bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quadriceps Strength Is Influenced by Skeletal Maturity in Adolescents Recovering From Anterior Cruciate Ligament Reconstruction
Authors: Casp Aaron J. , Bodkin Stephan G. , Kew Michelle E. , Noona Sean W. , Lesevic Milos , Hart Joseph M. , Diduch David 
Published: November 2020

Background:
Anterior cruciate ligament injuries and anterior cruciate ligament reconstructions (ACLRs) are common, especially in adolescent patients. Recovery of strength, jumping performance, and perceived/subjective function are often used to make a return to sports decisions after injury. It is unknown how skeletal maturity may influence strength recovery after ACLR. The purpose of this study was to compare the strength and patient-reported outcomes in adolescent ACLR patients with and without open distal femur and proximal tibia physes.

Methods:
One hundred seventeen consecutive patients under the age of 18 were referred for routine strength and subjective outcomes evaluation following ACLR, 100 were included in the final analyses after excluding those with prior injuries, those tested outside for 4 to 12 month postoperative window, and those with incomplete clinical data. All study patients completed patient-reported outcomes, and underwent isometric and isokinetic testing of knee extensor and flexor strength to calculate normalized peak torque and limb symmetry. Statistical analyses were performed on all outcomes data using a 2×2 (physeal status: open, closed; and sex: male, female) with analysis of covariance where age and preoperative activity level were used as covariates.

Results:
A significant interaction between sex and physeal status for isokinetic knee extension peak torque and isometric knee extension peak torque, and limb symmetry index was found. This indicated that males with open physes were stronger and more symmetric than males with closed physes and females with open physes at ~6 months post-ACLR. There were no differences between sexes for patients with closed physes. No interactions were observed for flexion strength. Male patients and patients with open physes had higher perceived knee function compared with their corresponding counterparts.

Conclusions:
After ACLR, adolescent patients with open physes had higher quadriceps strength compared with patients with closed physes. Overall, those skeletally less mature patients actually fared better on the functional strength tests, suggesting that functional recovery is not hindered by the presence of an incompletely closed physis.

Level of Evidence:
Level III—retrospective comparative study.
What is the Optimal Surgical Method for Achieving Correction and Avoiding Neurological Complications in Pediatric High-grade Spondylolisthesis?
Authors: Rocos Brett , Strantzas Samuel , Zeller Reinhard , Lewis Stephen , Tan Tony , Lebel David 
Published: November 2020

Background:
Controversy persists in the treatment of high-grade spondylolisthesis (HGS). Surgery is recommended in patients with intrusive symptoms and evidence debates the competing strategies. This study compares the radiologic outcomes and postoperative complications at a minimum of 2 years follow-up for patients with HGS treated with instrumented fusion with partial reduction (IFIS) with those treated with reduction, decompression, and instrumented fusion (RIF). We hypothesize that IFIS leads to a lower rate of complication and revision surgery than RIF.

Methods:
A retrospective comparative methodology was used to analyze consecutive HGS treated surgically between 2006 and 2017. Patients diagnosed with ≥grade 3 spondylolisthesis treated with arthrodesis before the age of 18 years with a minimum of 2 years follow-up were included. Patients were excluded if surgery did not aim to achieve arthrodesis or was a revision procedure. Cases were identified through departmental and neurophysiological records.

Results:
Thirty patients met the inclusion criteria. Mean follow-up was 4 years. Ten patients underwent IFIS and the remaining 20 underwent RIF. The 2 groups showed no difference in demographics, grade of slip, deformity or presenting symptoms. Of 10 treated with IFIS, the SA reduced by a mean of 10 degrees and C7 sagittal vertical line changed by 31 mm. In the RIF cohort, SA reduced by 16 degrees and C7 sagittal vertical line reduced by 26 mm. PT was unchanged in both groups. In IFIS cohort, 2 patients showed postoperative weakness, resolved by 2 years. None required revision surgery. In the RIF group, 4 sustained dural tears and 1 a laminar fracture, 7 showed postoperative weakness or dysaesthesia, 3 of which had not resolved by 2 years. Eight patients underwent unplanned further surgery, 3 for pseudarthrosis.

