bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial Disparities are Present in the Timing of Radiographic Assessment and Surgical Treatment of Hip Fractures
Authors: Ali Iman , Vattigunta Saisanjana , Jang Jessica M. , Hannan Casey V. , Ahmed M. Shafeeq , Linton Bob , Kantsiper Melinda E. , Bansal Ankit , Srikumaran Uma 
Published: December 2019

Abstract

Background
Hip fractures are associated with 1-year mortality rates as high as 19% to 33%. Nonwhite patients have higher mortality and lower mobility rates at 6 months postoperatively than white patients. Studies have extensively documented racial disparities in hip fracture outcomes, but few have directly assessed racial disparities in the timing of hip fracture care.

Questions/purposes
Our purpose was to assess racial disparities in the care provided to patients with hip fractures. We asked, (1) do racial disparities exist in radiographic timing, surgical timing, length of hospital stay, and 30-day hospital readmission rates? (2) Does the hospital type modify the association between race and the outcomes of interest?

Methods
We retrospectively reviewed the records of 1535 patients aged 60 years or older who were admitted to the emergency department and treated surgically for a hip fracture at one of five hospitals (three community hospitals and two tertiary hospitals) in our health system from 2015 to 2017. Multivariable generalized linear models were used to assess associations between race and the outcomes of interest.

Results
After adjusting for patient characteristics, we found that black patients had a longer mean time to radiographic evaluation (4.2 hours; 95% confidence interval, -0.6 to 9.0 versus 1.2 hours; 95% CI, 0.1-2.3; p = 0.01) and surgical fixation (41 hours; 95% CI, 34-48 versus 34 hours 95% CI, 32-35; p < 0.05) than white patients did. Hospital type only modified the association between race and surgical timing. In community hospitals, black patients experienced a 51% (95% CI, 17%-95%; p < 0.01) longer time to surgery than white patients did; however, there were no differences in surgical timing between black and white patients in tertiary hospitals. No race-based differences were observed in the length of hospital stay and 30-day hospital readmission rates.

Conclusions
After adjusting for patient characteristics, we found that black patients experienced longer wait times to radiographic evaluation and surgical fixation than white patients. Hospitals should consider evaluating racial disparities in the timing of hip fracture care in their health systems. Raising awareness of these disparities and implementing unconscious bias training for healthcare providers may help mitigate these disparities and improve the timing of care for patients who are at a greater risk of delay.

Level of Evidence
Level III, therapeutic study.
Folliculitis Decalvans and Lichen Planopilaris Phenotypic Spectrum—A Series of 7 New Cases With Focus on Histopathology
Authors: Egger Andjela , Stojadinovic Olivera , Miteva Mariya 
Published: December 2019

Background:Folliculitis decalvans (FD) and lichen planopilaris (LPP) are classified as neutrophilic and lymphocytic cicatricial alopecias according to the North American Hair Research Society. Recently, a clinical phenotype combining concomitant or sequential features for both was described as a FD LPP phenotypic spectrum (FDLPPPS).Objectives:To review the most common phenotypic presentation of FDLPPPS with a main focus on histopathology.Methods:We reviewed retrospectively series of 7 patients with a similar phenotypic presentation with special focus on the histologic pattern. All patients presented with concomitant features for FD and LPP and recalcitrant course unresponsive to topical and systemic immunomodulatory/anti-inflammatory agents.Results:The most common clinical phenotype was that of hairless patches on the vertex with lost follicular ostia and perifollicular scale and the following diagnostic findings: (1) polytrichia; (2) positive bacterial culture forStaphylococcusin over 50% of the samples isolated from pustules and hemorrhagic crusts; (3) “mixed” histologic features for primary cicatricial alopecia including multicompound follicular structures of average 2–5 follicles (follicular packs), atrophy of the follicular epithelium, lymphohistiocytic infiltrate with granulomas, and prominent plasma cells, but absence of neutrophilic infiltrate in all cases except scarce neutrophils in one; and (4) clinical improvement with adjuvant systemic antimicrobials.Conclusions:The FDLPPPS may be underreported and should be considered in all cases of LPP recalcitrant to treatment. Dermatologists and dermatopathologists should recognize this phenotypic spectrum to guide optimal clinical management consisting of immunomodulatory and anti-inflammatory agents along with systemic antimicrobials.
Determinants of 30-day Morbidity in Adult Cranioplasty: An ACS-NSQIP Analysis of 697 Cases
Authors: Armstrong Rachel E. , Ellis Marco F. 
Published: December 2019

