bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of T1-S1 Spine Height of Postoperative Rib-based Implant Patients With Age-matched Peers
Authors: Johnson Mitchell A. , Cahill Patrick J. , Qiu Catherine , Lott Carina , Mayer Oscar H. , Flynn John M. , Anari Jason B. 
Published: January 2020

Background:
Severe early-onset scoliosis leads to deficient spine height, thoracic growth inhibition, and ultimately pulmonary compromise. Rib-based growing instrumentation seeks to correct thoracic deformities, in part by correcting the spinal deformity, adding height, increasing thoracic volume, and allowing for continual spinal growth until maturity. However, the amount of growth in these patients relative to their peers is unknown.

Methods:
Sixty patients who had undergone surgical intervention for the treatment of early-onset scoliosis were assessed via radiographic measurements of coronal T1-S1 height and major curve angle before implantation and again at most recent follow-up (minimum 2 years). T1-S1 measurements were then compared with age-matched peers to assess growth differences. Clinical information was examined for relevant parameters.

Results:
The average age of our cohort at initial surgery and most recent follow-up was 4.4±3.8 and 10.0±4.4 years old, respectively. In this patient set, there was an average increase in T1-S1 height of 13.1±11.1 mm per year, with the majority of growth occurring in the first 2 years following implantation, and improvement in a major curve from 68±8 to 53±7 degrees. Overall, 77% of patients saw improvement in the major curve at most recent follow-up. Furthermore, a statistically significant greater percent of expected growth was seen in congenital compared with neuromuscular scoliosis (P<0.001). In addition, a weak negative correlation was observed between a number of surgical lengthenings and T1-S1 growth.

Conclusions:
Rib-based implant intervention has been shown to improve the major curve, but only improves growth potential to around 80% of expected growth. Scoliosis diagnosis type also influences growth rate potential, with congenital scoliosis patients being surgically treated earlier in life and having a growth rate approaching that of a healthy individual.

Level of Evidence:
Level III—Case control.
Restrictive Transfusion Practice in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation: A Single-Center Experience
Authors: Doyle Andrew J. , Richardson Carla , Sanderson Barnaby , Wong Katie , Wyncoll Duncan , Camporota Luigi , Barrett Nicholas A. , Hunt Beverley J. , Retter Andrew 
Published: January 2020

Objectives:
Restrictive transfusion policies have been adopted in critical care, although these have not included patients receiving extracorporeal membrane oxygenation. We aimed to assess survival outcomes, adverse events related to RBC transfusion, and cost implications following a change from a “liberal” to a “restrictive” RBC transfusion practice in patients receiving extracorporeal membrane oxygenation.

Design:
Retrospective observational study.

Setting:
Single high-volume tertiary critical care department at a university hospital.

Patients:
Patients 16 years old or greater receiving venovenous extracorporeal membrane oxygenation between 2011 and 2017 for more than 24 hours.

Interventions:
None.

Measurements and Main Results:
Clinical diagnoses, complications, outcomes, median hemoglobin, and hematocrit levels were obtained from patients’ electronic records. All laboratory results for hemoglobin and hematocrit were included. RBC transfusions were obtained from prescription charts. We included 402 patients: 99 during a “liberal” transfusion practice (2011–2014)—when the target hemoglobin level was greater than 100 g/L; and 303 treated during a “restrictive” transfusion practice (2014–2017) when the target hemoglobin level was greater than 80 g/L. We found that survival outcomes did not change following the implementation of a “restrictive” transfusion policy. There was also a decrease in the extracorporeal blood flow rates with restrictive transfusion of 0.5 L/min. Nonsurvivors of venovenous extracorporeal membrane oxygenation had higher usage of RBC units following a change in transfusion practice. The restrictive strategy allowed a cost saving of £454 per patient.

Conclusions:
These results suggest that the adoption of a more restrictive approach to RBC transfusion during venovenous extracorporeal membrane oxygenation is more cost-effective and associated with similar survival outcomes, than when compared with a more liberal approach.
Special prognostic phenomenon for patients with mid-range ejection fraction heart failure: a systematic review and meta-analysis
Authors: Guo Pan , Dai Jian-Feng , Feng Chao , Chen Shu-Tao , Feng Jin-Ping 
Published: January 2020

Abstract

Background:
Clinical features and outcomes of heart failure (HF) with mid-range ejection fraction (HFmrEF) remain controversial. Thus, we systematically reviewed literatures of clinical research to assess and analyze characteristics and prognosis of patients with HFmrEF.

