to usual care’ EBF rates and duration as well as anthropometric measurements of infants before and after intervention were compared using proportions and mean differences.ResultsAttrition rates of 10.7% and 14.7% were observed in the intervention and control groups, respectively. Treatment groups were identical in all baseline characteristics and participants in the intervention group showed a slower rate of decline in the practice of EBF. The mean difference of 0.6 months (95% confidence interval: −0.22, 1.42) in EBF duration between intervention and control groups was not statistically significant (t = 1.45; p = 0.149). Similarly, the difference in the EBF rates at the 6th month for the intervention (55.2%) and control (46.8%) groups was not statistically significant (χ2 = 0.623; p = 0.430). Although the intervention group had significantly higher mean weight (p = 0.030) and length (p = 0.044) at the 6th month, the difference in the gain in weight and length of these infants over the period was only significant for the weight (p = 0.044). Although the incidence of adverse clinical nutritional status was more in the control group, these differences were not statistically significant.ConclusionMobile phone-based intervention has positive effects on the rate and duration of EBF as well as the growth of young infants. Sustaining this simple and cheap technology will improve infant wellbeing especially in resource-constrained settings.
Anesthesia and the brain after concussion
Authors: Pasternak Jeffrey J. , Abcejo Arnoley S. 
Published: August 2020

Purpose of review
To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations.

Recent findings
Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be most vulnerable to secondary injury.

Summary
Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma and strive to maintain cerebral homeostasis in the perianesthetic period.
Comparison of Clinical and Radiographic Outcomes of Laminoplasty, Anterior Decompression With Fusion, and Posterior Decompression With Fusion for Degenerative Cervical Myelopathy
Authors: Inose Hiroyuki , Yoshii Toshitaka , Kimura Atsushi , Takeshita Katsushi , Inoue Hirokazu , Maekawa Asato , Endo Kenji , Miyamoto Takuya , Furuya Takeo , Nakamura Akira , Mori Kanji , Kanbara Shunsuke , Imagama Shiro , Seki Shoji , Matsunaga Shunji , Okawa Atsushi 
Published: August 2020

Study Design.
Prospective multicenter study.

Objective.
The aim of this study was to compare the clinical and radiographic results of laminoplasty (LAMP), anterior decompression with fusion (ADF), and posterior decompression with fusion (PDF) for degenerative cervical myelopathy (DCM).

Summary of Background Data.
Although ADF, LAMP, and PDF have been performed for DCM, little is known about the difference in impact of these surgical treatments on clinical and radiographic outcomes.

Methods.
We prospectively enrolled patients who were scheduled for surgery for DCM and compared the clinical and radiographic results of ADF, LAMP, and PDF.

Results.
In total, 171 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score), European Quality of Life-5 Dimensions (EQ-5D), and Neck Disability Index (NDI) scores improved in all groups postoperatively. However, no significant differences were found in C-JOA, EQ-5D, and NDI scores and recovery rate among the groups. Regarding radiographic parameters, although the operation had no effect on cervical lordosis (CL) and the C2–7 sagittal vertical axis (SVA) in the ADF group, they worsened in the LAMP and PDF group. Although there were no significant differences in any preoperative radiographic parameters within the ADF and LAMP group, CL was significantly lower and the C2–7 SVA was significantly higher in the nonrecovery group within the PDF group. Logistic regression analysis showed that preoperative lower CL was an independent risk factor for poor recovery in the PDF group.

Conclusion.
Although groups showed no significant differences in clinical outcomes, cervical alignment worsened after surgery in the LAMP and PDF groups. Within the PDF group, lower CL was an independent risk factor for poor recovery. Therefore, the indications for PDF in DCM patients with preoperative kyphotic alignment should be carefully considered.

Level of Evidence: 3
Validation of PROMIS Physical Function in MIS TLIF
Authors: Jenkins Nathaniel W. , Parrish James M. , Cha Elliot D.K. , Lynch Conor P. , Sayari Arash J. , Geoghegan Cara E. , Jadczak Caroline N. , Mohan Shruthi , Singh Kern 
Published: August 2020

Study Design.
Retrospective cohort.

