bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elderly as a Predictor for Perioperative Complications in Patients Undergoing Multilevel Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Claus Chad F. , Lytle Evan , Tong Doris , Bahoura Matthew , Garmo Lucas , Yoon Elise , Jasinski Jacob , Kaufmann Ascher , Richards Boyd , Soo Teck M. 
Published: December 2019

Study Design.
This was a single-institute retrospective study.

Objective.
To describe perioperative and postoperative complications in elderly who underwent multilevel minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) while identifying predictors of complications.

Summary of Background Data.
The number of elderly patients undergoing spinal fusion is rising. Spinal surgery in the elderly is considered high risk with high rates of complications. Perioperative and postoperative complications in elderly undergoing multilevel MIS TLIF is, however, not known.

Methods.
A retrospective analysis was performed on 467 consecutive patients who underwent multilevel MIS TLIF at a single institution from 2013 to 2017. Two cohorts, 70 years or older and 50 to 69 years old were analyzed. Multiple logistic regressions with minor and major complication rates as the dependent variables were performed to identify predictors of complication based on previously cited risk factors. A p-value of 0.008 or less was considered significant.

Results.
One hundred fifty-two elderly and 315 nonelderly patients underwent multilevel MIS TLIFs. The average age was 76.4 and 60.4 years for the elderly and nonelderly cohorts. We observed 13 major (8.44%) and 72 minor (47.4%) complications in the elderly. No difference was noted in complication rates between the cohorts, except for urinary tract infection (P = .004) and urinary retention (P = .014). There were no myocardial infarctions; hardware complications; visceral, vascular, and neural injuries; or death. Length of stay, comorbidity, and length of surgery were predictive of major and minor complications.

Conclusion.
Elderly may undergo multilevel MIS TLIF with comparable complication rates. Age was not a predictor of complications. Rather, attention should focus on evaluation of comorbidity and limiting operative times.

Level of Evidence: 3
Begin Again and Continue With Life: A Qualitative Study on the Experiences of Cardiac Rehabilitation Patients
Authors: Jokar Fariba , Yousefi Hojatllah , Yousefy Alireza , Sadeghi Masoumeh 
Published: December 2019

ABSTRACT

Background:
Cardiovascular diseases are a main cause of mortality worldwide. However, new diagnostic techniques and treatments have increased the rate of survival for patients with cardiovascular disease. Cardiac rehabilitation programs aim to maintain and enhance the quality of life of patients and improve the secondary prevention of coronary artery disease. Suboptimal participation in rehabilitation programs, early exit from these programs, and not achieving lasting changes are cardiac rehabilitation challenges that are associated with health issues, including the increased need for medication, repeated hospitalization, failure in the secondary prevention programs, and long waiting lists. Exploring the meaning of behavioral changes in the context of cardiac rehabilitation may facilitate the design of effective interventions that are critical to achieving the goals of cardiac rehabilitation programs.

Purpose:
This study explored the mechanisms that underlie behavioral changes within cardiac rehabilitation centers.

Methods:
We used a descriptive qualitative approach, which is widely acknowledged as the best approach for eliciting in-depth descriptions of behavioral changes in the context of cardiac rehabilitation centers. Using purposive sampling, 15 men and 8 women with coronary heart disease were referred to the two cardiac rehabilitation centers participating in this study. The inclusion criteria were participation in four cardiac rehabilitation sessions and ability and willingness to participate. The data were collected using semistructured in-depth interviews, and the inductive thematic analysis method was used for analysis.

Results:

“Trying to stay alive” and “begin again” arose as the two main themes related to behavioral change. These themes include the changes in cognition and values that lead to improvements in the process of behavioral change as a major outcome of cardiac rehabilitation.

Conclusions:
Using psychosocial interventions such as creating and strengthening hope and meaningful intrinsic motivation in the context of rehabilitation centers often helps deal with these challenges. “Trying to stay alive” may take place before referral to a cardiac rehabilitation center. Therefore, psychosocial nursing interventions such as motivational interviewing are designed to improve a process that may be already underway. Thus, stress and anxiety may be treated based on beliefs and emotions. The primary emphasis in cardiac rehabilitation should include changing the beliefs of the patient and motivating her or him to achieve sustainable behavioral change.
Loop Electrosurgical Excision Procedure Treats Cervical Intraepithelial Neoplasia 2/3 Among HIV− and HIV+ Women in Kenya
Authors: Mehta Naaman , Orang'o Omenge , Itsura Peter , Tonui Philip , Bussmann Hermann , Bogers JP , Liu Tao , Cu-Uvin Susan 
Published: December 2019

Objective
The aim of the study was to compare loop electrosurgical excision procedure (LEEP) as treatment for cervical intraepithelial neoplasia (CIN) 2/3 in HIV− versus HIV+ women.

