bluuebunny/crossref_metadata_2025_split huggingface dataset:
Positive End-expiratory Pressure and Distribution of Ventilation in Pneumoperitoneum Combined with Steep Trendelenburg Position
Authors: Shono Atsuko , Katayama Nozomi , Fujihara Tatsuya , Böhm Stephan H. , Waldmann Andreas D. , Ugata Kei , Nikai Tetsuro , Saito Yoji 
Published: November 2019

Abstract

Background
Pneumoperitoneum and a steep Trendelenburg position during robot-assisted laparoscopic prostatectomy have been demonstrated to promote a cranial shift of the diaphragm and the formation of atelectasis in the dorsal parts of the lungs. However, neither an impact of higher positive end-expiratory pressure (PEEP) on preserving the ventilation in the dorsal region nor its physiologic effects have been fully examined. The authors hypothesized that PEEP of 15 cm H2O during robot-assisted laparoscopic prostatectomy might maintain ventilation in the dorsal parts and thus improve lung mechanics.

Methods
In this randomized controlled study, 48 patients undergoing robot-assisted laparoscopic prostatectomy were included in the analysis. Patients were assigned to the conventional PEEP (5 cm H2O) group or the high PEEP (15 cm H2O) group. Regional ventilation was monitored using electrical impedance tomography before and after the establishment of pneumoperitoneum and 20° Trendelenburg position during the surgery. The primary endpoint was the regional ventilation in the dorsal parts of the lungs while the secondary endpoints were lung mechanics and postoperative lung function.

Results
Compared to that in the conventional PEEP group, the fraction of regional ventilation in the most dorsal region was significantly higher in the high PEEP group during pneumoperitoneum and Trendelenburg position (mean values at 20 min after taking Trendelenburg position: conventional PEEP, 5.5 ± 3.9%; high PEEP, 9.9 ± 4.7%; difference, –4.5%; 95% CI, –7.4 to –1.6%; P = 0.004). Concurrently, lower driving pressure (conventional PEEP, 14.9 ± 2.5 cm H2O; high PEEP, 11.5 ± 2.8 cm H2O; P < 0.001), higher lung dynamic compliance, and better oxygenation were demonstrated in the high PEEP group. Postoperative lung function did not differ between the groups.

Conclusions
Application of a PEEP of 15 cm H2O resulted in more homogeneous ventilation and favorable physiologic effects during robot-assisted laparoscopic prostatectomy but did not improve postoperative lung function.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Systematic Review of Outcomes Following 10-year Mark of Spine Patient Outcomes Research Trial (SPORT) for Spinal Stenosis
Authors: Oster Brittany A. , Kikanloo Sina Rashidi , Levine Nicole L. , Lian Jayson , Cho Woojin 
Published: November 2019

Study Design.
We performed a comprehensive search of Pubmed, MEDLINE, and EMBASE for all English-language studies of all levels of evidence pertaining to SPORT, in accordance with Preferred Reported Items for Systematic Reviews and Meta-analayses (PRISMA) guidelines.

Objective.
We aim to summarize the 10-year clinical outcomes of SPORT and its numerous follow-up studies for spinal stenosis.

Summary of Background Data.
The Spine Patient Outcomes Research Trial (SPORT) was a landmark randomized control trial including approximately 2,500 patients at 13 clinics across the country. SPORT compared surgical and nonoperative management of the three most common spinal pathologies.

Methods.
Keywords utilized in the literature search included: SPORT, spine patient outcomes research trial, spinal stenosis, and surgical outcomes.

Results.
Surgical intervention showed significantly greater improvement in pain and physical function scales from 6 weeks through 4 years. However, between 4 and 8 years, the difference between the two groups diminished, and the benefits in both groups stabilized. Secondary factors investigated showed that smoking was a confounding variable for treatment benefits and a positive sedimentation sign correlated with a greater surgical treatment effect. Obese patients were found to have higher rates of infection and reoperation and less improvement from baseline function. Risk factors for reoperation included duration of pretreatment symptoms for longer than 12 months, increased age, multiple levels of stenosis, predominant back pain, no physical therapy, greater leg pain, the use of antidepressants and no neurogenic claudication upon enrollment.

Conclusion.
Ten years after its inception, SPORT has made strides in standardization and optimization of treatment for spinal pathologies. SPORT has provided clinicians with insight about outcomes of surgical and nonoperative treatment of spinal stenosis. Results showed significantly greater improvement through 4 year follow up in those patients that received surgical treatment, however the difference between the surgical and nonsurgical groups diminished at 8 year follow up.