Conclusions:
RIF and IFIS show similar radiologic outcomes. RIF shows a higher rate of unplanned return to surgery, pseudarthrosis and persisting neurological changes.

Level of Evidence
Level III—retrospective comparative study.
Can Chiari Osteotomy Favorably Influence Long-term Hip Degradation in Multiple Epiphyseal Dysplasia and Pseudoachondroplasia?
Authors: Andrzejewski Aurélie , Péjin Zagorka , Finidori Georges , Badina Alina , Glorion Christophe , Wicart Philippe 
Published: November 2020

Background:
Multiple epiphyseal dysplasia (MED) and pseudoachondroplasia (PSACH) are congenital skeletal disorders characterized by irregular epiphyses, mild or severe short stature and early-onset osteoarthritis which frequently affect the hips. The current study evaluates the long-term results of the Chiari osteotomy in MED and PSACH patients.

Methods:
Twenty patients (14 MED and 6 PSACH) were retrospectively included. Clinical assessment used the Postel Merle d’Aubigné (PMA) score and the Hip disability and Osteoarthritis Outcome Score (HOOS). Risser index, Sharp angle, acetabular depth index, center-edge angle, Tönnis angle, and femoral head coverage were measured on the preoperative radiographs and at last follow-up. The Treble index, which identifies the hip at risk in MED patients, was also determined. Stulberg classification (grades I to V) was used to evaluate the risk of osteoarthritis in the mature hips.
Statistical analyses determined differences between preoperative and postoperative data. The Kaplan Meier method was used to calculate the survival rate of the operated hips using total hip arthroplasty as the endpoint.

Results:
Thirty-three hips which underwent a Chiari osteotomy were reviewed. The average follow-up was 20.1 years. The PMA scores were significantly better at last follow-up than preoperatively. All radiographic parameters significantly improved. Moreover, the Sharp angle, center-edge angle, and femoral head coverage improved to a normal value at hip maturity. All of the operated hips had a Treble index of type I. At hip maturity, a majority of hip were aspherical congruent (Stulberg grades of III and IV). The survival rate of the operated hips was 80.7% at 24 years postoperative.

Conclusions:
The Chiari osteotomy is a satisfying solution for severe symptomatic hip lesions in MED and PSACH patients. At long-term follow-up, this procedure lessens pain and improves hip function, which delays total hip arthroplasty indication.

Level of Evidence:
Level IV.
Anatomic Relationship of the Femoral Neurovascular Bundle in Patients With Congenital Femoral Deficiency
Authors: Huser Aaron J. , Kwak Yoon Hae , Rand Troy J. , Paley Dror , Feldman David S. 
Published: November 2020

Background:
Congenital femoral deficiency (CFD) is a rare condition that affects the morphology of the hip and surrounding soft tissues. Bony deformity and distorted muscular anatomy are well known, but no studies have described the relationship of the femoral neurovascular (NV) bundle to surgically relevant anatomic landmarks. The authors compared the location of the femoral NV bundle on the affected side in patients with CFD with the unaffected side. The authors hypothesized that the bundle on the pathologic side would be in an abnormal position relative to the unaffected side.

Methods:
Thirty-three patients diagnosed with unilateral CFD who had undergone preoperative magnetic resonance imaging of the pelvis were included in our study. The authors identified the femoral NV bundle on the axial cuts and measured its distance from the anterior superior iliac spine (ASIS), anterior inferior iliac spine (AIIS), and lesser trochanter (LT). Anatomic percent change and absolute measurements were then compared and correlated with associated boney deformities and the Paley classification.

Results:
The distance from the femoral NV bundle to the ASIS, AIIS, and LT was significantly different compared with the unaffected side. The AIIS absolute distance and AIIS percent change significantly correlated with the neck-shaft angle of the proximal femur.

Conclusions:
In patients with CFD, the femoral NV bundle seems to be further from the LT and closer to the AIIS on the affected side when compared with the unaffected side. magnetic resonance imaging may be helpful to understand the course of the femoral NV bundle before reconstruction in patients with CFD; however, the authors recommend identification of the femoral NV bundle before transection of the proximal rectus femoris tendon to provide safe surgical care.