Background:
Cranioplasty is performed to restore the function and anatomy of the skull. Many techniques are used, including replacement of the bone flap and reconstruction with autologous or synthetic materials. This study describes the complication profile of adult cranioplasty using a prospective national sample and identifies risk factors for 30-day morbidity.

Methods:
The American College of Surgeon’s National Surgery Quality Improvement Project database for 2015–2016 was utilized. Cases were identified by current procedural terminology code, size, and type (autologous/alloplastic). χ2, Fisher exact, and ANOVA tests compared demographic differences. Univariate and multivariate logistic regressions were performed to identify risk factors for 30-day morbidity and mortality.

Results:
Six hundred ninety-seven cranioplasty cases were identified. Two cases used 2 types of cranioplasties and were counted in both groups. Five hundred forty-three cranioplasties were alloplastic, 57 were autologous, and 99 were classified as “Other.” Age, race, diabetes, ventilator dependency, congestive heart failure, hypertension, wound infection, sepsis, and bleeding disorders were identified on univariate analysis to increase complication risk. Multivariate analysis identified age of the patient, systemic sepsis, and bleeding disorders as significant risk factors for complications. There was no difference in complications between cranioplasty types. Overall and medical complications were greater in cranioplasties >5 cm (P < 0.001).

Conclusions:
Cranioplasty is a morbid procedure, with a complication rate of 27.4% and a mortality rate of 3.0% in this national sample. Factors such as age, sepsis, bleeding disorders, and size increase risk. Identification and modification of risk factors may guide operative timing and influence informed consent.
Examining the financial and quality performance effects of group purchasing organizations
Authors: Walker Daniel M. , McAlearney John S. , Sharma Luv , Kim Yoon Hee 
Published: December 2019

Background
Hospitals frequently enter into group purchasing organizations (GPOs) to manage supply costs, yet there is mixed evidence regarding the benefit for hospitals to participate in a GPO. However, the role of GPOs on hospital operations has expanded into dimensions of quality that have not been previously examined.

Purpose
The aim of this study was to examine the effect of hospital participation in a GPO, as well as GPO network characteristics, on both financial and quality performance outcomes.

Approach
Data from multiple secondary sources regarding hospital and GPO characteristics were used to create an unbalanced panel of hospitals from 2012 to 2015. This data set was then aggregated to the GPO network level to address questions related to network characteristics, including concentration, bed size, geographic scope, and focus. We evaluated three hospital-level outcomes: supply expense, clinical processes of care score, and patient experience score. The mean of each outcome among all hospitals in a GPO in a given year was used for analyses at the network level. We used fixed and random effect models to assess the effect of hospital characteristics and network characteristics on three measures of financial and quality performance.

Results
We found no difference between GPO and non-GPO hospitals for any of the outcomes. However, analyses at the network level revealed network characteristics, including concentration, size, and scope, that affected both supply expense and patient experience scores, but not clinical processes of care.

Conclusions
These results indicate that GPO participation may be motivated for reasons beyond cost and quality performance impacts.

Practice Implications
Hospitals and GPOs should consider network characteristics, such as the concentration and geographical dispersion of the GPO network. Alternatively, GPOs may seek to develop homogeneously sized networks dispersed locally in order to best deliver both financial and quality benefits to their members.
Neuroman: Voxel Phantoms from Surface Models of 300 Head Structures Including 12 Pairs of Cranial Nerves
Authors: Park Jin Seo 
Published: December 2019

