bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Upper Instrumented Vertebra Horizontalization
Authors: Wang Yu , Shi Benlong , Liu Zhen , Sun Xu , Qiao Jun , Wang Bin , Qiu Yong , Zhu Zezhang 
Published: May 2020

Study Design.
A retrospective study.

Objective.
To determine the significance of postoperative upper instrumented vertebra (UIV) horizontalization on the evolution of proximal compensatory curve after hemivertebra resection and short fusion in young patients with lumbosacral hemivertebra (LSHV).

Summary of Background Data.
Postoperative compensatory curve progression (CCP) is an undesired complication in patients undergoing spinal fusion. Posterior-only hemivertebra resection and short fusion has gradually become a preferred treatment for young patients with LSHV. Postoperative UIV horizontalization might play an important role in the behavior of compensatory curve after surgery.

Methods.
This study reviewed a consecutive series of patients undergoing posterior-only LSHV resection and short fusion from August 2006 to June 2016. The radiographic parameters were measured at preoperation, immediately postoperation, and the last follow-up. Based on the immediately postoperative UIV tilt, patients were divided into horizontal group (UIV tilt < 5°) and inclined group (UIV tilt ≥5°). Postoperative CCP was defined as the Cobb angle of compensatory curve increased more than 10° than the immediately postoperative value.

Results.
Forty-eight patients (8.1 ± 3.4 yrs) were recruited. Seventeen patients with immediately postoperative UIV tilt more than or equal to 5° constituted the inclined group, while the other 31 patients were in horizontal group. The two groups had similar age, fusion levels, preoperative spinal curvatures, and sagittal profiles. Compared with horizontal group, patients in inclined group had greater CBD (20.7 ± 14.8 mm vs. 13.2 ± 9.9 mm, P = 0.041) and greater Cobb angle of compensatory curve (17.7 ± 8.2° vs. 9.1 ± 5.3°, P < 0.001) at the last follow-up. Thirteen patients of inclined group experienced postoperative CCP, which was more prevalent than that in horizontal group (76.5% vs. 9.7%, P < 0.001).

Conclusion.
Horizontalizing the UIV can reduce the risk of postoperative CCP in LSHV patients undergoing posterior-only hemivertebra resection and short fusion.

Level of Evidence: 3
Outcomes of Minimally Invasive versus Open Surgery for Intermediate to High-grade Spondylolisthesis
Authors: Lak Asad M. , Abunimer Abdullah M. , Rahimi Amina , Tafel Ian , Chi John , Lu Yi , Groff Michael , Zaidi Hasan A. 
Published: May 2020

Study Design.
Retrospective cohort study.

Objective.
The primary objective of our study was to evaluate the surgical outcomes and complications of minimally invasive surgery (MIS) versus open surgery in the management of intermediate to high grade spondylolisthesis, and secondarily to compare the outcomes following MIS in-situ fusion versus MIS reduction and open in-situ fusion versus open reduction subgroups.

Summary of Background Data.
High-grade spondylolisthesis is a relatively rare spine pathology with unknown prevalence. The optimal management and long-term prognosis of high-grade spondylolisthesis remain controversial.

Methods.
A multicenter, retrospective cohort study of adult patients who were surgically treated for grade II or higher lumbar or lumbosacral spondylolisthesis from January 2008 until February 2019, was conducted.

Results.
A total of 57 patients were included in this study. Forty cases were treated with open surgery and 17 with MIS. Specifically, seven patients underwent MIS in-situ fusion, 11 patients open in-situ fusion, an additional 10 patients underwent MIS reduction, and 29 had open reduction. Patients who underwent open surgery had significantly better pain relief at short-term follow-up with no statistically significant difference in the rate of complications (25% vs. 35.2%, P = 0.44), as compared with MIS. The most common complications were related to instrumentation (17.7%), followed by neurological complications (14.5%), wound infection/dehiscence (6.5%), and post laminectomy syndrome (1.6%). The average follow-up time was 9.1 ± 6.2 months. In a subgroup comparison, the complication rate in the open in-situ fusion (36.3%) versus open reduction (20.6%) subgroup was non-significant (P = 0.42). However, complication rate in the MIS reduction group (55%) was significantly higher than MIS in-situ fusion (P = 0.03).