Materials and Methods
Seventy-five HIV− and 75 HIV+ women at 6 months or more after LEEP for CIN 2/3 were enrolled between September 2013 and November 2014 in this prospective cohort study at the cervical cancer screening clinic in Eldoret, Kenya. Visual inspection with acetic acid (VIA), followed by cervical cytology with conventional cytology, was performed on all women. Women with positive VIA or abnormal cervical cytology underwent colposcopy/biopsy. Lesion progression, persistence, and regression were assessed to quantify the efficacy of LEEP.

Results
Post–loop electrosurgical excision procedure screening test showed both a negative VIA and normal cervical cytology in 64 (85%) of HIV− and 57 (77%) HIV+ women (risk difference = 8.3%, CI = −4.2% to 21%, p = .20). Eleven (15%) HIV− and 17 (23%) HIV+ (p = .20) women had positive VIA, abnormal cervical cytology, or both and were referred for colposcopy/biopsy. Twenty-one (8 HIV−, 13 HIV+) women were biopsied. Of the 8 HIV− women, 4 (50%) had CIN lesions that regressed, 3 (38.0%) persisted, and 1 (12%) progressed to invasive cancer after LEEP. Of the 13 HIV+ women, 6 (46%) had CIN lesions that regressed, 7 (54%) had CIN lesions that persisted, and no HIV+ women had CIN lesions that progressed after LEEP. There was no difference in estimated efficacies of LEEP for HIV− and HIV+ women (92.7% versus 89.4%, risk difference = 3.3%, CI = −4.8% to 15.3%, p = .85).

Conclusions
Loop electrosurgical excision procedure for CIN 2/3 is effective treatment for HIV− and HIV+ women in low-resource settings. Future efforts should improve follow-up after treatment.
Time-Dependent Squamous Cell Carcinoma Antigen in Prediction of Relapse and Death of Patients With Cervical Cancer
Authors: Chang Chung , Chen Jiabin , Huang Chi-Hsiang , Lee Wen-Ying , Hsu Li-Chuan , Chiang An Jen 
Published: December 2019

Objective
The aim of the study was to develop a methodology to identify the best use of a longitudinally measured biomarker in relevance to prognosis.

Materials and Methods
Data of squamous cell carcinoma antigen (SCC-Ag) from 770 patients with cervical squamous cell carcinoma (SCC) were used. The pretreatment, nadir, and time-dependent SCC-Ag values were analyzed in relevance to disease relapse and death with univariate and multivariate analysis side by side with a variety of available clinicopathologic factors. The predictive power of the significant variates was evaluated by C-index with 5-fold cross validation.

Results
The pretreatment, nadir, and time-dependent SCC-Ag were all significant risk factors for both relapse and death in the univariate analysis (p < .05), and the time-dependent SCC-Ag had the highest C-index in both events. The nadir and time-dependent SCC-Ag were both independently significant in response to relapse with International Federation of Gynecology and Obstetrics (FIGO) stage as the covariate, and the latter had a higher C-index (0.745). Only the time-dependent SCC-Ag was independently significant together with FIGO stage in response to death with the C-index at 0.844.

Conclusions
Increases in the serum level of SCC-Ag in cervical SCC patients suggest a higher risk of both relapse and death. The best use of serial SCC-Ag measurements is to include the time-dependent value in prognostic assessment with FIGO stage also accounted for. Cervical SCC patients should be followed up on their levels of SCC-Ag, and prognostic evaluation should be updated with recent measurements.
Diagnosing Anal Squamous Intraepithelial Lesions With and Without p16: An Interobserver Variability Study
Authors: Krishnamurti Uma , Mohammad Mohammad , Monsrud Ashley , Mosunjac Mario , Oprea Gabriela , Hanley Krisztina , Tadros Talaat , Flowers Lisa , Mosunjac Marina 
Published: December 2019

Objective
Morphologic diagnosis and grading of anal squamous intraepithelial lesions (ASILs) are challenging. In this study, we investigated interobserver variability and p16 utility in accurately grading anal SIL.

