bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity
Authors: Taniguchi Yuki , Ohara Tetsuya , Suzuki Satoshi , Watanabe Kota , Suzuki Teppei , Uno Koki , Yamaguchi Toru , Yanagida Haruhisa , Nakayama Keita , Kotani Toshiaki , Watanabe Kei , Hirano Toru , Yamamoto Takuya , Kawamura Ichiro , Sugawara Ryo , Takeshita Katsushi , Demura Satoru , Oku Norihiro , Sato Tatsuya , Fujiwara Kenta , Akazawa Tsutomu , Murakami Hideki , Kakutani Kenichiro , Matsubayashi Yoshitaka , Kawakami Noriaki 
Published: November 2020

Study Design.
A retrospective multicenter cohort study.

Objective.
The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity.

Summary of Background Data.
Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology.

Methods.
We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR.

Results.
We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16–6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08–4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27–5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07–3.07) were the risk factors for the incidence of UPROR.

Conclusion.
The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.

Level of Evidence: 3
Development and Verification of a Digital Twin Patient Model to Predict Specific Treatment Response During the First 24 Hours of Sepsis
Authors: Lal Amos , Li Guangxi , Cubro Edin , Chalmers Sarah , Li Heyi , Herasevich Vitaly , Dong Yue , Pickering Brian W. , Kilickaya Oguz , Gajic Ognjen 
Published: November 2020

Objectives:
To develop and verify a digital twin model of critically ill patient using the causal artificial intelligence approach to predict the response to specific treatment during the first 24 hours of sepsis.

Design:
Directed acyclic graphs were used to define explicitly the causal relationship among organ systems and specific treatments used. A hybrid approach of agent-based modeling, discrete-event simulation, and Bayesian network was used to simulate treatment effect across multiple stages and interactions of major organ systems (cardiovascular, neurologic, renal, respiratory, gastrointestinal, inflammatory, and hematology). Organ systems were visualized using relevant clinical markers. The application was iteratively revised and debugged by clinical experts and engineers. Agreement statistics was used to test the performance of the model by comparing the observed patient response versus the expected response (primary and secondary) predicted by digital twin.

Setting:
Medical ICU of a large quaternary- care academic medical center in the United States.

Patients or Subjects:
Adult (> 18 year yr old), medical ICU patients were included in the study.

Interventions:
No additional interventions were made beyond the standard of care for this study.

Measurements and Main Results:
During the verification phase, model performance was prospectively tested on 145 observations in a convenience sample of 29 patients. Median age was 60 years (54–66 d) with a median Sequential Organ Failure Assessment score of 9.5 (interquartile range, 5.0–14.0). The most common source of sepsis was pneumonia, followed by hepatobiliary. The observations were made during the first 24 hours of the ICU admission with one-step interventions, comparing the output in the digital twin with the real patient response. The agreement between the observed versus and the expected response ranged from fair (kappa coefficient of 0.41) for primary response to good (kappa coefficient of 0.65) for secondary response to the intervention. The most common error detected was coding error in 50 observations (35%), followed by expert rule error in 29 observations (20%) and timing error in seven observations (5%).

Conclusions:
We confirmed the feasibility of development and prospective testing of causal artificial intelligence model to predict the response to treatment in early stages of critical illness. The availability of qualitative and quantitative data and a relatively short turnaround time makes the ICU an ideal environment for development and testing of digital twin patient models. An accurate digital twin model will allow the effect of an intervention to be tested in a virtual environment prior to use on real patients.
Validation of Inflammopathic, Adaptive, and Coagulopathic Sepsis Endotypes in Coronavirus Disease 2019
Authors: Sweeney Timothy E. , Liesenfeld Oliver , Wacker James , He Yudong D. , Rawling David , Remmel Melissa , Coyle Sabrina , Midic Uros , Kotsaki Antigone , Kanavou Aggeliki , Leventogiannis Konstantinos , Kontogeorgou Ioanna , Giamarellos-Bourboulis Evangelos J. 
Published: November 2020

Objectives:
Complex critical syndromes like sepsis and coronavirus disease 2019 may be composed of underling “endotypes,” which may respond differently to treatment. The aim of this study was to test whether a previously defined bacterial sepsis endotypes classifier recapitulates the same clinical and immunological endotypes in coronavirus disease 2019.