Conclusion.
MIS reduction is associated with a higher rate of complications in the management of grade II or higher lumbar or lumbosacral spondylolisthesis. The management of this complex pathology may be better addressed via traditional open surgery.

Level of Evidence: 3
Intra- and Post-Complications of Cervical Laminoplasty for the Treatment of Cervical Myelopathy
Authors: Mesregah Mohamed Kamal , Buchanan Ian A. , Formanek Blake , Wang Jeffrey C. , Buser Zorica 
Published: May 2020

Study Design.
Retrospective database study.

Objective.
To assess the intra- and postoperative complications of cervical laminoplasty and to evaluate the effect of intraoperative neuromonitoring use on postoperative limb paralysis incidence.

Summary of Background Data.
Cervical laminoplasty is a known procedure for the management of cervical spondylotic myelopathy (CSM).

Methods.
This was a retrospective study of 532 patients with CSM who underwent cervical laminoplasty between 2007 and the first quarter of 2016 using the Humana subset of the PearlDiver Database. The database was queried using the relevant International Classification of Diseases (ICD-9 and ICD-10) codes for CSM and Current Procedural Terminology (CPT) codes for cervical laminoplasty. The intra- and postoperative incidence of surgical and medical complications and reoperations was then determined and was compared with a propensity score-matched cohort of patients who had posterior laminectomy and fusion (490 patients in each group), using multivariate logistic regression analysis.

Results.
Laminoplasty was associated with a lower incidence of dysphagia (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.16–0.79; P = 0.014), 30-day readmission (OR = 0.51, 95% CI = 0.35–0.75; P < 0.001), urinary tract infection (OR = 0.58, 95% CI = 0.37–0.93; P = 0.023), and incision and drainage, exploration or evacuation (OR = 0.28, 95% CI = 0.08–0.79; P = 0.026). The use of intraoperative neuromonitoring was associated with a non-significant lower incidence of limb paralysis within 1 and 3 months postoperatively (OR = 0.52 and 0.51, 95% CI = 0.23–1.19 and 0.23–1.11; P = 0.119 and 0.091, respectively).

Conclusion.
Compared with posterior laminectomy and fusion, laminoplasty had lower rates of dysphagia, urinary tract infection, and 30-day readmission. The use of intraoperative neuromonitoring was associated with a lower risk of postoperative limb paralysis, but it did not achieve statistical significance.

Level of Evidence: 4
Tropomyosin receptor kinase inhibitors in the management of sarcomas
Authors: Wilding Christopher P. , Loong Herbert H. , Huang Paul H. , Jones Robin L. 
Published: May 2020

Purpose of review
Genetic aberrations resulting in tropomyosin receptor kinase (TRK) fusion proteins can drive oncogenesis and are postulated to occur in up to 1% of solid tumours. However, TRK fusions in adult sarcomas are rare and there is a significant challenge in identifying patients with sarcomas harbouring TRK fusions in the clinical setting. Despite a recent European Society of Medical Oncology consensus article regarding screening of tumours for TRK fusions, economical and practical limitations present a barrier to widespread screening of sarcomas.

Recent findings
Larotrectinib and entrectinib are pan-TRK inhibitors which have both received FDA approval for the management of solid tumours harbouring NTRK fusions. Initial results of a number of clinical trials have demonstrated promising efficacy and safety data, including dramatic and durable responses in patients with sarcomas. As such, TRK inhibitors represent a promising treatment option in a small cohort of adult sarcoma patients, where currently treatment options are limited. The emergence of acquired resistance is a concern associated with TRK inhibitor therapy and a number of second-generation agents targeting TRK kinase mutations driving acquired resistance have entered early-phase clinical trials.