Objective.
We evaluate the correlation of the Patient-Reported Outcomes Measurement Information System for physical function (PROMIS-PF) with legacy patient-reported outcome measures (PROMs) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) up to 2 years postoperatively.

Summary of Background Data.
PROMIS-PF has not been validated past 6 months following MIS TLIF.

Methods.
A surgical registry was retrospectively reviewed for eligible MIS TLIFs between May 2015 and September 2017. Inclusion criteria were primary, one- or two-level MIS TLIFs for degenerative spinal pathology. Patients without preoperative or 2-year follow up PROMIS-PF surveys were excluded. Demographic, perioperative, and PROMs including Visual Analog Scale (VAS) back, VAS leg, Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) physical component summary (PCS) scores, and PROMIS-PF at preoperative and postoperative timepoint (e.g., 6 weeks, 12 weeks, 6 months, 1 year, and 2 years). A paired t test evaluated PROM improvement from baseline. The relationship of PROMIS-PF with VAS back, VAS leg, SF-12 PCS, and ODI was evaluated with a Pearson correlation coefficient.

Results.
The 68-subject cohort was 41.2% female, with an average age of 52.9 years; 44.1% were obese, and the majority underwent one-level fusions (95.6%). Pain (VAS back, VAS leg) and disability metrics (ODI) demonstrated significant improvement at all timepoints following MIS TLIF when compared to baseline (all P < 0.001). Physical function (SF-12 PCS, PROMIS-PF) demonstrated significant postoperative improvement at 12 weeks, 6 months, 1 year, and 2 years (all P < 0.001). All evaluated timepoints, with the exception of preoperative VAS back scores, revealed strong PROMIS-PF correlations with VAS back, VAS leg, ODI, and SF-12 PCS.

Conclusion.
PROMIS-PF demonstrated a strong correlation with pain (VAS back, VAS leg), disability (ODI) and physical function (SF-12) at all postoperative follow-ups through 2 years. Our study provides longitudinal evidence for utilizing PROMIS-PF as a valid physical function measure among patients undergoing MIS TLIF.

Level of Evidence: 4.
Hounsfield Unit for Assessing Vertebral Bone Quality and Asymmetrical Vertebral Degeneration in Degenerative Lumbar Scoliosis
Authors: Wang Hui , Zou Da , Sun Zhuoran , Wang Longjie , Ding Wenyuan , Li Weishi 
Published: August 2020

Study Design.
Retrospective analysis.

Objectives.
The aim of this study was to demonstrate the correlation between degenerative lumbar scoliosis (DLS) and osteoporosis based on Hounsfield unit (HU) measurement from computed tomography (CT) scans, and to investigate the asymmetrical vertebral degeneration in DLS.

Summary of Background Data.
The correlation between DLS and osteoporosis measured by dual-energy x-ray absorptiometry (DEXA) is debated, since T-scores measured by DEXA scan can be overestimated due to abdominal vessel wall calcification, degenerative bony spurs, and facet hypertrophy. The reliability and accuracy of HU to determine osteoporosis are shown in many reports, but it has never been used to assess the vertebral bone quality for DLS patients.

Methods.
Nighty-five DLS patients were retrospectively reviewed. Regions of interest for HU were measured on three coronal images of the lumbar vertebrae. HU measurement of the whole vertebrae from L1 to L5 was obtained, then HU measurement within concave and convex sides were obtained separately in L5, upper and lower end vertebrae, apex vertebrae, neutral vertebrae, stable vertebrae.

Results.
HU value presented a gradually increasing trend from L1 to L5. No correlation was detected between Cobb angle and mean HU value of the 5 lumbar vertebrae, or between Cobb angle and HU value of every lumbar vertebrae separately. HU value was higher within concavity than that within convexity of the same vertebrae both in major and compensatory curve. Asymmetric HU ratio in apex vertebrae positively correlated with Cobb angle. Stable vertebrae were the first proximal vertebrae that present opposite orientation of asymmetric HU ratio from the other lumbar vertebrae.