Methods:
PubMed, Embase, and Web of Science were searched for cohort studies up to April 23, 2019. Clinical features and multivariate adjusted hazard ratios (HRs) of endpoints of short-term all-cause mortality (SAM), long-term all-cause mortality (LAM), long-term cardiovascular death (LCD) and long-term HF rehospitalization (LHR) among patients with HFmrEF and HF with preserved ejection fraction (HFpEF), HF with reduced ejection fraction (HFrEF) were well addressed. The primary outcome was LAM.

Results:
Totally 19 studies were included in this study with 164,678 patients enrolled. The follow-up time of LAM was 3.6 ± 2.5 years. HRs of LAM, SAM, LCD, LHR indicated that the risks of patients with HFmrEF were higher than HFpEF patients but lower than HFrEF patients, as for LAM, HFmrEF:HFpEF (reference) HR: 1.07, 95% confidence interval (CI): 1.00–1.15 (I

2
= 63%, P = 0.0005); HFmrEF:HFrEF (reference) HR: 0.80, 95% CI: 0.73–0.88 (I

2
= 70%, P < 0.0001). However, HFmrEF patients had the lowest rate in LAM (30.94%), SAM (2.73%), LCD (17.45%), LHR (26.36%) compared with the other two groups.

Conclusions:
This systematic review and meta-analysis compared features and prognosis between patients with HFmrEF and HFpEF, HFrEF by HRs. There appeared a special “separation phenomenon” showing rates of endpoints were inconsistent with their hazards in patients with HFmrEF compared with HFpEF patients.
Results of the NRG Oncology/RTOG 0848 Adjuvant Chemotherapy Question—Erlotinib+Gemcitabine for Resected Cancer of the Pancreatic Head
Authors: Abrams Ross A. , Winter Kathryn A. , Safran Howard , Goodman Karyn A. , Regine William F. , Berger Adam C. , Gillin Michael T. , Philip Philip A. , Lowy Andrew M. , Wu Abraham , DiPetrillo Thomas A. , Corn Benjamin W. , Seaward Samantha A. , Haddock Michael G. , Song Suisui , Jiang Yixing , Fisher Barbara J. , Katz Alan W. , Mehta Sharmila , Willett Christopher G. , Crane Christopher H. 
Published: January 2020

Purpose:NRG/RTOG 0848 was designed to determine whether adjuvant radiation with fluoropyrimidine sensitization improved survival following gemcitabine-based adjuvant chemotherapy for patients with resected pancreatic head adenocarcinoma. In step 1 of this protocol, patients were randomized to adjuvant gemcitabine versus the combination of gemcitabine and erlotinib. This manuscript reports the final analysis of these step 1 data.Methods:Eligibility—within 10 weeks of curative intent pancreaticoduodenectomy with postoperative CA19-9<180. Gemcitabine arm—6 cycles of gemcitabine. Gemcitabine+erlotinib arm—gemcitabine and erlotinib 100 mg/d. Two hundred deaths provided 90% power (1-sided α=0.15) to detect the hypothesized OS signal (hazard ratio=0.72) in favor of the arm 2.Results:From November 17, 2009 to February 28, 2014, 163 patients were randomized and evaluable for arm 1 and 159 for arm 2. Median age was 63 (39 to 86) years. CA19-9 ≤90 in 93%. Arm 1: 32 patients (20%) grade 4 and 2 (1%) grade 5 adverse events; arm 2, 27 (17%) grade 4 and 3 (2%) grade 5. GI adverse events, arm 1: 22% grade ≥3 and arm 2: 28%, (P=0.22). The median follow-up (surviving patients) was 42.5 months (min-max: <1 to 75). With 203 deaths, the median and 3-year OS (95% confidence interval) are 29.9 months (21.7, 33.4) and 39% (30, 45) for arm 1 and 28.1 months (20.7, 30.9) and 39% (31, 47) for arm 2 (log-rankP=0.62). Hazard ratio (95% confidence interval) comparing OS of arm 2 to arm 1 is 1.04 (0.79, 1.38).Conclusions:The addition of adjuvant erlotinib to gemcitabine did not provide a signal for increased OS in this trial.
Restarting Oral Anticoagulation in Patients With Atrial Fibrillation After an Intracranial Hemorrhage
Authors: Nguyen Nhi Y. , Frishman William H. 
Published: January 2020

Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In western countries with aging populations, atrial fibrillation poses a significant health concern, as it is associated with a high risk of thromboembolism, stroke, congestive heart failure, and myocardial infarction. Thrombi are generated in the left atrial appendage, and subsequent embolism into the cerebral circulation is a major cause of ischemic stroke. Therefore, patients have a lifetime risk of stroke, and those at high risk, defined as a CHA2DS2-VASc2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, age 65-74 yrs, sex category) ≥2, are usually placed on oral anticoagulants. Unfortunately, long-term anticoagulation poses bleeding risks, of which intracranial hemorrhage (ICH) is the most feared and deadly complication.
In patients who survive an ICH, the question of oral anticoagulation resumption arises. It is a therapeutic dilemma in which clinicians must decide how to manage the risk of thromboembolism versus recurrent hemorrhage. Although there is a substantial amount of retrospective data on the topic of resumption of anticoagulation, there are, at this time, no randomized controlled trials addressing the issue. We therefore sought to address ICH risk and management, summarize high quality existing evidence on restarting oral anticoagulation, and suggest an approach to clinical decision-making.
Recommendations for the Use of Antibiotics in Primary and Secondary Esthetic Breast Surgery
Authors: Prantl Lukas , Momeni Arash , Brebant Vanessa , Kuehlmann Britta , Heine Norbert , Biermann Niklas , Brix Eva 
Published: January 2020

Summary:
The use of systemic prophylactic antibiotics to reduce surgical-site infection in esthetic breast surgery remains controversial, although the majority of surgeons prefer to utilize antibiotics to prevent infection. Nonetheless, postoperative acute and subclinical infection and capsular fibrosis are among the most common complications following implant-based breast reconstruction. After esthetic breast augmentation, up to 2.9% of women develop infection, with an incidence rate of 1.7% for acute infections and 0.8% for late infections. After postmastectomy reconstruction (secondary reconstruction), the rates are even higher. The microorganisms seen in acute infections are Gram-positive, whereas subclinical late infections involving microorganisms are typically Gram-negative and from normal skin flora with low virulence. In primary implantation, a weight-based dosing of cefazolin is adequate, an extra duration of antibiotic cover does not provide further reduction in superficial or periprosthetic infections. Clindamycin and vancomycin are recommended alternative for patients with β-lactam allergies. The spectrum of microorganism found in late infections varies (Gram-positive and Gram-negative), and the antibiotic prophylaxis (fluoroquinolones) should be extended by vancomycin and according to the antibiogram when replacing implants and in secondary breast reconstruction, to target microorganisms associated with capsular contracture. All preoperative antibiotics should be administered <60 minutes before incision to guarantee high serum levels during surgical procedure.
The Use of Hypochlorous Acid Lavage to Treat Infected Cavity Wounds
Authors: Wongkietkachorn Apinut , Surakunprapha Palakorn , Wittayapairoch Jakrapan , Wongkietkachorn Nuttapone , Wongkietkachorn Supawich 
Published: January 2020

Summary:
Managing cavity wounds that cannot be cleaned using standard irrigating solution is challenging. An immunocompromised patient with a horseshoe perianal abscess was selected to represent a heavy infection in cavity wounds. Diluted povidone-iodine was initially used to lavage the wounds, but the fever persisted and the irrigation was painful. Hypochlorous acid was then used to irrigate the wound. One day after administration of the hypochlorous acid, the fever began to subside, suggesting that this solution was able to adequately destroy the infecting microorganisms. The patient rated his pain during this procedure as 2/10. The infection had cleared within 2 weeks, and a swab culture found no microbial growth. The wound volume was reduced by more than 90% after 5 weeks, and final wound closure was achieved after 6 weeks. By comparison, another patient with a horseshoe perianal abscess who underwent traditional irrigation with diluted povidone-iodine and wet-to-dry dressing faced similar problems, but the fever in this case did not subside, and the wound became more complicated. He complained of pain during the irrigation with diluted povidone-iodine, giving the procedure a pain score of 10/10. Wound care was also difficult due to fecal contamination. As a result, the patient had to undergo colostomy to divert feces to the abdomen, thus preventing it from contaminating the wound. Time to final wound closure was 10 weeks. These cases illustrate the effectiveness of hypochlorous acid in dealing with infection in wound cavities.
The Use of Autologous Serum to Reverse Severe Contact Lens-induced Limbal Stem Cell Deficiency
Authors: Yeh Shu-I , Chu Ting-Wen , Cheng Huey-Chuan , Wu Chien-Hsiu , Tsao Yeou-Ping 
Published: January 2020

Purpose:
To describe the efficacy of autologous serum (AS) eye drops to reverse severe contact lens (CL)-induced limbal stem cell (LSC) deficiency (LSCD).