Level of Evidence: 3
Upper Cervical Surgery, Increased Signal Intensity of the Spinal Cord, and Hypertension as Risk Factors for Dyspnea After Multilevel Anterior Cervical Discectomy and Fusion
Authors: An Seong Bae , Lee Jong Joo , Kim Tae Woo , Shin Dong Ah , Yi Seong , Kim Keung Nyun , Yoon Do Heum , Ha Yoon 
Published: November 2019

Study Design.
Retrospective study.

Objective.
To investigate the associated risk factors for acute respiratory distress after multilevel anterior cervical discectomy and fusion (ACDF) with a focus on the subjective symptom, dyspnea.

Summary of Background Data.
Acute respiratory distress after ACDF is a relatively common adverse event, the cause of which is usually soft tissue swelling or hematoma. It can result in serious morbidity and requires careful, focused treatment.

Methods.
We reviewed the records of 532 patients (from January 2014 to August 2018) who had undergone multilevel ACDF surgery. Acute respiratory distress was defined as a complaint of dyspnea within 5 postoperative days. We investigated the patients’ demographic parameters, comorbidities, and surgical procedure details. We also investigated radiologic parameters, including magnetic resonance imaging (MRI), with special attention to the prevertebral soft tissue thickness at C3 and C6. Statistical analysis was performed using the Student's t test and multiple logistic regression analysis.

Results.
Out of a total of 484 patients studied after exclusion criteria were applied, 31 patients (6.6%) experienced dyspnea after surgery. We selected 92 patients from the non-dyspnea group and compared them with 31 patients from the dyspnea group. On univariate analysis, upper cervical surgery involving C3, increased cord signal intensity on T2-weighted imaging (T2WI) magnetic resonance imaging (MRI), hypertension, smoking, and prevertebral soft tissue swelling at C3 level on postoperative day 1 were statistically significant factors associated with dyspnea. On logistic regression analysis, upper cervical surgery involving C3, increased cord signal intensity on T2WI MRI, and hypertension were found to be statistically significant variables (P < 0.05).

Conclusion.
Patients undergoing upper cervical surgery involving C3, and having increased cord signal intensity on T2WI MRI and hypertension need to be monitored more carefully for acute respiratory distress after multilevel ACDF.

Level of Evidence: 4
Transcriptome-wide Sequencing Reveals Molecules and Pathways Involved in Neurofibromatosis Type I Combined With Spinal Deformities
Authors: Cai Siyi , Yang Yuemei , Jia Binghan , Wu Zhihong , Zhang Jianguo , Shen Jianxiong , Qiu Guixing 
Published: November 2019

Mini
We identified differentially expressed genes (DEGs) that may be involved in the development of neurofibromatosis type I by whole-transcriptional sequencing. Seven hundred eighty DEGs were identified which include protein coding genes, miRNAs, and lncRNAs. The enrichment analysis may reveal pathways that these DEGs involved. A total of 383 protein-pairs for DEGs may unfold the possible mechanism how the disease is developed.

Study Design.
This is a clinical basic study on neurofibromatosis type I (NF-1) with spinal deformity.

Objective.
The current research focuses on screening key molecules affecting NF-1 with spinal deformity by transcriptome sequencing and discovering its underlying molecular biological mechanisms.

Summary of Background Data.
NF-1 is a complex multisystem human disorder, which is often found in spinal deformities patients. The success rate of orthopedic surgery for neurofibromatosis type I combined with spinal deformities patients was low because of the lack of molecular pathology.

Methods.
In our study, the transcriptome-wide sequencing was preformed to identify the differentially expressed genes (DEGs) involved in this disease.

Results.
Seven hundred eighty DEGs were identified which include protein coding genes, miRNAs, and lncRNAs. The DO, GO, KEGG and Reactome enrichment analysis may reveal pathways that these DEGs involved. And the 383 protein-pairs for DEGs that are involved in NF-1 combined with spinal deformities may unfold the possible mechanism how this disease is developed.

Conclusion.
The differentially expressed miRNAs and lncRNAs may contribute the ceRNA network. We focused on three key DEGs: FGFR2, MAP3K1 and STAT4. FGFR2 and MAP3K1 are members of the RAS/RAF/MEK/ERK-signaling pathway, and STAT4 were involved in the JAK/STAT pathway. The expression changes were verified by other researches and the functional cross-talk between the Ras/MAPK and JAK/STAT pathways may contribute in the disease development. This study took insight of the molecular mechanism of this disease. More detailed interactions between these factors are needed to be further explored. These key DEGs and involved pathways may provide clues in the clinical process for patients with NF-1, especially in prognosis prediction.

