bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical stand-alone PEEK cage versus anchored cage with screws in single-level anterior cervical discectomy and fusion: A prospective cohort study
Authors: Khattab Mohamed Fawzy , Kotb Ahmed 
Published: February 2020

Background:
Anterior cervical discectomy and fusion (ACDF) is a gold standard procedure for surgical management of symptomatic cervical degenerative disc disease. Traditionally, iliac crest bone graft was used as a strut graft to fill the disc space after discectomy. However, several complications have been observed, including donor site hematoma, infection, and pain. A cage can be used as an alternative, but cage dislodgement can be a devastating complication. Some surgeons advocate plate application to augment the cage construct, but the incidence of dysphagia is much higher with longer operative times. An anchored cage with screws could reduce postoperative dysphagia and simultaneously fix the cage. This study compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage with the anchored cage with screws for single-level ACDF.

Methods:
This prospective study was conducted in 50 patients who underwent single-level ACDF for cervical degeneration, with radiculopathy or myelopathy, from January, 2012, to January, 2014, at a single institution. Follow-up was 2 yr. Twenty-one patients were allocated to the stand-alone cage group (group 1) and 29 to the anchored cage with screws group (group 2). The Neck Disability Index (NDI), Visual Analogue Scale (VAS) of the arm and neck, radiographic segmental cervical angle (CA), and disc height assessments were done preoperatively, at 6 mo, and at 2 yr postoperatively.

Results:
Clinical outcomes showed improvement in both groups. The change between final follow-up (24 mo) and 6 mo postoperative CA (P=0.01) and disc height (P=0.02) showed statistically better outcomes for the anchored cage group (group 2) than the stand-alone cage group (group 1). The VAS showed significant pain improvement in the stand-alone group (group 1) than in the anchored cage with screws group (group 2) at 2 yr. The NDI difference was highly significant (P=0.001) preoperatively and at 6 mo postoperatively in favor of group 2, but this did not persist at 2-year follow-up.

Conclusions:
For one-level ACDF, the anchored cage with screws has some advantage compared to the stand-alone PEEK cage in avoiding dysphagia and restoring disc space height and cervical lordosis. We suggest the anchored spacer may be a good substitute for the stand-alone cage in one-level ACDF.

Level of Evidence:
Level II
Improving Quality in the Treatment of Pediatric Forearm Fractures: Minimizing the Need for Repeat Intervention With Long-arm Extension Casting
Authors: Neal Kevin M. , Osterbur Todd A. , Kiebzak Gary M. 
Published: February 2020

Purpose:
Repeat intervention for pediatric forearm fractures after closed manipulation is as high as 46% with flexed elbow (FE) long-arm casts. Casting with the elbow extended (EE) has been advocated as an alternative technique. We documented outcomes of patients treated with closed manipulation and casting with EE long-arm casts for displaced, diaphyseal both-bone forearm fractures.

Methods:
We retrospectively reviewed charts for patients who had sedated manipulations and casting for closed, diaphyseal forearm fractures. Open fractures, immediate surgical intervention, metabolic bone disease, recurrent fractures, and Monteggia injuries were excluded. Closed manipulations were performed by orthopaedic residents assisted by cast technicians, with sedation provided by emergency department physicians. Radiographic angulation and displacement of the radius and ulna on immediate postreduction radiographs and all follow-up radiographs were recorded. Patients requiring repeat intervention were compared with those who did not by using the Mann-Whitney U and Fisher exact tests.

Results:
Of 86 patients (7.2±2.8 y) available for analysis, 82 (95.3%) completed treatment after a single-sedated manipulation and placement of an EE long-arm cast. There were no malunions or nonunions. The average follow-up was 50 days. Four (4.7%) patients required repeat interventions (2 had surgery, 1 had a repeat sedated manipulation, and 1 had a nonsedated manipulation). There were no statistically significant differences in age, sex, laterality, fracture position in the diaphysis, or immediate postreduction angulation of the radius or ulna. A literature review showed average repeat intervention rates of 14.9% (range, 0% to 45.9%) for FE casts and 3.3% (range, 0% to 15%) for EE casts.