Design:
Prospective single-center observational cohort study.

Setting:
Patients were enrolled in Athens, Greece, and blood was shipped to Inflammatix (Burlingame, CA) for analysis.

Patients:
Adult patients within 24 hours of hospital admission with coronavirus disease 2019 confirmed by polymerase chain reaction and chest radiography.

Interventions:
None.

Measurements and Main results:
We studied 97 patients with coronavirus disease 2019, of which 50 went on to severe respiratory failure (SRF) and 16 died. We applied a previously defined 33-messenger RNA classifier to assign endotype (Inflammopathic, Adaptive, or Coagulopathic) to each patient. We tested endotype status against other clinical parameters including laboratory values, severity scores, and outcomes. Patients were assigned as Inflammopathic (29%), Adaptive (44%), or Coagulopathic (27%), similar to our prior study in bacterial sepsis. Adaptive patients had lower rates of SRF and no deaths. Coagulopathic and Inflammopathic endotypes had 42% and 18% mortality rates, respectively. The Coagulopathic group showed highest d-dimers, and the Inflammopathic group showed highest C-reactive protein and interleukin-6 levels.

Conclusions:
Our predefined 33-messenger RNA endotypes classifier recapitulated immune phenotypes in viral sepsis (coronavirus disease 2019) despite its prior training and validation only in bacterial sepsis. Further work should focus on continued validation of the endotypes and their interaction with immunomodulatory therapy.
Adrenocortical carcinoma: current treatment options
Authors: De Filpo Giuseppina , Mannelli Massimo , Canu Letizia 
Published: November 2020

Purpose of review
In this article, we focus on the current and future treatment options for adrenocortical carcinoma (ACC).

Recent findings
Radical surgery remains the only curative treatment for ACC. Recent reports showed a longer overall survival (OS) in patients with high risk of recurrence treated with adjuvant mitotane; the time in target range (14–20 mg/l) is related to low risk of relapse both in adjuvant and in palliative setting. In patients who experience disease progression after etoposide, doxorubicin, cisplatin with mitotane (EDP-M), gemcitabine and metronomic capecitabine, or the less used streptozotocin, represent a second-line chemotherapy option. Temozolomide can be employed as a third-line chemotherapy. To date, unsatisfactory results have been obtained on the efficacy of targeted therapies. Clinical trials are ongoing to evaluate the efficacy of tyrosine kinase and immune checkpoint inhibitors.

Summary
ACC is a rare disease with a poor prognosis. The main therapy is represented by radical surgery conducted by an expert surgeon. Adjuvant mitotane has to be started in patients with high risk of recurrence. In patients with inoperable disease, the scheme EDP-M is the most employed. Few data are available on second-line and third-line chemotherapy in patients with disease progression after EDP-M. Currently, the role of targeted therapies is under evaluation.
Immune checkpoint inhibitors in driver mutation-positive nonsmall cell lung cancer: is there a role?
Authors: Lee Jiyun , Ahn Myung-Ju 
Published: November 2020

Purpose of review
Despite advances in immunotherapy for nonsmall cell lung cancer patients, the clinical efficacy of drugs for patients with oncogenic driver mutations remains limited. This article aimed to comprehensively review the currently available data on the efficacy and safety of immune checkpoint blockade (ICB) for patients with driver mutation-positive lung cancer.

Recent findings
Despite the positive interaction between activation of oncogenic pathways and upregulated PD-L1 expression demonstrated in preclinical studies, the efficacy of single-agent ICB in patients with oncogenic mutation has largely been discouraging, except for those with KRAS mutations. The combination therapies using ICB with tyrosine kinase inhibitors (TKIs) for EGFR/ALK alteration raised a concern for the high incidence of treatment-related adverse events, notably hepatotoxicity and interstitial lung disease. A novel combination with bevacizumab demonstrated promising efficacy with tolerable safety profiles.