Level of Evidence: N/A
Proximal Junctional Kyphosis After Posterior Spinal Fusion for Severe Kyphoscoliosis in a Patient With PIEZO2-deficient Arthrogryposis Syndrome
Authors: Uehara Masashi , Kosho Tomoki , Takano Kyoko , Inaba Yuji , Kuraishi Shugo , Ikegami Shota , Oba Hiroki , Takizawa Takashi , Munakata Ryo , Hatakenaka Terue , Takahashi Jun 
Published: November 2019

Study Design.
Case report.

Objective.
Describe the clinical and radiological outcomes of a patient with a piezo-type mechanosensitive ion channel component 2 (PIEZO2)-deficient arthrogryposis receiving surgery for severe kyphoscoliosis.

Summary of Background Data.
Spinal deformity is a characteristic feature of arthrogryposis due to PIEZO2 gene deficiency, for which surgical correction is indicated when the deformity is progressive to avoid neurological deficits and respiratory impairment. However, there exist few reports on the surgical treatment of spinal deformity in PIEZO2-deficient arthrogryposis, and no therapeutic standards have been established.

Methods.
We retrospectively reviewed a case of proximal junctional kyphosis after posterior spinal fusion for severe kyphoscoliosis in PIEZO2-deficient arthrogryposis.

Results.
The patient was a 13-year-old girl with PIEZO2-deficient arthrogryposis who underwent posterior spinal fusion with an all-pedicle screw construct from T2 to L2 for a preoperative main thoracic curve Cobb angle of 78° and thoracic kyphotic angle of 83°. Postoperative Cobb angle of the main thoracic curve and thoracic kyphotic angle were improved at 11° and 34°, respectively. Although revision surgery was required for neurological deficits from proximal junctional kyphosis, she could walk with a crutch and improvements in clinical questionnaire scores were noted at 2 years and 3 months after surgery.

Conclusion.
Based on the present case, posterior spinal fusion represents a good treatment option for severe spinal deformity in PIEZO2-deficient arthrogryposis. Careful consideration of fusion level is needed to prevent proximal junctional kyphosis.

Level of Evidence: 5
Progression Prediction of Mild Cervical Spondylotic Myelopathy by Somatosensory-evoked Potentials
Authors: Feng Xiaoning , Hu Yong , Ma Xun 
Published: November 2019

Study Design.
Retrospective study to correlate classification of somatosensory-evoked potentials (SEPs) with symptomatic progress of patients with mild cervical spondylotic myelopathy (CSM).

Objective.
The aim of this study was to evaluate the usefulness of SEPs for predicting symptomatic progress of mild CSM.

Summary of Background Data.
SEPs have been used for clinical diagnosis and intraoperative neuromonitoring in patients with CSM. However, the prognostic value of SEPs in predicting the progression of CSM remains unclear.

Methods.
A total of 200 patients with a clinical diagnosis of mild CSM were enrolled between September 2014 and February 2018. All patients received clinical assessment with the modified Japanese Orthopedic Association scale (mJOA), magnetic resonance imaging, and SEP tests in the first clinical visit and at 1-year follow-up. A classification of upper and lower limbs SEP was developed. At 1-year follow-up, patients with symptom decline >2 points in mJOA were considered progressive myelopathy cases. The relationship of progressive myelopathy and classifications of SEP was investigated.

Results.
Fifty-four of 200 cases presented with progressive myelopathy. The incidence of progressive myelopathy was 2.6%, 27.7%, 23.8%, 86.7%, and 100% in Class I, II, III, IV, and V of upper SEPs, respectively, and 18.8%, 39.4%, 42.3%, and 62.5% in Class I, II, III, and IV of lower SEPs, respectively. For the combination classification of upper and lower SEPs, the incidence of progressive myelopathy was 0%, 13.7%, 24.3%, 91.1%, and 100% in Class I, II, III, IV, and V, respectively. There was a significant correlation of the incidence of progressive myelopathy with SEP classification for the upper SEPs (r = 0.94, P < 0.01) and the combination SEPs (r = 0.95, P < 0.01).

Conclusion.
The incidence of progressive degenerative myelopathy increased with the upper and combination SEP classifications. Thus, classification of SEPs could predict the clinical decline in mJOA in CSM, reflecting the probability of worsening of myelopathy.