Conclusions:
There was a low rate of repeat interventions (4.7%) in patients with EE casts compared with historical rates for FE casts. Improving the quality of health care involves identifying and implementing practices that provide the best outcomes at the lowest costs. The use of EE long-arm casts following closed manipulation of pediatric forearm fractures may decrease the rate of repeat manipulation or surgery compared with conventional FE casts.

Level of Evidence:
Level IV—case series.
Chronic Opioid Use Is Associated With Surgical Site Infection After Lumbar Fusion
Authors: Pirkle Sean , Reddy Srikanth , Bhattacharjee Sarah , Shi Lewis L. , Lee Michael J. 
Published: February 2020

Study Design.
Retrospective, database review.

Objective.
The purpose of this study was to explore the association between preoperative opioid use and postoperative infection requiring operative wound washout in elective lumbar fusion patients.

Summary of Background Data.
Numerous peer-reviewed publications have conducted multivariate analyses of risk factors for surgical site infection. However, few have explored preoperative opioid use. Opioids have been widely prescribed preoperatively for pain management, but their effect on postsurgical infection is currently inconclusive.

Methods.
We retrospectively queried the PearlDiver national insurance claims database and included patients from 2007 to 2017 with a history of lumbar fusion. Any interbody fusion history designated exclusion. We stratified patients by single or multilevel procedures and conducted univariate analyses of previously documented infection risk factors, as well as our variable of interest, chronic preoperative opioid use. Variables associated (P < 0.100) with the outcome measure of 90-day postoperative infection treated with operative irrigation and wound debridement were included in a multivariate analysis.

Results.
A total of 12,519 patients matched our inclusion criteria. Among the single-level cohort, only diabetes was observed to be associated with infection requiring operative wound washout and thus no subsequent regression was performed. For the cohort of patients who underwent multilevel fusion, chronic opioid use, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and hypertension trended toward significance in the univariate analysis and were included in a logistic regression model. In the multivariate analysis, chronic opioid use (odds ratio [OR] = 1.435, P = 0.025), diabetes (OR = 1.591 P = 0.003), and congestive heart failure (OR = 1.929, P = 0.003) were identified as independent risk factors for infection requiring operative wound washout.

Conclusion.
In this analysis, preoperative opioid use was significantly associated with infection requiring operative wound washout in multilevel lumbar fusion patients. Limiting opioid consumption may have the benefit of reducing the risk of infection following spine surgery.

Level of Evidence: 3
A Positive (+ve) Postoperative Upper Instrumented Vertebra Tilt Angle (≥0°) Significantly Increases the Risk of Medial Shoulder and Neck Imbalance in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients
Authors: Kwan Mun Keong , Lee Sin Ying , Ch’ng Pei Ying , Chung Weng Hong , Chiu Chee Kidd , Chan Chris Yin Wei 
Published: February 2020

Study Design.
Retrospective study.

Objective.
To investigate the relationship between a +ve postoperative Upper Instrumented Vertebra (UIV) (≥0°) tilt angle and the risk of medial shoulder/neck and lateral shoulder imbalance among Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) patients following Posterior Spinal Fusion.

Summary of Background Data.
Current UIV selection strategy has poor correlation with postoperative shoulder balance. The relationship between a +ve postoperative UIV tilt angle and the risk of postoperative shoulder and neck imbalance was unknown.

Methods.
One hundred thirty-six Lenke 1 and 2 AIS patients with minimum 2 years follow-up were recruited. For medial shoulder and neck balance, patients were categorized into positive (+ve) imbalance (≥+4°), balanced, or negative (−ve) imbalance (≤−4°) groups based on T1 tilt angle/Cervical Axis measurement. For lateral shoulder balance, patients were classified into +ve imbalance (≥+3°) balanced, and −ve imbalance (≤−3°) groups based on Clavicle Angle (Cla-A) measurement. Linear regression analysis identified the predictive factors for shoulder/neck imbalance. Logistic regression analysis calculated the odds ratio of shoulder/neck imbalance for patients with +ve postoperative UIV tilt angle.