Summary
Other than patients with the KRAS mutation who demonstrate relatively favorable response to ICB, a single-agent ICB therapy should be considered for those who retain good performance status but have no other therapeutic options available. Further studies on the combination of ICB and TKI are needed to identify the most viable pair regarding safety. Additional studies using novel combination partners, such as anti-VEGF inhibitors, are also warranted.
Inter- and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion (CatLet©) angiographic scoring system in patients with acute myocardial infarction
Authors: Liu Jin-Mei , He Yang , Teng Ruo-Ling , Qian Xiao-Dong , Dai Yun-Lang , Xu Jian-Ping , Zhao Xin , Jiang Ting-Bo , He Yong-Ming 
Published: November 2020

Abstract

Background:
Previously, we developed a novel
C
oronary
A
rtery
T
ree description and
L
esion
E
valua
T
ion (CatLet©) angiographic scoring system, which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction (AMI). Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. However, the reproducibility of the CatLet score in both inter- and intra-observer remains to be evaluated.

Methods:
A total of 30 consecutive AMI patients, admitted in September of 2015, were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score. Another set of 49 consecutive AMI patients, admitted between September and October in 2014, were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score. The weighted kappa was used to express the degree of agreement.

Results:
The weighted kappa values (95% confidence interval) for the intra- and inter-observer reproducibility of the CatLet Score were 0.82 (0.59–1.00, Z = 7.23, P < 0.001) and 0.86 (0.54–1.00, Z = 5.20, P < 0.001), respectively, according to the tertile analysis (≤14, 15–22, >22). Regarding the adverse characteristics pertinent to lesions and dominance parameters, the kappa values for the inter-observer variability were 0.80 (0.56–1.00, Z = 6.47, P < 0.001) for total number of lesions, 0.57 (0.28–0.85, Z = 3.03, P < 0.001) for bifurcation, 0.69 (0.43–0.96, Z = 5.06, P < 0.001) for heavy calcification, 1.00 (0.72–1.00, Z = 6.93, P < 0.001) for tortuosity, 0.54 (0.26–0.82, Z = 3.78, P < 0.001) for thrombus, 0.69 (0.48–0.91, Z = 6.29, P < 0.001) for right coronary artery dominance, 0.69 (0.41–0.96, Z = 4.91, P < 0.001) for left anterior descending artery length, and 0.22 (0.06–0.51, Z = 1.56, P = 0.06) for diagonal size. Equivalent values for the intra-observer variability were moderate to almost perfect (range 0.54–1.00).

Conclusions:
The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent. The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.
Development of a Patient-Reported Outcome Questionnaire to Evaluate Primary Mitochondrial Myopathy Symptoms: The Primary Mitochondrial Myopathy Symptom Assessment
Authors: Gwaltney Chad , Stokes Jonathan , Aiudi Anthony , Mazar Iyar , Ollis Sarah , Love Emily , Espensen Ashlee , Shields Alan L. 
Published: November 2020

Objectives:
Primary mitochondrial myopathy (PMM) is a genetic condition characterized by life-limiting symptoms such as muscle weakness, fatigue, and pain. Because these symptoms are best reported by individuals with PMM, the objective of this qualitative research study was to develop a PMM-specific patient-reported outcome (PRO) questionnaire.

Method:
Individuals with PMM were interviewed, identifying the most salient symptoms of PMM and assessing the resulting questionnaire's relevance and comprehensibility.

Results:
Developed based on patient interviews, the 10-item Primary Mitochondrial Myopathy Symptom Assessment assesses patients' symptom experiences at their worst in the last 24 hours. Individuals with PMM confirmed the concepts of the questionnaire as relevant and comprehensive to their symptom experiences and responded to the items consistently with developers' intentions.