Materials and Methods
Six pathologists evaluated the degree of SIL on hematoxylin and eosin slides from 146 anal biopsies, followed by the review of both p16 and hematoxylin and eosin slides in cases where p16 was previously performed. κ was calculated in the following 4 ways: (A) 4-tiered diagnosis (negative for SIL [NSIL], anal intraepithelial neoplasia [AIN 1, AIN 2, AIN 3]); (B) 3-tiered diagnosis (NSIL and AIN 1 [pooled], AIN 2, AIN 3); (A) 3-tiered diagnosis (NSIL, low-grade SIL, high-grade SIL [HSIL]); and (D) 2-tiered diagnosis (no HSIL, HSIL).

Results
There is only moderate agreement with a 4-tiered diagnosis with or without p16 (κ = 0.48–0.57). There is substantial agreement when AIN 2 and AIN 3 are pooled as HSIL in cases with or without p16 review (κ = 0.71–0.78). There is almost perfect agreement with a 2-tiered diagnosis of negative for HSIL and HSIL both in cases where p16 was used and where p16 was not required, with the best agreement for a 2-tiered diagnosis with concurrent p16 review.

Conclusions
This study highlights the importance of a judicious use of p16 for diagnosis. When there is no need for p16 by the Lower Anogenital Squamous Terminology guidelines, interobserver agreement was substantial to almost perfect with a 2-tiered diagnosis. However, when its use is indicated but it is not performed or reviewed, the agreement is much lower even with a 2-tiered diagnosis. Rational use of p16 will ensure diagnostic accuracy and the best possible patient care.
Association of Body Mass Index With Adherence to Cervical Cancer Screening Recommendations in Hispanic Women
Authors: Pérez Cynthia M. , González-Barrios Daisy , Ramos-Cartagena Jeslie M. , Ortiz Ana P. 
Published: December 2019

Objective
Obese women have higher cervical cancer incidence and mortality than their counterparts, possibly related to nonadherence to screening recommendations. We assessed the association of body mass index with adherence to cervical cancer screening recommendations in Hispanic women living in Puerto Rico, a minority population with the highest incidence of cervical cancer in the United States.

Materials and Methods
We included 536 Hispanic women aged 21 to 64 years enrolled in a population-based study of human papillomavirus (HPV) infection. Demographic and clinical characteristics and risky behaviors were collected using structured interviews. Weight and height were measured to classify body mass index as underweight, normal, overweight, and obesity (class I, class II, class III). Adherence to cervical cancer screening recommendations was self-reported. Logistic regression models were fit to estimate the odds ratio with 95% CI after adjusting for covariates.

Results
Nearly one third (29.7%) of women were overweight and 43.5% were obese (class I: 22.6%, class II: 11.0%, class III: 9.9%). Overall adherence to cervical cancer screening within the past 3 years was 78.5%, being lowest among women with class III obesity (60.4%). After multivariable adjustment, only women with class III obesity had significantly higher odds (odds ratio = 2.5, 95% CI: 1.2–5.1) of reporting nonadherence to cervical cancer screening compared with normal weight women.

Conclusions
Adherence to cervical cancer screening in this population was below the Healthy People 2020 target of 93%, especially for women with morbid obesity. These findings highlight the importance of adequate interventions to decrease cervical cancer screening disparities in these women.
Specimen Fragmentation and Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy Outcomes
Authors: Grubman Jessica , Meinhardt Summer S. , Nambiar Anjali , Lea Jayanthi S. 
Published: December 2019

Objective
Surgical technique for loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC) emphasizes a uniform specimen, but sequelae of specimen fragmentation are not established. We evaluated outcomes between fragmented and unfragmented excisional biopsy specimens.

Materials and Methods
Loop electrosurgical excision procedure and CKCs from January 2010 to October 2013 were reviewed. Intraepithelial lesion grade, fragmentation, margin, and Endocervical curettage status were analyzed. Adenocarcinoma in situ and cancer were excluded. Repeat procedures during the study period were included in follow-up. Loop electrosurgical excision procedures with top hat with no separate fragments were analyzed independently versus those with fragmented LEEP and/or top hat. Indeterminate margin was defined as inconclusive or unevaluable margin, or intraepithelial lesion in unidentifiable margin or fragment. Outcomes involved residual or recurrent disease and repeat procedures for intraepithelial lesion. χ2 was used for statistical analysis.