Methods:
This is a prospective, uncontrolled, interventional case series that enrolled 20 eyes of 14 consecutive patients diagnosed with severe CL-induced LSCD at presentation, based on clinical examination, at a tertiary referral center for the period December 2016 to December 2018. All eyes underwent AS treatment for at least 2 weeks with a follow-up for at least 2 months. Demographic data and treatment outcomes were collected and analyzed.

Results:
The mean patient age at presentation was 30.5 years (range, 19–49 years). The mean duration of soft contact lens wear was 15.6 years (SD, 7.58 years; range, 5–31 years). All study eyes had pain and blurred vision at presentation. All eyes had recurrent or persistent corneal epithelial defect, stromal scarring and opacity, and superficial vascularization and peripheral pannus at presentation. Aggressive treatment with AS succeeded in all eyes. Signs and symptoms of LSCD stabilized in all eyes within 2 weeks and resolved in 6 eyes (30.0%) in 2 weeks, 9 eyes (45.0%) in 4 weeks, and 5 eyes (25.0%) in 8 weeks. The mean follow-up time was 9.45 ± 1.79 weeks (range, 8–24 weeks).

Conclusions:
Early identification and aggressive treatment of the ocular surface disease with AS can medically reverse severe CL-induced LSCD and prevent the need for surgical intervention.
Longitudinal Analysis of Infrared Meibography in Patients Undergoing Hematopoietic Stem Cell Transplantation
Authors: Bernabei Federico , Versura Piera , Pellegrini Marco , Moscardelli Fabiana , Bonifazi Francesca , Sessa Mariarosaria , Arpinati Mario , Scorcia Vincenzo , Giannaccare Giuseppe 
Published: January 2020

Purpose:
To evaluate meibomian gland (MG) changes in patients undergoing hematopoietic stem cell transplantation (HSCT) by infrared meibography and to further investigate possible correlations with hematological characteristics.

Methods:
Thirty-three patients were included: infrared meibography of the lower eyelid, Schirmer test, tear break-up time, ocular surface staining, and Ocular Surface Disease Index questionnaire were conducted before (V0) and 4 months after HSCT (V1). A paired samples t test was used to compare parameters before and after HSCT. A mixed analysis of variance was used to assess the effect of hematological characteristics on changes of MG loss (MGL) after HSCT.

Results:
MGL and corneal staining significantly increased after HSCT (respectively, from 24.3% ± 10.1% to 32.2 ± 15.0 and from 1.2 ± 1.5 to 2.0 ± 1.7; always P < 0.011), whereas tear break-up time significantly decreased (from 6.6 ± 4.2 seconds to 3.2 ± 2.2; P < 0.001). At V1, 19 patients (57.6%) belonged to ocular graft-versus-host disease severity grade 0, 8 (24.2%) to grade I, and 6 (18.2%) to grade II. The percentage of MGL at V0 and the increase of MGL from V0 to V1 did not differ between patients who developed ocular graft-versus-host disease and those who did not (always P > 0.05). At V1, MGs' quality reduced in 16 patients (48.5%), remained unchanged in 14 (42.4%), and improved in 3 (9.1%). The increase of MGL after HSCT was higher in patients receiving myeloablative conditioning regimen (P = 0.005).

Conclusions:
MG function, loss, and quality significantly worsened after HSCT. Myeloablative conditioning regimen was associated with higher MGL.
Neural substrates for poststroke complex regional pain syndrome type I: a retrospective case–control study using voxel-based lesion symptom mapping analysis
Authors: Kim Jun Yup , Yoon Seo Yeon , Kim Jinna , Jeong Yong Hyu , Kim Yong Wook 
Published: January 2020