Conclusion.
Progression of degenerative scoliosis presents no correlation with osteoporosis based on HU measurement but could increase the asymmetrical vertebral degeneration, especially in apex vertebrae. Distraction of the pedicle screws at concave side, instead of compression of pedicle screws at convex side, should be a priority to correct lumbosacral curve.

Level of Evidence: 3
Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis
Authors: Alanay Ahmet , Yucekul Altug , Abul Kadir , Ergene Gokhan , Senay Sahin , Ay Binnaz , Cebeci Barbaros Omer , Yalinay Dikmen Pinar , Zulemyan Tais , Yavuz Yasemin , Yilgor Caglar 
Published: August 2020

Study Design.
Retrospective analysis of prospectively collected data.

Objective.
To report the follow-up curve behaviors in different Sanders staging groups.

Summary of Background Data.
Vertebral body tethering (VBT) is a growth modulation technique that allows gradual spontaneous follow-up curve correction as the patient grows. There is a lack of scientific evidence regarding appropriate patient selection and timing of implantation.

Methods.
Patients were grouped into five as: Sanders 1, 2, 3, 4–5, and 6–7. Data were collected preoperatively, at the day before discharge, and at each follow-up. Outcome measures were pulmonary and mechanical complications, readmission, and reoperation rates. Demographic, perioperative, clinical, radiographic, and complication data were compared using Fisher–Freeman–Halton exact tests for categorical variables and Kruskal-Wallis tests for the continuous variables.

Results.
Thirty-one (29 F, 2 M) consecutive patients with a minimum of 12 months of follow-up were included. The mean age at surgery was 12.1 (10–14). The mean follow-up was 27.1 (12–62) months. The mean preoperative main thoracic curve magnitude was 47° ± 7.6°. For all curves, preoperative and first erect curve magnitudes, bending flexibility, and operative correction percentages were similar between groups (for all comparisons, P > 0.05). The median height gained during follow-up was different between groups (P < 0.001), which was reflected into median curve correction during follow-up. Total curve correction percentage was different between groups (P = 0.009). Four (12.9%) patients had pulmonary and six (19.4%) had mechanical complications. One (3.2%) patient required readmission and two (6.5%) required reoperation. Occurrence of pulmonary complications was similar in Sanders groups (P = 0.804), while mechanical complications and overcorrection was significantly higher in Sanders 2 patients (P = 0.002 and P = 0.018).

Conclusion.
Follow-up curve behavior after VBT is different in patients having different Sanders stages. Sanders 2 patients experienced more overcorrection, thus timing and/or correction should be adjusted, since Sanders 3, 4, and 5 patients displayed a lesser risk of mechanical complications.

Level of Evidence: 3.
Fragility Analysis of Statistically Significant Outcomes of Randomized Control Trials in Spine Surgery
Authors: Muthu Sathish , Ramakrishnan Eswar 
Published: August 2020

Study Design.
Systematic review.

Objectives.
The aim of this study was to assess the robustness of statistically significant outcomes from randomized control trials (RCTs) in spine surgery using Fragility Index (FI) which is a novel metric measuring the number of events upon which statistical significance of the outcome depends.

Summary of Background Data.
Many trials in Spine surgery were characterized by fewer outcome events along with small sample size. FI helps us identify the robustness of the results from such studies with statistically significant dichotomous outcomes.

Methods.
We conducted independent and in duplicate, a systematic review of published RCTs in spine surgery from PubMed Central, Embase, and Cochrane Database. RCTs with 1:1 prospective study design and reporting statistically significant dichotomous primary or secondary outcomes were included. FI was calculated for each RCT and its correlation with various factors was analyzed.

Results.
Seventy trials met inclusion criteria with a median sample size of 133 (interquartile range [IQR]: 80–218) and median reported events per trial was 38 (IQR: 13–94). The median FI score was 2 (IQR: 0–5), which means if we switch two patients from nonevent to event, the statistical significance of the outcome is lost. The FI score was less than the number of patients lost to follow-up in 28 of 70 trials. The FI score was found to positively correlated with sample size (r = 0.431, P = 0.001), total number of outcome events (r = 0.305, P = 0.01) while negatively correlated with P value (r = −0.392, P = 0.001). Funding, journal impact-factor, risk of bias domains, and year of publication did not have a significant correlation.