Conclusions:
The Primary Mitochondrial Myopathy Symptom Assessment is a content-valid PRO questionnaire with qualitative and quantitative support as a valuable tool to evaluate and monitor the day-to-day experience of PMM symptoms from the patient perspective.
Sleep and Breathing After Nusinersen Therapy in a Child With Spinal Muscular Atrophy
Authors: Kouri Ioanna , Demirel Nadir , Haile Dawit T. , Selcen Duygu , Kotagal Suresh 
Published: November 2020

Abstract

Background:
Spinal muscular atrophy (SMA) type 3 is an autosomal recessive neurological disorder associated with a deletion/mutation in the survival motor neuron gene, with gradually progressive degeneration of the motor neurons of the spinal cord and brainstem, which causes muscle weakness responsible for impairment of swallowing, breathing, and mobility.

Report of case:
We report an 11-year-old girl with SMA type 3 with moderate to severe obstructive sleep apnea (OSA) syndrome refractory to adenotonsillectomy and noninvasive ventilatory support. She was started on nusinersen, which is a novel disease modifying therapy for SMA. This new treatment led to improvement of the OSA in a short period, likely from better respiratory muscle function.

Conclusions:
The improvement in OSA supports the role of nusinersen in sleep-related upper respiratory muscle function in SMA type 3.
Incidence of postoperative sore throat after using a new technique of insertion of a second generation Laryngeal Mask Airway
Authors: Li Xiaoxiao , Wang Xiuli , Zhao Ye , Jiang Zhenfei , Lv Xueli , Nie Xinrui , Li Tong , Wang Xinghe , Dai Lingyun , Liu Su 
Published: November 2020

BACKGROUND
Sore throat is a common complication after Laryngeal Mask Airway Supreme (SLMA) insertion.

OBJECTIVE
The aim of this study was to determine whether a new SLMA insertion technique (not removing the pilot tube blocker before insertion) lowers the incidence of sore throat in the postanaesthesia care unit (PACU).

DESIGN
A prospective, single-centre, parallel randomised controlled trial.

SETTING
Operating room and PACU at a hospital in China from June to September 2019.

PATIENTS
Four hundred and eight patients aged 18 to 65 years with American Society of Anaesthesiologists physical status class I or II who were scheduled for elective surgery requiring anaesthesia and SLMA insertion.

INTERVENTIONS
Leaving the blocker at the end of the pilot tube in situ (this blocker keeps the valve open and the balloon remains partially inflated but will deflate with pressure) or removing the blocker and actively deflating the cuff before SLMA insertion.

MAIN OUTCOME MEASURES
The primary outcome was the incidence of postoperative sore throat in the PACU. The secondary outcomes included sore throat severity (Prince Henry Hospital Pain Score), first-attempt success rate, ease of insertion, time to successful SLMA insertion, oropharyngeal leak pressure, grade of view on fibreoptic bronchoscopy (indicating the accuracy of SLMA positioning) and adverse events.

RESULTS
The incidence of sore throat was 33/204 (16.2%) in the nonremoval group, and 65/204 (31.9%) in the removal group (P < 0.001). The first-attempt success rate was 174/204 (85.3%) in the nonremoval group and 150/204 (73.76%) in the removal group (P = 0.003; relative risk 1.160, 95% CI 1.049 to 1.282). The Kaplan--Meier curves showed that the insertion time in the nonremoval group was shorter (log-rank P = 0.01).

CONCLUSION
The new insertion technique, leaving the blocker attached to the end of the pilot balloon, resulted in a reduced incidence and severity of postoperative sore throat in the PACU, and an improved first-attempt success rate and the accuracy of SLMA positioning.

TRIAL REGISTRATION
Chinese Clinical Trial Registry identifier: ChiCTR1900023022
The analgesic effectiveness of ilioinguinal-iliohypogastric block for caesarean delivery
Authors: Singh Narinder P. , Makkar Jeetinder K. , Bhatia Nidhi , Singh Preet Mohinder 
Published: November 2020

BACKGROUND
An effective analgesia strategy following caesarean delivery should be designed to improve fetomaternal outcomes. Much recent research has focused on the efficacy of ilioinguinal-iliohypogastric (II-IH) block for providing such analgesia.