Results.
Postoperative UIV tilt angle and preoperative T1 tilt angle were predictive of +ve medial shoulder imbalance. Postoperative UIV tilt angle and postoperative PT correction were predictive of +ve neck imbalance. Approximately 51.6% of patients with +ve medial shoulder imbalance had +ve postoperative UIV tilt angle. Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance and 3.3 times increased odds of developing +ve neck imbalance. Postoperative UIV tilt angle did not predict lateral shoulder imbalance.

Conclusion.
Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance (T1 tilt angle ≥+4°) and 3.3 times increased odds of developing +ve neck imbalance (cervical axis ≥+4°).

Level of Evidence: 4
Risk Factors and Assessment Using an Endoscopic Scoring System for Early and Persistent Dysphagia After Anterior Cervical Decompression and Fusion Surgery
Authors: Ohba Tetsuro , Hatsushika Kyousuke , Ebata Shigeto , Koyama Kensuke , Akaike Hiroshi , Yokomichi Hiroshi , Masuyama Keisuke , Haro Hirotaka 
Published: February 2020

Study Design:
Prospective study.

Objectives:
Preoperative and postoperative dysphagia was evaluated by an otolaryngology doctor and a speech-language-hearing therapist using the eating assessment tool (EAT-10) and Hyodo-Komagane scores. The objective was to achieve a more precise evaluation of the incidence and risk factors of early and persistent dysphagia after anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:
Although numerous reports have explored the risk factors for dysphagia after ACDF, these factors remain controversial. The main reason for this situation is that the methods for evaluating dysphagia are not adequate or uniform.

Materials and Methods:
This study involved a retrospective 47 consecutive patients who had undergone ACDF and been followed up for at least 1 year. Sagittal alignment of the cervical spine was evaluated by a preoperative x-ray. Univariate and multivariate logistic regression analyses were performed to determine risk factors for transient or persistent dysphagia.

Results:
The study showed that 34% of patients developed dysphagia in the early postoperative period and that 25.5% of patients still had persistent dysphagia 1 year postoperatively. 8.5% of patients had already developed dysphagia preoperatively, with a significant positive correlation observed between preoperative and postoperative dysphagia.
Aging and smoking were significant risk factors for transient dysphagia. A preoperative cervical kyphotic angle at the C3/C4, C4/C5 disk-level and change in the kyphotic angle at C4/C5 during surgery were significant risk factors of persistent dysphagia 1 year after surgery.

Conclusions:
This is the first study to show dysphagia after anterior cervical spine surgery using the EAT-10 score and Hyodo-Komagane score with endoscopic evaluation. Aging and smoking were significant risk factors for transient dysphagia, while preoperative local kyphosis angles of C3–C4 and C4–C5 and change in the kyphotic angle at C4/C5 during surgery may be a key alignment of risk factors for postoperative persistent dysphagia.

Level of Evidence:
Level: III.
Dissecting the spatial bone marrow microenvironment of hematopoietic stem cells
Authors: Kokkaliaris Konstantinos D. 
Published: February 2020

Purpose of review
Hematopoietic stem cells (HSCs) reside in specialized anatomical microenvironments within the bone marrow space, termed HSC niches. Different bone marrow imaging modalities have been utilized to visualize HSCs in situ, and unravel the cellular identity of bone marrow cell types located in their immediate proximity. However, despite extensive research, the exact identity of bone marrow populations that physically associate with HSCs remains controversial.

Recent findings
Recent advances in volumetric imaging enable precise identification of bone marrow populations and their spatial distribution both at tissue-wide scale and single-cell resolution. In addition, single-cell RNA sequencing and mass-cytometry-based approaches dissect the complexity of the bone marrow microenvironment with unprecedented resolution. Here, we review current concepts regarding bone marrow populations that physically associate with HSCs and recent efforts to localize HSCs and their niche populations.