Results
Fragmented specimens were more likely to have any positive margin (p = .01), multiple positive margins (p < .001), and indeterminate margin (p < .001) than unfragmented specimens. There was no significant difference in rates of positive, insufficient, or high-grade Endocervical curettage (p = .74, 0.54, 0.92). Patients with fragmented specimens were more likely to have high-grade lesion recurrence in the following 3 years (p = .04) versus patients with index unfragmented specimens, though not compared with those with unfragmented LEEP + top-hat cases. Overall rates of repeat LEEP/CKC or hysterectomy for dysplasia were not different (p = .56).

Conclusions
Fragmentation of LEEP and CKC specimens is associated with higher rates of positive margins, recurrent high-grade intraepithelial lesions, and indeterminate margins. These may cause diagnostic uncertainty, require closer follow-up, and increase cost with more visits and studies.
Genetic Epidemiology of Hearing Loss in the 22 Arab Countries: A Systematic Review
Authors: Sidenna Mariem , Fadl Tasnim , Zayed Hatem 
Published: December 2019

Background:
Hearing loss (HL) is a heterogeneous condition that causes partial or complete hearing impairment. Hundreds of variants in more than 60 genes have been reported to be associated with Hereditary HL (HHL). The HHL prevalence is thought to be high in the Arab population; however, the genetic epidemiology of HHL among Arab populations is understudied. This study aimed to systematically analyze the genetic epidemiology of HHL in Arab countries.

Methods:
We searched four literature databases (PubMed, Scopus, Science Direct, and Web of Science) from the time of inception until January 2019 using broad search terms to capture all the reported epidemiological and genetic data related to Arab patients with HHL.

Findings:
A total of 2,600 citations were obtained; 96 studies met our inclusion criteria. Our search strategy yielded 121,276 individuals who were tested for HL over 52 years (1966–2018), of whom 8,099 were clinically diagnosed with HL and belonged to 16 Arab countries. A total of 5,394 patients and 61 families with HHL were genotyped, of whom 336 patients and 6 families carried 104 variants in 44 genes and were from 17/22 Arab countries. Of these variants, 72 (in 41 genes) were distinctive to Arab patients. Arab patients manifested distinctive clinical phenotypes. The incidence of HHL in the captured studies ranged from 1.20 to 18 per 1,000 births per year, and the prevalence was the highest in Iraq (76.3%) and the lowest in Jordan (1.5%).

Interpretation:
This is the first systematic review to capture the prevalence and spectrum of variants associated with HHL in an Arab population. There appears to be a distinctive clinical picture for Arab patients with HHL, and the range and distribution of variants among Arab patients differ from those noted in other affected ethnic groups.
Single High‐dose Vitamin D3 Supplementation in Pediatric Patients With Inflammatory Bowel Disease and Hypovitaminosis D
Authors: Lee Rose , Maltz Ross M. , Crandall Wallace V. , Plogsted Steven W. , Shaikhkhalil Ala K. , Bowden Sasigarn A. , Mezoff Ethan A. 
Published: December 2019

ABSTRACTObjectives:The primary aim was to determine the effectiveness of a single high‐dose of oral vitamin D3 (stoss therapy) in children with inflammatory bowel disease (IBD) and hypovitaminosis D. Our secondary aim was to examine the safety of stoss therapy.Methods:We conducted a randomized, prospective study of 44 patients, ages 6 to 21 years, with IBD and 25‐hydroxyvitamin D (25‐OHD) concentrations <30 ng/mL. Patients were randomized to receive 50,000 IU of vitamin D3 once weekly for 6 weeks (standard of care, SOC group) or 300,000 IU once (stoss group). Serum 25‐OHD levels were obtained at baseline, 4 and 12 weeks. Safety monitoring labs were performed at week 4.Results:Thirty‐nine of 44 enrolled patients (19 stoss, 20 SOC) completed the study. Baseline vitamin D levels were not significantly different between the groups. Stoss therapy resulted in a substantial rise in 25‐OHD levels at week 4, equivalent to the weekly regimen (53.6 ± 17.3 vs 54.6 ± 17.5 ng/mL). At week 12, serum 25‐OHD levels decreased in both groups, significantly lower in the stoss group, but remained close to 30 ng/mL (29.8 ± 7.1 vs 40.4 ± 11.9 ng/mL, P = 0.04). A significant interaction with treatment group over time was observed (P = 0.0003). At the week‐4 time point, all patients who received stoss therapy had normal serum calcium and PTH levels. Eighty percentage of patients preferred stoss therapy to the weekly regimen.Conclusions:Stoss therapy was safe and effective in raising 25‐OHD in children with IBD commensurate to that of the weekly regimen.
Knowledge deficits and barriers to performing soft-tissue coverage procedures: An analysis of participants in an orthopaedic surgical skills training course in Mexico
Authors: Albright Patrick D. , Mackechnie Madeline C. , Jackson J. Hunter , Chopra Aman , Holler Jordan T. , Flores Biard Antonio , Padilla Rojas Luis G. , Morshed Saam , Miclau Theodore , Shearer David W. , Terry Michael J. 
Published: December 2019