DESIGN
A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVES
To investigate the effectiveness of II-IH block in patients undergoing caesarean delivery. The primary outcome was the cumulative parenteral morphine equivalents at 24 h. Pain scores at 4 to 6 and 24 h postsurgery, time to first rescue analgesia and adverse effects were the secondary outcomes analysed.

DATA SOURCES
Two reviewers searched independently PubMed, Embase, Google Scholar and the Cochrane central registers of a controlled trial from their inception until June 2020.

METHODOLOGY
Prospective randomised control trials comparing II-IH block with either systemic analgesia alone or a placebo block (non-active controls) were eligible for inclusion. Only trials that reported their methods comprehensibly and transparently were included. Cochrane methodology was used to assess the risk of bias. Data are presented as mean difference with 95% confidence interval (CI).

RESULTS
Thirteen trials comprising a total of 858 patients were included. Opioid (intravenous morphine equivalents) consumption was reduced by 15.57 mg (95% CI −19.87 to −11.28; P < 0.00001; I
2 = 95%) during the first 24 h in patients receiving II-IH block when compared with placebo or no block. Patients receiving general anaesthesia showed a greater reduction in morphine requirement at 24 h than those receiving neuraxial anaesthesia. Adequate ‘information size’ for the above outcome was confirmed with trial sequential analysis to rule out the possibility of a false-positive result. II-IH also significantly reduced pain scores at rest more so at 4 to 6 h than at 24 h.

CONCLUSIONS
Our study suggests that the use of II-IH blocks is associated with a lower 24 h requirement for intravenous morphine equivalents in patients undergoing caesarean delivery. However, given the methodological limitations, data should be interpreted with caution until more studies are available.
Home-Initiated-Programme-to-Prepare-for-Operation: evaluating the effect of an animation video on peri-operative anxiety in children
Authors: Nair Tanuja , Choo Candy S.C. , Abdullah Nur S. , Lee Sumin , Teo Lois L.E. , Chen Yong , Nah Shireen A. , Chiang Li-Wei 
Published: November 2020

BACKGROUND
Hospital admissions and surgical operations commonly trigger anxiety in young children. Despite employing numerous support measures in our hospital, such as a pre-operative play room, the encouragement of parental companionship during induction of anaesthesia and distraction therapy, allaying the anxiety of our young surgical patients remains a challenge.

OBJECTIVES
To evaluate the effectiveness of a Home-Initiated-Programme-to-Prepare-for-Operation (HIPPO) on emotional manifestation and anxiety in children undergoing surgery.

DESIGN, SETTING AND PATIENTS
One hundred and thirty children were randomly assigned to either control or intervention group between February 2018 and April 2019 in a tertiary paediatric hospital in Singapore.

INTERVENTION
In addition to our standard pre-operative workflow, the intervention group received an additional home preparation kit consisting of an animated video on preoperative preparation and age-specific preoperative preparation activity sheets.

MAIN OUTCOME MEASURES
The primary outcome was the Children's Emotional Manifestation Scale score to evaluate behaviour and emotion in the children before and during induction of anaesthesia. Secondary outcomes evaluated anxiety levels in parents and children, the child's behaviour and degree of co-operation using the State-Trait Anxiety Inventory scores, State-Trait Anxiety Inventory Children scores, the Induction Compliance Checklist scores, the Visual Analogue Scale scores for anxiety and the feedback questionnaire.

RESULTS
The difference between the Children's Emotional Manifestation Scale score in control and intervention groups was not statistically significant. A promising difference was however observed in one of the secondary outcomes where the state-State-Trait Anxiety Inventory Children scores of 7 to 10-year olds in the intervention group almost reached significance; P = 0.067.

CONCLUSION
Despite being a child-friendly, easily accessible and affordable tool for patient education, HIPPO did not reduce anxiety experienced by children in the pre-operative waiting area or during induction of anaesthesia.

TRIAL REGISTRATION
ClinicalTrials.gov, identifier: NCT04271553.