Summary
With the growing appreciation of the implications of TRK fusions, this review will summarize the emerging clinical trial data of TRK inhibitors in sarcomas. Although in their infancy, clinical trial results are encouraging, and as further results and analyses are released, we will have a greater understanding of their impact on clinical practice and the management of patients with sarcomas.
Clinical efficacy of the modified Helicobacter pylori eradication therapy for Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: a meta analysis
Authors: Xie Ya-Lin , He Chun-Yan , Wei Si-Qi , Guan Wen-Ju , Jiang Zheng 
Published: May 2020

AbstractBackgroundHelicobacter pylori(HP) has been considered to be one of the primary causes of gastric mucosa-associated lymphoid tissue (MALT) lymphoma since 1993. Low-grade gastric MALT lymphoma with HP is widely treated with HP eradication therapy, according to each specific clinical situation. However, several studies and guidelines indicate that the modified HP eradication therapy is also valid for HP-negative gastric MALT lymphoma. The aim of this study was to perform a meta-analysis of the clinical efficacy of the modified HP eradication therapy for gastric MALT lymphoma without HP.MethodsWe searched studies that reported the response rate of the modified HP eradication therapy regimen for gastric MALT lymphoma without HP by using PubMed, Medline, and Ebsco from January 1971 until February 2019. All statistical analyses were carried out using R 3.5.3 (Mathsoft Company, Cambridge, MA, USA). The pooled response rate was expressed as a decimal. The heterogeneity test was performed using theI-squared (I2) statistic.ResultsA total of 14 studies were selected with a total of 148 patients with HP-negative gastric MALT lymphoma. The overall pooled response rate was 0.38 (95% confidence interval [CI]: 0.29–0.47). The combined estimate isI2 = 57% (P < 0.01). The study subjects were categorized by factors (area of patients). The pooled response rate of the sub-groups (Korea, Japan, China, and Western countries) was 0.63 (95% CI: 0.50–0.76), 0.16 (95% CI: 0.05–0.30), 0.38 (95% CI: 0.20–0.55), and 0.57 (95% CI: 0.08–1.00). The response rate showed that the modified HP eradication therapy was effective for patients with HP-negative gastric MALT lymphoma, especially in Korea and Western countries.ConclusionTherefore, the modified HP eradication therapy can be considered an optional therapy for patients with low-grade HP-negative gastric MALT lymphoma. However, several limitations were revealed in the meta-analysis. Further systematic reviews and research are required.
What's in the Neuromuscular Junction Literature?
Authors: Lacomis David 
Published: May 2020

AbstractFour retrospective studies from the United States, Europe, and Asia address outcomes in juvenile myasthenia gravis. Common features include earlier onset with ocular myasthenia gravis (MG) and generally good outcomes overall. Patients who were seronegative, had equivocal acetylcholine receptor (AChR) antibodies, or had only clustered AChR antibodies had better outcomes. An article highlighting the utility of median nerve slow-repetitive stimulation is reviewed and another showing the high sensitivity of repetitive nerve stimulation in myasthenic crisis is covered. Two articles address the thymus and thymectomy in non-AChR antibody-positive autoimmune MG. Longer term data on eculizumab as well as studies of cyclophosphamide, rituximab, and tacrolimus are summarized. Other topics include the possible role of statins in MG and central nervous system autoimmune comorbidities.
Infraglottic versus supraglottic jet-ventilation for endobronchial ultrasound-guided transbronchial needle aspiration
Authors: Anwar Maria , Fritze Robert , Base Eva , Wasserscheid Thomas , Wolfram Nadja , Koinig Herbert , Hackner Klaus , Lambers Christopher , Schweiger Thomas , Errhalt Peter , Hoda Mir A. 
Published: May 2020

BACKGROUND
For endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under general anaesthesia, both rigid bronchoscopy and laryngeal masks (LMAs) with superimposed high-frequency jet ventilation can be used. Despite the fact that in Europe rigid bronchoscopy for EBUS-TBNA is still widely used, an increasing number of centres use jet ventilation via the LMA for this procedure. To our knowledge no clinical trials have ever been made to compare these two methods. This trial aimed to evaluate whether patients recover from the procedure more quickly when a LMA is used for ventilation compared with rigid bronchoscopy where muscle relaxants and deep anaesthesia are required.

OBJECTIVES
We wanted to test the hypothesis that there is no difference in the postoperative recovery of patients in the postanaesthesia care unit (PACU) after EBUS-TBNA with jet ventilation via a rigid bronchoscope and a LMA. Secondary outcomes were the difference of duration of anaesthesia, the diagnostic outcome of the procedure and drug quantities for both groups.