Abstract
Poststroke complex regional pain syndrome (CRPS) is characterized by swelling, pain, and changes in the skin that appear on the affected wrist and hand. In this retrospective study, we analyzed the relationship between poststroke CRPS and the location of stroke lesion. From all patients admitted to our hospital from 2009 to 2019, we recruited 80 patients affected by their first unilateral stroke who met the inclusion/exclusion criteria. Thirty-eight patients diagnosed with CRPS after stroke were assigned to the experimental group according to the “Budapest criteria” adopted by the International Association for the Study of Pain, and 42 patients without CRPS were included as controls. Regions of interest were manually drawn on T1-weighted magnetic resonance images, and data were normalized to a standard brain template. In the poststroke CRPS group, the relationship between the location of brain lesion and pain severity was analyzed using Freedman–Lane multivariable regression adjusting for Medication Quantification Scale rating, which was the only parameter to show a statistically significant correlation with pain intensity. A threshold of P < 0.01 was considered statistically significant for all voxel-based lesion symptom mapping tests, corrected for multiple comparisons with 5000 permutations. Analyses using voxel-wise subtraction and Liebermeister statistics indicated that the corticospinal tract (CST) was associated with the development of poststroke CRPS. Statistically significant correlations were found between pain intensity and the CST and the adjacent lentiform nucleus. Our results suggest that the CST may be a relevant neural structure for development of poststroke CRPS and the intensity of pain caused by the syndrome.
Insight Into Differences in Dietary Sodium Adherence Between Men and Women With Heart Failure
Authors: Lennie Terry A. , Moser Debra K. , Chung Misook L. 
Published: January 2020

Background
Men with heart failure are reported to be less adherent to low-sodium diets than women are. One potential reason may be that men consume more food and, consequently, more sodium than women do.

Objectives
The aims of this study were to compare dietary sodium intake, urine sodium excretion, and sodium density of diet consumed between men and women with heart failure and to determine whether sex moderated the relationship of kilocalories (kcals) consumed with dietary and urine sodium.

Methods
A total of 223 patients with heart failure (mean age, 62 ± 12 years; 70% men, 46% New York Heart Association class III–IV) completed detailed 4-day food diaries and provided 24-hour urine sodium samples. To account for sodium density of food, dietary sodium and urine sodium were referenced to sodium per 1000 kcal.

Results
On an absolute basis, men consumed 23% more kcals and 28% more sodium than women did; 24-hour sodium excretion was 16% higher in men than in women. There were no differences between men and women when dietary sodium and urinary sodium were referenced to 1000 kcal, indicating they consumed foods with similar sodium density. However, both moderation analyses showed that the dietary sodium intake of men and women with lower kcal intake was similar, whereas men with higher kcal intake consumed more sodium-dense foods than women did.

Conclusion
The results suggest that the men with higher sodium intake than women had 2 reasons for nonadherence. They consumed more food and foods with higher sodium density than women did.
The Diagnostic Accuracy and Sensitivity for Malignancy of Radial-Endobronchial Ultrasound and Electromagnetic Navigation Bronchoscopy for Sampling of Peripheral Pulmonary Lesions
Authors: McGuire Anna L. , Myers Renelle , Grant Kyle , Lam Stephen , Yee John 
Published: January 2020

Background:
Lung cancer screening with computed tomography chest is identifying peripheral pulmonary lesions (PPLs) suspicious for early-stage lung cancer at increasing rates. Radial-endobronchial ultrasound (R-EBUS) and electromagnetic navigation bronchoscopy (ENB) are 2 methods to sample PPLs to diagnose and treat early lung cancer. ENB has a higher operating financial cost, however, the rationale for its use is possible higher diagnostic accuracy versus R-EBUS.

Objective:
The objective of this study was to determine the comparative diagnostic accuracy, sensitivity, and negative predictive value for R-EBUS and ENB in sampling PPLs.

Methods:
A systematic review and meta-analysis were conducted. The Ovid Medline database was queried for original research reporting a diagnostic yield of R-EBUS or ENB for PPLs identified on computed tomography chest suspicious for malignancy. The I
2 statistic assessed study heterogeneity. Random effects models produced pooled estimates of diagnostic accuracy and sensitivity for malignancy. Reasons for heterogeneity were explored with meta-regression. Publication bias and small study effects were assessed.

Results:
A total of 41 studies involved 2988 lung nodules (R-EBUS 2102, ENB 886) in 3204 patients (R-EBUS 2097, ENB 1107). Overall sensitivity to detect cancer was 70.7% [95% confidence interval (CI): 67.2-74.0]; R-EBUS 70.5% (95% CI: 66.1-74.8), ENB 70.7% (95% CI: 64.7-76.8). Pooled overall diagnostic accuracy was 74.2% (95% CI: 71.0-77.3); R-EBUS 72.4% (95% CI: 68.7-76.1), ENB 76.4% (95% CI: 70.8-82.0). The localization modalities had comparative safety profiles of <2% complications.

Conclusion:
Both technologies have a high proportion of successful PPL localization with similar sensitivity for malignancy and accuracy. As such, both reasonable options for health care authorities to employ diagnostic algorithms.