Level of Evidence:
Level IV—case-control study of diagnostic studies.
Hand Bone Age Radiography: Comparison Between Slot-scanning and Conventional Techniques
Authors: Nguyen Jie C. , Guariento Andressa , Nicholson Anthony , Nguyen Michael K. , Gendler Liya , Ho-Fung Victor , Zhu Xiaowei , Talwar Divya , Darge Kassa , Flynn John M. , Cahill Patrick J. 
Published: November 2020

Background:
Determination and longitudinal monitoring of progressive skeletal maturity are essential in the management of children with scoliosis. Although different methods for determining skeletal maturity exists, the most widely practiced method relies on the ossification pattern of the bones of the hand and wrist, which is traditionally acquired using conventional techniques and after the acquisition of the spine using the low-dose slot-scanning technique. Whereas the existing published literature has published promising results on the use of the slot-scanning technique to acquire these hand and wrist radiographs, image quality and radiation dose have not been systematically compared between these techniques. Thus, the objective of our study is to compare image quality, interpretation reliability, and radiation dose of hand bone age radiographs between slot-scanning and conventional techniques using age- and sex-matched children.

Methods:
This retrospective study included children who underwent hand radiographs using slot-scanning between October 1, 2019 and December 31, 2019; and matched children who underwent conventional radiography. Blinded to technique, 5 readers reviewed all radiographs after randomization to rate image quality and to determine bone age using the Greulich and Pyle classification. Dose area product was recorded. Mann-Whitney and t tests were used to compare variables between techniques and intraclass correlation (ICC) to determine observer agreement.

Results:
Our study cohort of 194 children (128 girls, 66 boys; mean age: 13.7±2.3 y) included 97 slot-scanning and 97 conventional radiographs. One (1%) slot-scanning and no conventional radiograph was rated poor in image quality. There was almost perfect interpretation reliability with slot-scanning with high interobserver (ICC=0.948) and intraobserver (ICC=0.996) agreements, comparable with conventional radiographs (ICCs=0.919 and 0.996, respectively). Dose area product (n=158) was lower (P<0.002) with slot-scanning than with conventional techniques.

Conclusion:
Almost perfect interobserver reliability and intraobserver reproducibility with slot-scanning radiographs (performed using significantly lower radiation doses) suggest that this technique for hand bone age determination can be a reliable adjunct to scoliosis monitoring.

Level of Evidence:
Level III.
Three-dimensional Analysis of Acetabular Morphology and Orientation in Patients With Slipped Capital Femoral Epiphysis
Authors: Paez Conner J. , Bomar James D. , Farnsworth Christine L. , Bandaralage Harsha , Upasani Vidyadhar V. 
Published: November 2020

Background:
Previous studies analyzing the acetabuli in patients with slipped capital femoral epiphysis (SCFE) have not definitively addressed the relationship between SCFE and acetabular shape. Femoral head overcoverage and acetabular version are thought to contribute to SCFE. The purpose of this study was to determine the acetabular morphology and orientation in hips with SCFE and compare them with normally developing children.

Methods:
Pelvic computed tomography (CT) images of patients with SCFE were compared with pelvic CTs of patients without orthopedic abnormalities (normal controls). Three-dimensional (3-D) reconstructions were created from each CT examination. Custom software uniformly aligned the pelvis then determined acetabular measures from the reconstructions including acetabular version, acetabular tilt, articular surface area, and acetabular coverage angle measured in a radial manner dividing the acetabulum into octants.

Results:
Two-hundred forty-four hips were included (53 SCFE, 31 unaffected contralateral hips in patients with SCFE, and 160 controls). The acetabular version was similar among SCFE hips, unaffected contralateral hips, and normal controls (P=0.48). Control hips had higher acetabular tilt than SCFE-affected hips (P=0.01) and unaffected contralateral hips (P=0.04). The acetabular surface area was higher in SCFE-affected hips compared with controls (P<0.05). SCFE-affected hips and the unaffected contralateral hips in patients with SCFE had increased acetabular coverage compared with controls in all 5 acetabular octants.

Conclusions:
Contrary to some previous studies, the authors did not find the acetabulum to be retroverted in patients with SCFE compared with controls. Both affected and unaffected hips of patients with SCFE have decreased acetabular tilt. Acetabular surface area is higher in hips with SCFE compared with normal controls, and both the SCFE-affected hips and unaffected hips had increased acetabular coverage compared with controls in all 5 octants of the acetabulum. The shared morphology of affected and unaffected hips in patients with SCFE suggests that their acetabular anatomy may predispose them to slip.