Summary
Defining the bone marrow cell types in the immediate proximity of HSCs in homeostasis and stress is key to determine the cellular and molecular cues driving HSC maintenance and regeneration.
Enhanced recovery after cesarean delivery: a challenge for anesthesiologists
Authors: Liu Zhi-Qiang , Du Wei-Jia , Yao Shang-Long 
Published: February 2020

AbstractEnhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.
ACR–ASTRO Practice Parameter for the Performance of Proton Beam Radiation Therapy
Authors: Shih Helen A. , Rengan Ramesh , Apisarnthanarax Smith , Cheng Chee-Wai , Daartz Juliane , DeLaney Thomas F. , Hartsell William F. , Indelicato Daniel J. , Keole Sameer R. , Rosenthal Seth , Hartford Alan C. 
Published: February 2020

Aim/Objectives/Background:
The American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for proton beam radiation therapy. Proton radiotherapy is the application of a high-energy proton beam to a patient in a clinical setting with therapeutic intent. Proton radiotherapy may permit improved therapeutic ratios with lower doses to sensitive normal structures and greater dose to target tumor tissues.

Methods:
A literature search was performed to identify published articles regarding clinical outcomes, reviews, quality assurance methodologies, and guidelines and standards for proton radiation therapy. Selected articles are referenced in the text. The following recommendations are based on firsthand experiences of multiple clinical authorities who employ proton therapy and have been peer reviewed by experts at different practicing institutions.

Results:
This practice parameter is developed to serve as a tool in the appropriate application of this evolving technology in the care of cancer patients or other patients with conditions where radiation therapy is indicated. It addresses clinical implementation of proton radiation therapy, including personnel qualifications, quality assurance standards, indications, and suggested documentation.

Conclusions:
This practice parameter is a tool to guide technical use of proton therapy and does not assess the relative clinical indication of proton radiotherapy when compared with other forms of radiotherapy, but to focus on the best practices required to deliver proton therapy safely and effectively, when clinically indicated. Costs of proton treatments are high, and the economic costs of proton radiotherapy may also need to be considered.
A Split-Scar Study Investigating the Effectiveness of Early Intervention With Electroabrasion on Improving the Cosmetic Appearance of Postsurgical Scars
Authors: Kannan Swati , de Golian Emily , Lee Nayoung , Smith Jonathan , Brian Jiang Shang I. 
Published: February 2020

BACKGROUND
Electroabrasion, which uses an in-office electrosurgical device, is a method of surgical planning that ablates the skin to the papillary dermis. Several reports demonstrate that intraoperative ablative interventions with lasers or dermabrasion can modulate scar formation more effectively. This investigation uses electroabrasion intraoperatively to mitigate scar formation.

OBJECTIVE
To evaluate the effectiveness of intraoperative electroabrasion for scar revision.

MATERIALS AND METHODS
This was a prospective, randomized, observer-blinded, split-scar study with 24 linear scar segments resulting from primary closures in patients undergoing Mohs micrographic surgery. After placement of dermal sutures, half of the wound was randomly treated with electroabrasion. The other half was used as the control. Scar appearance was assessed by a blinded observer and by the patient using the Patient and Observer Scar Assessment Scale at 1 to 2 weeks, 1 month, and 3 months after surgery.

RESULTS
At the 3-month follow-up, both patient and observer variables measuring scar contour improved on the treated side, whereas erythema was worse. Overall, no difference was seen in total scores between the 2 sides.

CONCLUSION
Based on this pilot study, scars treated with electroabrasion revealed improved surface topography but worsened erythema. Future studies with more refined electrosurgical settings are needed for further evaluation.
THE RAP STUDY, REPORT TWO
Authors: Haj Najeeb Bilal , Deak Gabor , Schmidt-Erfurth Ursula , Gerendas Bianca S. 
Published: February 2020

Purpose:
To explore the regional distribution of macular neovascularization type 3 (MNV3).

Methods:
Seventy-eight eyes of 78 patients were reviewed. We defined the location of each lesion after applying a modified ETDRS grid and the incidence of simultaneous MNV1 or 2. Also, we investigated the distribution of MNV3 at the outline of the foveal avascular zone and when the diameter of foveal avascular zone was less than 325 µm.