DESIGN
Prospective randomised single blinded two centre controlled trial.

SETTING
Two centres in Austria participated. Patients were enrolled from December 2016 until January 2018.

PATIENTS
Ninety patients for elective EBUS-TBNA were enrolled and assigned to one of two intervention groups. Two patients were excluded before and eleven patients were excluded after EBUS-TBNA. Seventy-seven were analysed.

INTERVENTIONS
Patients assigned to group 1 were ventilated with a LMA; those assigned to group 2 were ventilated via a rigid bronchoscope. Vital signs, drug dosage, duration of anaesthesia, recovery, PACU stay and Aldrete score at the PACU were recorded.

MAIN OUTCOME MEASURES
The primary endpoint was an integral over time of a modified Aldrete score. Secondary endpoints were the durations of the interventions, the recovery from anaesthesia and PACU stay, initial and mean Aldrete values at PACU, the effect site concentration of Propofol according to the Schnider pharmacokinetic model, the peak ultiva rates and the diagnostic outcome.

RESULTS
We were not able to show any significant difference regarding the postoperative recovery criteria based on the Aldrete score, the durations measured and the diagnostic outcomes. Vital signs remained stable and in an equal range in both groups. There were no differences in the mean effect site propofol concentration and the peak ultiva rates.

CONCLUSION
EBUS-TBNA under general anaesthesia using a LMA with SHJV is equal to rigid bronchoscopy with superimposed high-frequency jet ventilation for the variables analysed.

TRIAL REGISTRATION
ISRCTN (ISRCTN58911367).
Gynecologic surgery tracking in obstetrics and gynecology residency
Authors: Siedhoff Matthew T. , Truong Mireille D. , Wright Kelly N. 
Published: May 2020

Purpose of review
This review aims to describe the influence of changes in obstetrics and gynecology on residency training and how tracking may help address emerging concerns around quality and safety in gynecologic surgery.

Recent findings
As has been shown in a variety of other surgical fields, recent evidence confirms that surgeries with higher volume gynecologists are associated with fewer complications, decreased cost, and an increase in use of minimally invasive surgery. Attending physicians and residents feel graduating obstetrics and gynecology (OB/GYN) trainees are unprepared to perform major surgery independently. Tracking has demonstrated tremendous success in general surgery, enriching trainee careers, allowing for increased operative and clinical experiences, enhancing autonomy, and improving mentorship, all while achieving equivalent or improved milestone achievement, case numbers, and board certification. A majority of medical students, residents, and OB/GYN residency program directors support tracking in OB/GYN. Currently, a single OB/GYN program provides tracking in the United States, with measurable success similar to that seen in general surgery.

Summary
Enhanced surgical volume results in better outcomes in gynecologic surgery, but current training models are insufficient to meet these volume demands. Tracking provides an attractive solution to create a more appropriate practicing model for physicians in women's health.
Prelaminated Supraclavicular Island Flap for Total Ear Reconstruction: A New Technique
Authors: Alves Hélio R. N. , de Rodriguez Juan Felippe G. U. M. , Fernandes Thadeu R. R. , Busnardo Fábio F. , Besteiro Júlio M. , Cernea Cláudio Roberto , Gemperli Rolf 
Published: May 2020

Summary:
Major ear reconstruction has progressed over the past years with the emergence of new techniques directed mainly to patients without available or usable local skin. However, microsurgical transfer requires specific training and eligible patients. The authors report a successful ear reconstruction with a prelaminated supraclavicular island flap in 3 stages, which may be a valuable resource for selected patients or when microsurgery is not available. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.
Risk Factors for Capsular Contracture: A Retrospective Study in Immediate Reconstruction versus Delayed Reconstruction
Authors: de Kerckhove Maiko , Iwahira Yoshiko 
Published: May 2020

Background:
Capsular contracture is a common complication among breast implant reconstruction patients. The aim of this study was to assess the duration of and risk factors associated with capsular contracture by comparing 2 reconstruction methods.