Level of Evidence:
Level III.
Effects of 5% Albumin Plus Saline Versus Saline Alone on Outcomes From Large-Volume Resuscitation in Critically Ill Patients
Authors: Gomez Hernando , Priyanka Priyanka , Bataineh Ayham , Keener Christopher M. , Clermont Gilles , Kellum John A. 
Published: November 2020

OBJECTIVES:
To compare 5% albumin with 0.9% saline for large-volume resuscitation (> 60 mL/Kg within 24 hr), on mortality and development of acute kidney injury.

DESIGN:
Retrospective cohort study.

SETTING:
Patients admitted to ICUs in 13 hospitals across Western Pennsylvania. We analyzed two independent cohorts, the High-Density Intensive Care databases: High-Density Intensive Care-08 (July 2000 to October 2008, H08) and High-Density Intensive Care-15 (October 2008 to December 2014, H15).

PATIENTS:
Total of 18,629 critically ill patients requiring large-volume resuscitation.

INTERVENTIONS:
Five percent of albumin in addition to saline versus 0.9% saline.

MEASUREMENTS AND MAIN RESULTS:
After excluding patients with acute kidney injury prior to large-volume resuscitation, 673 of 2,428 patients (27.7%) and 1,814 of 16,201 patients (11.2%) received 5% albumin in H08 and H15, respectively. Use of 5% albumin was associated with decreased 30-day mortality by multivariate regression in H08 (odds ratio 0.65; 95% CI 0.49–0.85; p = 0.002) and in H15 (0.52; 95% CI 0.44–0.62; p < 0.0001) but was associated with increased acute kidney injury in H08 (odds ratio 1.98; 95% CI 1.56–2.51; p < 0.001) and in H15 (odds ratio 1.75; 95% CI 1.58–1.95; p < 0.001). However, 5% albumin was not associated with persistent acute kidney injury and resulted in decreased major adverse kidney event at 30, 90, and 365 days. Propensity matched analysis confirmed similar associations with mortality and acute kidney injury.

CONCLUSIONS:
During large-volume resuscitation, 5% albumin was associated with reduced mortality and major adverse kidney event at 30, 90, and 365 days. However, a higher rate of acute kidney injury of any stage was observed that did not translate into persistent renal dysfunction.
The Diagnostic Yield of Routine Admission Blood Cultures in Critically Ill Patients
Authors: Verboom Diana M. , van de Groep Kirsten , Boel C. H. Edwin , Haas Pieter Jan A. , Derde Lennie P. G. , Cremer Olaf L. , Bonten Marc J. M. 
Published: November 2020

OBJECTIVES:
Although the Surviving Sepsis Campaign bundle recommends obtaining blood cultures within 1 hour of sepsis recognition, adherence is suboptimal in many settings. We, therefore, implemented routine blood culture collection for all nonelective ICU admissions (regardless of infection suspicion) and evaluated its diagnostic yield.

DESIGN:
A before-after analysis.

SETTING:
A mixed-ICU of a tertiary care hospital in the Netherlands.

PATIENTS:
Patients acutely admitted to the ICU between January 2015 and December 2018.

MEASUREMENTS AND MAIN RESULTS:
Automatic orders for collecting a single set of blood cultures immediately upon ICU admission were implemented on January 1, 2017. Blood culture results and the impact of contaminated blood cultures were compared for 2015–2016 (before period) and 2017–2018 (after period). Positive blood cultures were categorized as bloodstream infection or contamination. Blood cultures were obtained in 573 of 1,775 patients (32.3%) and in 1,582 of 1,871 patients (84.5%) in the before and after periods, respectively (p < 0.0001), and bloodstream infection was diagnosed in 95 patients (5.4%) and 154 patients (8.2%) in both study periods (relative risk 1.5; 95% CI 1.2–2.0; p = 0.0006). The estimated number needed to culture for one additional patient with bloodstream infection was 17. Blood culture contamination occurred in 40 patients (2.3%) and 180 patients (9.6%) in the before period and after period, respectively (relative risk 4.3; 95% CI 3.0–6.0; p < 0.0001). Rate of vancomycin use or presumed episodes of catheter-related bloodstream infections treated with antibiotics did not differ between both study periods.