Level of Evidence: 4
Systematic Review and Meta-Analysis of Effects of Transfusion on Hemodynamic and Oxygenation Variables*
Authors: Cavalcante dos Santos Elaine , Orbegozo Diego , Mongkolpun Wasineenart , Galfo Valentina , Nan Wang , Gouvêa Bogossian Elisa , Taccone Fabio Silvio , Vallet Benoît , Creteur Jacques , Vincent Jean-Louis 
Published: November 2019

Objectives:
RBC transfusions can increase oxygen availability to the tissues, but studies have provided conflicting results. The objectives of this study were, therefore, to evaluate, using systematic review and meta-analysis, the effects of transfusion on hemodynamic/oxygenation variables in patients without acute bleeding.

Data Sources:
PubMed, Scopus, Cochrane Database of Systematic Reviews, and Embase from inception until June 30, 2019.

Study Selection:
All articles that reported values of prespecified hemodynamic or oxygenation variables before and after RBC transfusion.

Data Extraction:
Publication year, number of patients, number of transfusions and the type of population studied, hemodynamic and oxygenation data (heart rate, cardiac index, mixed venous oxygen saturation or central venous oxygen saturation, oxygen delivery index, oxygen consumption index, oxygen extraction ratio, arteriovenous oxygen difference and arterial blood lactate) before and after transfusion. We performed a meta-analysis for each variable for which there were sufficient data to estimate mean differences. We also performed subgroup analyses comparing septic with nonseptic patients.

Data Synthesis:
We retrieved 6,420 studies; 33 met the inclusion criteria, 14 of which were in patients with sepsis. In the meta-analysis, the estimated mean differences and 95% CIs comparing the periods before and after transfusion were –0.0 L/min/m2 (–0.1 to 0.1 L/min/m2) (p = 0.86) for cardiac index; –1.8 beats/min (–3.7 to 0.1 beats/min) (p = 0.06) for heart rate; 96.8 mL/min/m2 (71.1–122.5 mL/min/m2) (p < 0.01) for oxygen delivery index; 2.9% (2.2–3.5%) (p < 0.01) for mixed venous oxygen saturation or central venous oxygen saturation; –3.7% (–4.4% to –3.0%) (p < 0.01) for oxygen extraction ratio; and 4.9 mL/min/m2 (0.9–9.0 mL/min/m2) (p = 0.02) for oxygen consumption index. The estimated mean difference for oxygen consumption index in the patients with sepsis was 8.4 mL/min/m2 (2.3–14.5 mL/min/m2; p = 0.01).

Conclusions:
Transfusion was not associated with a decrease in mean cardiac output or mean heart rate. The increase in mean oxygen delivery following transfusion was associated with an increase in mean oxygen consumption after transfusion, especially in patients with sepsis.
Keystone Perforator Island Flap for Postmastectomy Defect Resurfacing in Late-stage Breast Cancer Patients
Authors: Rini Irena Sakura , Krisna Made Ananda , Kamayana Jenisa , Djarot Kasih Rahardjo , Gunardi Alberta Jesslyn 
Published: November 2019

Background:
Late-stage breast cancer usually presents with locally advanced disease, with or without metastasis. The primary tumor is typically large with skin infiltration which affects quality of life. Surgical resection will result in an extensive defect which potentially deteriorates patients’ quality of life if not properly managed. Keystone perforator island flap (KPIF) is a local advancement flap based on multiple perforators which can be a reliable reconstructive method to close an extensive defect.

Methods:
This is a case series of 11 patients with symptomatic late-stage breast cancers indicated for neoadjuvant chemotherapy and subsequent mastectomy at Dharmais Cancer Hospital. The postmastectomy defect was closed with KPIF and clinical evaluation included flap success rate, percentage of flap necrotic area, and quality of life. There are modifications of the KPIF consisting of the more rounded shape and additional flap movement of the flap’s distal lateral ends to the center resembling an “omega” conformation.

Results:
Mean percentage of flap necrosis area was 9.7% and none of the patients needed additional surgery. The patients’ quality of life evaluated using Patient-reported Aesthetic European Organization for Research and Treatment of Cancer (EORTC) Quality of Life, Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life, Questionnaire-Breast Cancer-23-questions (QLQ-BR23) was fair, with sufficiently good scores for global health status and functional scale, and minimal symptomatology burden. The lowest score was for fatigue and financial difficulties parameters from QLQ-C30 and sexual functioning and future perspective from QLQ-BR23.