Abstract
For a precise simulation of electromagnetic radiation effects, voxel phantoms require detailed structures to approximate humans. The phantoms currently used still do not have sophisticated structures. This paper presents voxel and surface models of 300 head structures with cranial nerves and reports on a technique for voxel reconstruction of the cranial nerves having very thin and small structures. In real-color sectioned images of the head (voxel size: 0.1 mm), 300 structures were segmented using Photoshop. A surface reconstruction was performed automatically on Mimics. Voxel conversion was run on Voxel Studio. The abnormal shapes of the voxel models were found and classified into three types: thin cord, thin layers, and thin parts in the structures. The abnormal voxel models were amended using extended, filled, and manual voxelization methods devised for this study. Surface models in STL format and as PDF files of the 300 head structures were produced. The STL format has good scalability, so it can be used in most three-dimensional surface model software. The PDF file is very user friendly for students and researchers who want to learn the head anatomy. Voxel models of 300 head structures were produced (TXT format), and their voxel quantity and weight were measured. A voxel model is difficult to handle, and the surface model cannot use the radiation simulation. Consequently, the best method for making precise phantoms is one in which the flaws of the voxel and surface models complement each other, as in the present study.
Factors Associated With Half- and Full-Marathon Race-Related Injuries: A 3-Year Review
Authors: Mohseni Michael M. , Filmalter Sara E. , Taylor Walter C. , Vadeboncoeur Tyler F. , Thomas Colleen S. 
Published: December 2019

Objective:
To better evaluate the relationships between training, demographics, and injury, this study sought to define race-related injury risk factors for half- and full-marathon runners.

Design:
This 3-year, observational cross-sectional study included adults who participated in a half or full marathon. Prerace and 2-week postrace surveys collected data on demographics, training factors, and injuries.

Setting:
This study took place during a nationally recognized marathon affiliated with a local hospital.

Participants:
Runners were recruited during the Expo in the days before the race. Postrace surveys were returned by 1043 half marathoners and 624 full marathoners (response rate, 83%).

Interventions:
This was an observational study; independent variables included demographic data and race year.

Main Outcome Measure:
The primary outcome was race-related injury that occurred during the race or within 2 weeks after the race.

Results:
Race-related injuries were reported by 24% of half marathoners and 30% of full marathoners. For half and full marathoners, respectively, significant factors for injuries were previous injury, lower peak weekly training mileage, and lower weekly mileage before race training. Factors significant for only half-marathon injuries were younger age, female sex, shorter distance of longest training run, and no formal training program. Factors significant for only full-marathon injuries were higher body mass index, fewer days running per week, and fewer years of running experience.

Conclusions:
Previous running injuries, undertraining, and inexperience increased race-related injury risk; women had higher risk than men. Decreased risk of injury was associated with training loads of greater than 23 miles/week for half marathoners and 40 miles/week for full marathoners.
Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis and Management of Mediastinal Cyst
Authors: Aravena Carlos , Patel Jinesh , Goyal Abha , Jaber Wissam , Khemasuwan Danai , Machuzak Michael , Cicenia Joseph , Gildea Thomas , Sethi Sonali , Mehta Atul C. , Almeida Francisco A. 
Published: December 2019

Background:
Foregut cysts account for >50% of cystic lesions in the mediastinum, of which bronchogenic cysts are most common. Surgical resection is the most definitive approach for its diagnosis and treatment. A recent systematic review, however, suggests that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a role in the management of bronchogenic cyst. We report our experience with EBUS-TBNA in the diagnosis and management of bronchogenic cysts.

Methods:
Medical records of patients with evidence of mediastinal cysts who underwent EBUS-TBNA between 2008 and 2016 were reviewed.
The primary aims of this study were to assess EBUS-TBNA diagnostic yield of peri-bronchial cysts and their specific type/origin and to determine its short-term and long-term drainage efficacy.

Results:
A total of 26 patients met the inclusion criteria. The cytopathology diagnosis was compatible with bronchogenic cyst in 4 cases, pleural-pericardial cyst in 3 cases, and 19 were indeterminate cysts. Successful long-term treatment occurred in 5.5% of the subjects. One patient developed inflammatory pericarditis after EBUS-TBNA.