Methods:
The medical charts of patients who received a reconstructed breast implant and underwent a capsule revision surgery were retrospectively reviewed. We examined patients’ background, skin expansion duration, time taken until capsule revision surgery, tissue expander/implant size, and postoperative complications.

Results:
Of the total 74 breasts [42 immediate reconstruction (Immediate) and 32 delayed reconstruction (Delayed) breasts], the age at the revision surgery was significantly older in the Delayed (59 years) than in the Immediate category (50 years; P = 0.002). The time taken until the capsule revision surgery was significantly shorter for the Immediate (63.5 months) than for the Delayed (121 months; P < 0.0001). The postoperative complication rate after expander insertion was significantly higher in the Immediate (62.5%) than in the Delayed (21.1%; P < 0.0001). The size of the expander and implant was significantly smaller in the Immediate (expander, 300 mL; implant, 240 mL) than in the Delayed (expander, 400 mL; implant, 300 mL) (expander, P = 0.008; implant, P = 0.004).

Conclusions:
The immediate reconstruction breasts had a shorter time to capsule revision surgery than the delayed reconstruction breasts. Our study suggested that the shorter time in immediate reconstruction was affected by postoperative complications after mastectomy with expander insertion and by selection of a smaller sized expander and implant.
Succession Planning in Healthcare: Myths, Realities, and Practical Advice
Authors: Schlichting Nancy M. 
Published: May 2020

SUMMARY
Succession planning appears to be a logical and essential component of human resources and leadership planning. However, the complexities and requirements of a successful succession planning process are significant and generally not well understood. Perhaps for this reason, succession planning often yields disappointing results. It is inherently an imperfect management process—as seen, for example, when an identified internal successor leaves an organization for a more immediate opportunity elsewhere. My experiences as CEO of Henry Ford Health System for 14 years and as chair of three compensation committees (for two public companies and one foundation) have given me a unique understanding of the challenges and opportunities of succession planning. This article highlights the myths, realities, and building blocks of effective succession planning in healthcare organizations.
What is the optimal blood pressure level for patients with atrial fibrillation treated with direct oral anticoagulants?
Authors: Minhas Jatinder S. , Coles Briana , Mistri Amit K. , Eveson David J. , Hussain Shazia T. , Potter John F. , Khunti Kamlesh , Robinson Thompson G. 
Published: May 2020

Objective:
Limited data exist to inform blood pressure (BP) thresholds for patients with atrial fibrillation prescribed direct oral anticoagulants (DOAC) therapy in the real world setting.

Methods:
SBP was measured in 9051 primary care patients in England on DOACs for atrial fibrillation with postinitiation BP levels available within the Clinical Practice Research Datalink. The incidence rate for the primary outcome of the first recorded event (defined as a diagnosis of first stroke, recurrent stroke, myocardial infarction, symptomatic intracranial bleed, or significant gastrointestinal bleed) and of secondary outcomes all-cause mortality and cardiovascular mortality were calculated by postinitiation BP groups.

Results:
The Cox proportional hazard ratio of an event [crude and adjusted hazard ratio 1.04 (95% confidence interval (CI) 1.00–1.08), P = 0.077 and 0.071, respectively] did not differ significantly with a 10 mmHg increase in SBP. The hazard of all-cause mortality [crude hazard ratio 0.83 (95% CI 0.80–0.86), P = 0.000; adjusted hazard ratio 0.84 (95% CI 0.81–0.87), P = 0.000] and cardiovascular mortality [crude hazard ratio 0.92 (95% CI 0.85–0.99), P = 0.021; adjusted hazard ratio 0.93 (95% CI 0.86–1.00), P = 0.041] demonstrated a significant inverse relationship with a 10 mmHg increase in SBP. Patients with a SBP within 161–210 mmHg had the lowest all-cause death rate, while patients with SBP within 121–140 mmHg had the lowest cardiovascular death rate.

Conclusion:
SBP values below 161 mmHg are associated higher all-cause mortality, but lower event risk in patients with atrial fibrillation on DOAC therapy. The nadir SBP for lowest event rate was 120 mmHg, for lowest cardiovascular mortality was 130 mmHg and for lowest all-cause mortality was 160 mmHg. This demonstrates a need for a prospective interventional study of BP control after initiation of anticoagulation.