Conclusion:
This is a preliminary study to show that a KPIF could be considered as a method for defect-resurfacing reconstruction after mastectomy.
Evidence-based Sterility: The Evolving Role of Field Sterility in Skin and Minor Hand Surgery
Authors: Yu Janelle , Ji Tianshu Angela , Craig Michael , McKee Daniel , Lalonde Donald H. 
Published: November 2019

Summary:
Field sterility is commonly used for skin and minor hand surgery performed in the ambulatory setting. Surgical site infection (SSI) rates are similar for these same procedures when performed in the main operating room (OR). In this paper, we aim to look at both current evidence and common sense logic supporting the use of some of the techniques and apparel designed to prevent SSI. This is a literature review of the evidence behind the ability of gloves, masks, gowns, drapes, head covers, footwear, and ventilation systems to prevent SSIs. We used MEDLINE, EMBASE, and PubMed and included literature from the inception of each database up to March 2019. We could not find substantial evidence to support the use of main OR sterility practices such as head covers, gowns, full patient draping, laminar airflow, and footwear to reduce SSIs in skin and minor hand surgery. Field sterility in ambulatory minor procedure rooms outside the main OR is appropriate for most skin and minor hand surgery procedures. SSIs in these procedures are easily treatable with minimal patient morbidity and do not justify the cost and waste associated with the use of main OR sterility.
The Use of Umbilical Amnion for Conjunctival Socket, Fornix, and Eyelid Margin Reconstruction
Authors: Slentz Dane H. , Joseph Shannon S. , Nelson Christine C. 
Published: November 2019

Purpose:
To describe outcomes using umbilical amnion for conjunctival fornix, socket, and eyelid margin reconstruction.

Methods:
A medical record review was performed to identify patients who had received umbilical amnion over a 2-year period in their department. Patient demographics, disease etiology, and data regarding surgical outcomes were collected. The primary outcome was the success rate of the surgical intervention.

Results:
Twenty-one patients received umbilical amnion for anophthalmic socket contracture (n = 16), orbital implant exposure (n = 3), ocular surface burn (n = 1), and cicatricial entropion repair (n = 1). The primary outcome was met in 76% of patients overall. In anophthalmic socket contracture, the primary outcome was met in 86% and 0% of patients with acquired and congenital anophthalmia, respectively. The primary outcome was met in all cases of orbital implant exposure and cicatricial entropion. The primary outcome was not met in a Roper-Hall grade IV ocular surface burn.

Conclusions:
Umbilical amnion is an ideal substrate graft for reconstruction of the conjunctival fornix, socket, and eyelid margin. Umbilical amnion appears to be efficacious for the management of socket contracture in acquired anophthalmia, orbital implant exposure, and cicatricial entropion. Further experience is needed to determine the efficacy of umbilical amnion in ocular surface burns.
Phenotypic and microRNA characterization of the neglected CD24+ cell population in MCF-7 breast cancer 3-dimensional spheroid culture
Authors: Boo Lily , Yeap Swee Keong , Ali Norlaily Mohd , Ho Wan Yong , Ky Huynh , Satharasinghe Dilan Amila , Liew Woan Charn , Tan Sheau Wei , Wang Mong-Lien , Cheong Soon Keng , Ong Han Kiat 
Published: November 2019

Background:
In vitro 3-dimensional (3D) spheroid culture has been widely used as model to enrich CD44+CD24dim/− cancer stem cells (CSC) with high aldehyde dehydrogenase 1 (ALDH1) activity. Although CD24+ subpopulation was known to be present in 3D spheroids and may influence cancer drug therapies, its characteristics and CSC properties were not well defined.

Methods:
In this study, CD24+ population from the Michigan Cancer Foundation-7 (MCF-7) spheroid was sorted and subjected to spheroid formation test, stem cell markers immunofluorescence, invasion and migration test, as well as microRNA expression profiling.

Results:
Sorted MCF-7 CD24+ cells from primary spheroids were able to reform its 3D spheroid shape after 7 days in nonadherent culture conditions. In contrast to the primary spheroids, the expression of SOX-2, CD44, CD49f, and Nanog was dim in MCF-7 CD24+ cells. Remarkably, MCF-7 CD24+ cells were found to show high expression of ALDH1 protein which may have resulted in these cells exhibiting higher resistance against doxorubicin and cisplatin when compared with that of the parental cells. Moreover, microRNA profiling has shown that the absence of CSC properties was consistent with the downregulation of major CSCs-related pathways including Hedgehog, wingless-related integration site (Wnt), and microtubule associated protein kinase (MAPK) signaling pathways. However, the upregulated pathways such as adherens junctions, focal adhesion, and tight junction suggest that CD24+ cells were probably at an epithelial-like state of cell transition.

Conclusion:
In conclusion, neglected CD24+ cells in MCF-7 spheroid did not exhibit typical breast CSCs properties. The presence of miRNAs and their analyzed pathways suggested that these cells could be a distinct intermediate cell state in breast CSCs.