Conclusion:
Diagnostic and therapeutic yield of EBUS-TBNA for mediastinal cysts is limited and surgical resection remains the treatment of choice.
Hormone replacement therapy and lung cancer risk in women: a meta-analysis of cohort studies
Authors: Jin Chao , Lang Baoping 
Published: December 2019

Abstract

Background:
Discordant results about the causal relationship between hormone replacement therapy use (HRT) and lung cancer risk in women had been reported. We therefore conducted a meta-analysis of cohort studies to evaluate this association.

Methods:
The PubMed and Embase databases were searched. Fixed- or random-effects model was used to pool the study-specific relative risks (RRs) with corresponding 95% confidence intervals (CIs). Sensitivity analysis, publication bias, and subgroup analysis were performed.

Results:
A total of 13 cohort studies met the inclusion criteria. Combined results indicated that compared with nonusers, women with HRT use were at a decreased risk (RR: 0.95, 95% CI: 0.91-0.99, I2 = 30.8%, P for heterogeneity = .137). In subgroup analysis by geographic area, smoking statue, type of hormones, and histology type of lung cancer, no significant association between HRT use and lung cancer was observed in most subgroups except in those studies which reported risk estimates adjusted for age, body mass index, smoking, and other confounders (RR: 0.95, 95 CI: 0.91-0.99, I2 = 33.0%, P for heterogeneity = .214). Both Begg funnel plot and Egger test (P = .243) suggested no evidence for publication bias.

Conclusion:
Our meta-analysis suggests ever use of HRT is associated with a decreased risk of lung cancer in women.
Laryngeal adenoid cystic carcinoma
Authors: Cui Yu , Bi Lirong , Sun Le , Wang Xin , Zhu Zhanpeng 
Published: December 2019

Abstract

Introduction:
Laryngeal adenoid cystic carcinoma (LACC) is an extremely rare malignant neoplasm. The etiology of LACC remains unknown, and it is characterized by multiple recurrences, slow progression, and late distant metastasis. This study aimed to provide more information regarding the characteristics, diagnosis, and treatment of LACC by analyzing 3 clinical cases and reviewing the literature on this topic.

Patient concerns:
Here, we present all 3 cases of LACC within the period between 2010 and 2019. Dyspnea was the most commonly observed symptom in these patients, followed by hoarseness, pharyngeal paresthesia, and difficulty swallowing.

Diagnosis:
All patients were pathologically confirmed as LACC.

Interventions:
All the patients underwent a combined therapy of surgical resection plus external irradiation.

Outcomes:
The follow-up time was between 2 and 6 years; no local recurrence occurred in any of the 3 patients. Lung metastasis was found in 1 patient 6 years after surgery.

Conclusion:
LACC is usually a slowly progressing cancer; the main treatment methods are surgery and radiotherapy, and the adequate radiotherapy dose should usually be greater than 60 Gy. The 5-year disease-specific survival rate is high; however, distant metastasis may still occur in patients with LACC even beyond 5 years after treatment. Therefore, patients with LACC require long-term surveillance.
Acupotomy for patients with carpal tunnel syndrome
Authors: Zhou Qiaoyin , Shen Yifeng , Sun Xiaojie , Qiu Zuyun , Jia Yan , Li Shiliang 
Published: December 2019

Abstract

Background:
This systematic review program is designed to provide an assessment of the effectiveness and safety of needle-knife therapy for the treatment of carpal tunnel syndrome (CTS).

Methods:
A cumulative search till October 2018 will be conducted in the following 8 databases: PubMed, EMBASE, Cochrane Controlled Trials Register, MEDLINE, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, and Wanfang Database, with no language or Publication status restrictions. All randomized controlled trials (RCT) for carpal tunnel syndrome will be considered eligible. The primary outcomes will include changes in the Boston carpal tunnel questionnaire (BCTQ) and visual analogue score (VAS), as well as safety and adverse events. Study inclusion, data extraction, and quality assessment will be done independently by 2 reviewers. If no substantial heterogeneity is detected, a meta-analysis will be performed. Continuous results will be expressed as mean differences or standard average differences, while binary data will be expressed as relative risks. The deviation risk and data synthesis will be assessed using the Review Manager software.

Results:
This study will provide a high-quality synthesis of BCTQ and VAS to assess the effectiveness and safety of acupotomy for carpal tunnel syndrome patients.