Conclusion.
Statistically significant dichotomous outcomes reported in spine surgery RCTs are more often fragile and outcomes of the patients lost to follow-up could have changed the significance of results and hence it needs caution before transcending their results into clinical application. The addition of FI in routine reporting of RCTs would guide readers on the robustness of the statistical significance of outcomes. RCTs with FI ≥5 without any patient lost to follow-up can be considered to have clinically robust results.

Level of Evidence: 1
Reconstruction of Full Thickness Defects on the Scalp With Artificial Dermal Regeneration Template: Analysis of Long-Term Results in 68 Cases
Authors: Benecke Johannes , Koenen Wolfgang , Mager Lisa , Weina Kasia , Klemke Claus-Detlev , Felcht Moritz , Faulhaber Jörg 
Published: August 2020

BACKGROUND
Artificial skin substitute templates have been shown to be a reliable solution for the reconstruction of large scalp defects with exposed skull bone, but there is a lack of long-term data.

OBJECTIVE
The aim of this retrospective study was to investigate the long-term outcome of the procedure in a large cohort of 68 cases.

MATERIALS AND METHODS
In total, 58 patients with 68 full thickness scalp defects with exposed skull bone, were included. Mean follow-up time was 24 (±19) months.

RESULTS
The mean size of the defects was 63 (±54) cm2. During the follow-up period, no local recurrences occurred. Complications were observed in 13% of the cases including template necrosis (4%), infections (4%), ulcerations (3%), and autograft necrosis (2%). During the final follow-up, 26 patients had died due to internal diseases not associated with the surgery. Cosmetic results were rated good by the patients and an independent observer.

CONCLUSION
The use of a dermal regeneration template for the reconstruction of large, full thickness defects of the scalp with exposed skull bone is a reliable method regarding the complication rate, safety of the procedure, and cosmetic outcome. Limitations of this study are the retrospective and single center design.
Nonsurgical Treatment of Postpartum Lower Abdominal Skin and Soft-Tissue Laxity Using Microfocused Ultrasound With Visualization
Authors: Lin Frank G. 
Published: August 2020

BACKGROUND
Microfocused ultrasound with visualization (MFU-V) is a well-established treatment modality for skin tightening. There is a paucity of evidence for its use in body treatments, such as the lower abdomen.

OBJECTIVE
To investigate the effectiveness and safety of MFU-V in treating lower abdominal skin and soft-tissue laxity in postpartum women.

METHODS
The lower abdomen of 20 female patients between 6 and 24 months postpartum are treated with MFU-V using 1.5-, 3.0-, and 4.5-mm transducers. Data are prospectively collected and analyzed at 3 and 6 months using subject-reported and investigator-reported outcome measures. One additional patient underwent planned abdominoplasty 6 weeks after MFU-V treatment with tissue assessed intraoperatively and histologically.

RESULTS
There was a mean improvement of 1.0 and 1.3 grades at 6 months using the investigator-reported and patient-reported skin laxity scale, respectively (p < .001). Patient-reported outcomes and satisfaction survey showed consistent improvement at 6 months. Histological examination of pretreated tissue showed increased total collagen, increased number and thickness of fibrous septae, and no change in fat cells within pretreated tissue compared with the control. No significant adverse events were recorded.

CONCLUSION
MFU-V is an effective and safe treatment modality for lower abdominal skin laxity in postpartum patients.
Canthal Rotation Flap: Analysis of Flap Mechanics
Authors: Syed Zain U. , Madden Nichelle , Donnelly Heidi B. 
Published: August 2020

BACKGROUND
Surgical defects of the medial canthus lack reconstructive options that are reproducible, precise, and uncomplicated. The canthal rotation flap is a simple rotation flap that respects the geometry of this anatomic location.