CONCLUSIONS:
Implementation of routine blood cultures was associated with a 1.5-fold increase of detected bloodstream infection. The 4.3-fold increase in contaminated blood cultures was not associated with an increase in vancomycin use in the ICU.
Tyrosine kinase inhibitors as induction therapy in nonsmall-cell lung cancer
Authors: Gong Juejun , Zhang Li 
Published: November 2020

Purpose of review
TKI therapy has shown excellent efficacy and favorable tolerability in patients with mutation-positive nonsmall cell lung cancer. However, there is no clear consensus on the role of TKI as induction therapy. In this article, we reviewed recently published studies to analyze the benefits of tyrosine kinase inhibitors, in particular, EGFR TKIs and ALK TKIs, as inducible treatments for NSCLC.

Recent findings
Several clinical trials have recently presented their latest data, giving analysis of patient's survival benefits and adverse events. Initial results have demonstrated promising efficacy and safety data. Some clinical case reports and retrospective analysis demonstrated that EGFR/ALK TKIs can significantly improve PFS and the rate of radical surgery. However, there was no statistically significant difference in overall survival time of almost all clinical trials.

Summary
TKIs are increasingly accepted by clinicians as induction therapy in NSCLC. Many studies have demonstrated that neoadjuvant therapy increases the likelihood of surgery and is associated with good resection rates, as evidenced by high prospective downstaging rates in patients with locally advanced NSCLC. However, the risk of recurrence remains high with no evidence of overall survival benefits being reported. Now that more clinical trials are being conducted and more data will be available for analysis, a clearer and more comprehensive view of what role TKIs play in induction therapy will emerge.
Lung cancer in China: current and prospect
Authors: Wu Fengying , Wang Lei , Zhou Caicun 
Published: November 2020

Purpose of review
To describe the current status of lung cancer in China, including incidence, prevention, molecular testing and treatment.

Recent findings
Lung cancer presents a major public health issue and an enormous burden on society in China, because of its increasing incidence and high mortality. Several distinct gene profiles were associated with lung cancer in China: high EGFR mutation rate, low KRAS mutation rate and more comorbidity of HBV infection. Thus, local Chinese Society of Clinical Oncology Guidelines with more consideration of drug accessibility, regional development differences were highly recommended for clinical practice. For treatment, targeted therapy has achieved fruitful progress. Immunotherapy in China was a little bit lag behind previously and now there is a surge of immunotherapeutic drugs under investigation. For future, more preventive strategies and more trials considering chrematistics of Chinese lung cancer are needed.

Summary
There are achievements and shortcomings for lung cancer prevention and treatment in China. More work considering distinct characteristic of lung caner in China are needed.
Laser Plume From Human Papillomavirus–Infected Tissue: A Systematic Review
Authors: Cox Surget V. , Dobry Allison S. , Zachary Christopher B. , Cohen Joel L. 
Published: November 2020

BACKGROUND
Laser procedures are becoming more prevalent across multiple medical specialties for a variety of indications. The plumes created by these lasers have raised concern for the dissemination of an infectious material.

OBJECTIVE
To review and summarize the information on viral dissemination in laser plumes available in the literature.

MATERIALS AND METHODS:
Data Sources A systematic review was performed on English and non-English articles using the PubMed and the Cochrane databases. A manual search of bibliographies from relevant articles was also performed to collect additional studies.

Study Selection
Only articles in the English language with full texts available that pertained to viral particles in laser plumes were included. Data Extraction Two authors performed independent article selections using predefined inclusion and exclusion criteria.

RESULTS
There have been case reports of possible transmission of human papillomavirus (HPV) by inhalation of laser-produced aerosols. Multiple investigators have attempted to recreate this scenario in the laboratory to qualify this risk. Others have conducted clinical experiments to determine the presence of HPV in laser plumes.

CONCLUSION
The current body of the literature suggests that laser surgeons are at a risk for HPV exposure by inhalation of laser-derived aerosols. We offer best practice recommendations for laser operators.