Conclusion:
This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with carpal tunnel syndrome.

PROSPERO registration number:
CRD42018108787.
Platelet-rich plasma vs corticosteroids for elbow epicondylitis
Authors: Li Ang , Wang Hongbo , Yu Zhenghong , Zhang Guangquan , Feng Shiqing , Liu Liyun , Gao Yanzheng 
Published: December 2019

Abstract

Objective:
The aim of this meta-analysis was to compare the effectiveness of platelet-rich plasma (PRP) vs corticosteroids for treatment of patients with lateral elbow epicondylitis.

Methods:
A literature search was performed in EMBASE, Medline, the Cochrane Library and PubMed. Randomized controlled studies comparing PRP with corticosteroids for the treatment of epicondylitis were included. The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the methodological quality of the included trials. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. The overall effect size of each anesthetic was calculated as the weighted average of the inverse variance of the study-specific estimates.

Results:
Seven randomized controlled trials were included in this review. The data from 2 studies were unavailable for meta-analysis, and the systematic review criteria were just achieved. Local corticosteroid injection yielded a significantly superior Disabilities of the Arm, Shoulder and Hand (DASH) score at 4 weeks (WMD, 11.90; 95% CI: 7.72 to 16.08; P < .00001; heterogeneity, χ2 = 0, I2 = 0%, P = 1.00) and 8 weeks (WMD, 6.29; 95% CI: 2.98 to 9.60; P = .0002, χ2 = 0, I2 = 0%, P = 1.00). Otherwise, it was noteworthy that a significantly lower VAS score (WMD, −2.61; 95% CI: −5.18 to −0.04; P = .05; heterogeneity, χ2 = 29.85, I2 = 97%, P < .00001) and DASH score (WMD, −7.73; 95% CI: −9.99 to −5.46; P < .00001, χ2 = 0.20, I2 = 0%, P = .66) existed in the PRP regimen than in the steroid regimen at the 24-week follow-up. More effective treatments were achieved in the PRP-treated patients than in the patients treated with corticosteroids (WMD, 3.33; 95% CI: 1.81 to 6.14; P = .000; heterogeneity, χ2 = 0.43, I2 = 0%, P = .51).

Conclusions:
Local corticosteroid injections demonstrated favorable outcomes compared with those of local PRP treatments for lateral elbow epicondylitis during the short-term follow-up period (4 weeks and 8 weeks post-treatment). Otherwise, at the long-term follow-up (24 weeks post-treatment), PRP injections had improved pain and function more effectively than corticosteroid injections.
Four reconstruction methods after laparoscopic distal gastrectomy
Authors: Ma Yanpeng , Li Fei , Zhou Xin , Wang Bingyan , Lu Siyi , Wang Wendong , Yu Shuqing , Fu Wei 
Published: December 2019

Abstract

Background:
There is no consensus regarding which reconstruction methods are superior after laparoscopic distal gastrectomy (LDG). This study compared four reconstruction methods after LDG for gastric cancer.

Methods:
Literature in EMBASE, PubMed, and the Cochrane Library was screened to compare Billroth I (B-I), Billroth II (B-II), Roux-en-Y (RY), and uncut Roux-en-Y (URY) anastomoses after LDG for gastric cancer. A Bayesian network meta-analysis (NMA) was conducted to compare these methods.

Results:
Eighteen studies involving 4347 patients were eligible for our NMA. The operative time in RY anastomosis was longer than that in B-I and B-II anastomoses. Blood loss and risk of gastrointestinal motility dysfunction were greater with RY anastomosis than with URY or B-I anastomosis. Furthermore, URY anastomosis was superior to the other 3 reconstruction methods for preventing food residue. For remnant gastritis, RY anastomosis was significantly superior to B-I and B-II anastomoses, whereas URY anastomosis was significantly superior to B-II anastomosis. In addition, RY and URY anastomoses were better than B-I and B-II anastomoses for preventing bile reflux.

Conclusions:
URY anastomosis tended to be a more favorable reconstruction method after LDG due to its operative simplicity and reduced long-term complications.