Abstract

Background:
An increasing number of traumatic injuries in low- and low-middle-income countries (LICs/LMICs) have coexisting injuries requiring soft-tissue coverage (flaps). Yet, there is a lack of subspecialty care and flap training in Latin America. This study assesses the effectiveness of a surgical skills training course in improving rotational and free flap knowledge and identifies barriers to performing these types of flaps.

Methods:
Participants attending a surgical skills training course in Guadalajara, Mexico completed a pre/postcourse flaps knowledge survey consisting of 15 questions from the plastic surgery in-training examination and also completed a 7-point Likert survey regarding perceived barriers to performing flaps at their institution.

Results:
Of the course participants, 17 (44.7%) completed the precourse knowledge survey, 24 (63.2%) completed the postcourse survey, and 37 (97.4%) completed the barriers survey. Scores improved from pre- to postcourse knowledge surveys (39.6% to 53.6%, P = .005). Plastic surgery subsection scores also improved (39.0% to 60.4%, P = .003). Twenty-five percent of attendees received prior flap training and had plastic surgeons available to perform flaps. Few participants (38.9%) reported flap procedures being commonly completed at their hospitals. Participants stating that flaps were uncommon in their hospital reported more institutional barriers and less access to dermatomes. These participants also reported lack of operating room and surgical personnel availability.

Conclusion:
A surgical skills training course may be useful in improving knowledge of soft-tissue coverage procedures. There are also modifiable physician and institutional barriers that can improve the ability to perform rotational and free flaps as identified by the course participants.
For Human Papillomavirus Self-Sampling, Stated Willingness Does Not Correspond With Subsequent Uptake by Rural Malawian Women
Authors: Hood Robert B. , Turner Abigail Norris , Huber-Krum Sarah , Lancaster Kathryn E. , Mwapasa Victor , Poindexter Tiara , Nampandeni Patrick , Esber Allahna , Norris Alison H. 
Published: December 2019

Background
Human papilloma virus (HPV), the causative agent for cervical cancer, can be tested for using self-collected vaginal samples. Self-collection is promising for HPV screening in hard-to-reach populations. To assess the relationship between willingness to self-collect and subsequent uptake of self-collection, we conducted a longitudinal study of reproductive-age women in rural Malawi.

Methods
At baseline, we asked women if they would be willing to self-collect a vaginal sample for HPV testing. At follow-up (12–18 months later), we offered the same women the opportunity to self-collect a sample for HPV testing. We examined unadjusted and adjusted associations between baseline willingness to self-collect a sample for HPV testing and uptake of self-collection at follow-up using log-binomial models.

Results
Among 122 women who, at baseline, indicated willingness to self-collect, n = 65 (53%) agreed to self-collect a sample at follow-up. Of 64 women who stated unwillingness at baseline to self-collect, n = 30 (47%) self-collected a sample for testing at follow-up. We observed no association between women's willingness at baseline and their observed self-collection decision at follow-up (unadjusted prevalence ratio, 1.14; 95% confidence interval, 0.83–1.55). The association remained null after adjustment for age, awareness of cervical cancer, and perceived behavioral control.

Conclusions
Our results suggest that evaluation of acceptability of self-collection should go beyond simply asking women if they would be willing to self-collect a vaginal sample. Given that half of this study's participants agreed to self-collect a sample when the opportunity was offered, regardless of their previously stated preferences, self-collection should be offered to everyone.