OBJECTIVE
To describe the authors' experience with reconstructive planning, flap mechanics, and geometric analysis of the medial canthus to achieve the best cosmetic outcome when using the canthal rotation flap.

METHODS
A retrospective review of 16 cases performed at Dayton Skin Care Specialists and Skin Care Specialty Physicians between 2016 and 2018 was completed with a blinded visual analog score (VAS).

RESULTS
Sixteen patients with Mohs defects in the medial canthus were reconstructed using the canthal rotation flap. Defect diameters ranged from 0.8 to 2.7 cm. Patient ages ranged from 17 to 88 years. The mean flap dimensions were 4.8 cm by 2.15 cm. No major complications were noted. The VAS scar rating at 2 to 5 months follow-up was available for 10 of 16 patients; the mean VAS was 2.1.

CONCLUSION
The canthal rotation flap is a reliable, single stage repair for small defects of the medial canthus that is optimized for the unique geometry of the medial canthus. This repair technique adds to the paucity of reconstructive options for the medial canthus.
Simulation-based teaching and models for caesarean sections: a systematic review to evaluate the tools for the ‘See One, Practice Many, Do One’ slogan
Authors: Sultana Nabiha , Betran Ana Pilar , Khan Khalid S. , Sobhy Soha 
Published: August 2020

Purpose of review
Caesarean sections are the most commonly performed procedure globally. Simulation-based training for caesarean sections can provide healthcare practitioners a safe and controlled environment to develop this life-saving skill. We systematically reviewed the use of simulation-based training for caesarean section and its effectiveness. Embase, Pubmed, Scopus and Web of Science were searched from inception to June 2019, without language restriction, for studies that included methods of simulation for caesarean section. Studies were selected and data extracted in duplicate. Synthesis analysed common themes on simulation-based training strategies.

Recent findings
There were 19 relevant studies including the following simulation-based methods: simulators (high and low fidelity), scenario-based drills training, e-learning and combinations. A common theme was simulation for rare events such as perimortem caesarean, impacted foetal head and uterine rupture. Combination studies appeared to provide a more comprehensive training experience. Studies rarely adequately assessed the educational or clinical effectiveness of the simulation methods.

Summary
There are different types of simulator models and manikins available for caesarean section training. Simulation-based training may improve technical skills and nontechnical skills, in a risk-free environment. More research is needed into simulation training effectiveness and its efficient incorporation into practice for improving outcomes.
Recommendations for Pregnancy in Rare Inherited Anemias
Authors: Taher Ali T. , Iolascon Achille , Matar Charbel F. , Bou‐Fakhredin Rayan , de Franceschi Lucia , Cappellini Maria Domenica , Barcellini Wilma , Russo Roberta , Andolfo Immacolata , Tyan Paul , Gulbis Beatrice , Aydinok Yesim , Anagnou Nicholas P. , Bencaiova Gabriela Amstad , Tamary Hannah , Martinez Patricia Aguilar , Forni Gianluca , Vindigni Raffaele ,   EHA Scientific Working Group on “Red Cells, Iron”
Published: August 2020

AbstractRare inherited anemias are a subset of anemias caused by a genetic defect along one of the several stages of erythropoiesis or in different cellular components that affect red blood cell integrity, and thus its lifespan. Due to their low prevalence, several complications on growth and development, and multi‐organ system damage are not yet well defined. Moreover, during the last decade there has been a lack of proper understanding of the impact of rare anemias on maternal and fetal outcomes. In addition, there are no clear‐cut guidelines outlining the pathophysiological trends and management options unique to this special population. Here, we present on behalf of the European Hematology Association, evidence‐ and consensus‐based guidelines, established by an international group of experts in different fields, including hematologists, gynecologists, general practitioners, medical geneticists, and experts in rare inherited anemias from various European countries for standardized and appropriate choice of therapeutic interventions for the management of pregnancy in rare inherited anemias, including Diamond‐Blackfan Anemia, Congenital Dyserythropoietic Anemias, Thalassemia, Sickle Cell Disease, Enzyme deficiency and Red cell membrane disorders.