Results:
The distribution of MNV3 was 4 lesions (5%) from the center to 500 µm, 72 (92%) from 500 µm to 1500 µm, and 2 (3%) from 1,500 µm to 3000 µm. The distribution in respect of the ETDRS fields was 7 (9%) nasal, 16 (20%) superior, 32 (40%) temporal, and 23 (31%) inferior. No additional MNV1 or 2 were found elsewhere. Most lesions tended to distribute along straight bands radiating from the perifoveal area, mainly in the temporal half (72%). None of the cases had MNV3 at the boundary of the foveal avascular zone. Only five cases had foveal avascular zone diameter of less than 325 µm, the closest lesion was 425 µm away from the center.

Conclusion:
MNV3 lesions are most likely neither symmetrical nor uniformly distributed. They have a higher affinity to distribute radially in the temporal perifoveal area.
BILATERAL PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER CARDIOPULMONARY BYPASS
Authors: Michalak Suzanne M. , Mukherjee Nisha , Gospe Sidney M. 
Published: February 2020

Purpose:
To report the first two observations of bilateral paracentral acute middle maculopathy in the early postoperative period after cardiopulmonary bypass procedures.

Methods:
Comprehensive ophthalmic examinations were performed, including best-corrected visual acuity, Humphrey visual field testing, dilated fundus examination, and optical coherence tomography.

Results:
Two patients complained of unilateral vision loss after cardiac surgery involving cardiopulmonary bypass. Unilateral optic disc edema consistent with ischemic optic neuropathy was observed in the symptomatic eye of each patient, whereas scattered cotton-wool spots were identified bilaterally. In addition, optical coherence tomography imaging revealed bilateral paracentral acute middle maculopathy, correlating with visual field defects detected on automated perimetry in the asymptomatic eyes.

Conclusion:
Although symptomatic postoperative vision loss is a rare complication of cardiac surgery, intraoperative retinal microvascular nonperfusion as a consequence of extracorporeal circulation of blood may be a more common and under-recognized occurrence.
Identification of key genes and their functions in palbociclib-resistant breast carcinoma by using bioinformatics analysis
Authors: Gao Guangyu , Shi Xinya , Yao Zhen , Shen Jiaofeng , Shen Liqin 
Published: February 2020

Background:
Palbociclib resistance is a significant problem in breast carcinoma, and its underlying molecular mechanisms remain poorly understood. This study aims to elucidate the molecular mechanisms of palbociclib resistance and to identify the key genes and pathways mediating progesterone resistance in breast cancer (BC).

Methods:
Gene dataset GSE117743 was downloaded from the Gene Expression Omnibus (GEO) database, which included 3 palbociclib-resistant and 3 palbociclib-sensitive BC cell lines. Then, we calculated the differentially expressed genes (DEGs) by using R software. Gene ontology and Enriched pathway analysis of genes we identified were analyzed by using the Database for Database of Annotation Visualization and Integrated Discovery (DAVID) and R software. The protein-protein interaction network was performed according to Metascape, String, and Cytoscape software.

Results:
In total, 447 DEGs were selected, which consisted of 67 upregulated and 380 downregulated genes. According to gene ontology annotation, DEGs were associated with cytoplasm, signal transduction, and protein binding. The research of the Kyoto Encyclopedia of Genes and Genomes (KEGG) demonstrated that genes enriched in certain tumor pathways, including IL-17 signaling pathways and Herpes simplex infection signaling pathways. Also, certain hub genes were highlighted after constructed and analyzed the protein-protein interaction network, including α-2A adrenergic receptor, cytochrome P450 subfamily IIR polypeptide, Cystathionine β-synthase, nucleotide-binding oligomerization domain-containing, erythropoietin-producing hepatocellular receptor A2 and adrenomedullin, which may be related with BC prognosis. A total of 4 of 6 hub genes had a significant relationship with the overall survival (P<0.05).

Conclusions:
Using microarray and bioinformatics analyses, we identified DEGs and determined a comprehensive gene network of progesterone resistance. We offered several possible mechanisms of progesterone resistance and identified therapeutic and prognostic targets of palbociclib resistance in BC.