bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of tranexamic acid with decreased blood loss in patients undergoing laminectomy and fusion with posterior instrumentation: a systematic review and meta-analysis
Authors: Brown Nolan J. , Choi Elliot H. , Gendreau Julian L. , Ong Vera , Himstead Alexander , Lien Brian V. , Shahrestani Shane , Ransom Seth C. , Tran Katelynn , Tafreshi Ali R. , Sahyouni Ronald , Chan Alvin , Oh Michael Y. 
Published: November 2021

OBJECTIVE
Tranexamic acid (TXA) is an antifibrinolytic agent associated with reduced blood loss and mortality in a wide range of procedures, including spine surgery, traumatic brain injury, and craniosynostosis. Despite this wide use, the safety and efficacy of TXA in spine surgery has been considered controversial due to a relative scarcity of literature and lack of statistical power in reported studies. However, if TXA can be shown to reduce blood loss in laminectomy with fusion and posterior instrumentation, more surgeons may include it in their armamentarium. The authors aimed to conduct an up-to-date systematic review and meta-analysis of the efficacy of TXA in reducing blood loss in laminectomy and fusion with posterior instrumentation.

METHODS
A systematic review and meta-analysis, abiding by PRISMA guidelines, was performed by searching the databases of PubMed, Web of Science, and Cochrane. These platforms were queried for all studies reporting the use of TXA in laminectomy and fusion with posterior instrumentation. Variables retrieved included patient demographics, surgical indications, involved spinal levels, type of laminectomy performed, TXA administration dose, TXA route of administration, operative duration, blood loss, blood transfusion rate, postoperative hemoglobin level, and perioperative complications. Heterogeneity across studies was evaluated using a chi-square test, Cochran’s Q test, and I2 test performed with R statistical programming software.

RESULTS
A total of 7 articles were included in the qualitative study, while 6 articles featuring 411 patients underwent statistical analysis. The most common route of administration for TXA was intravenous with 15 mg/kg administered preoperatively. After the beginning of surgery, TXA administration patterns were varied among studies. Blood transfusions were increased in non-TXA cohorts compared to TXA cohorts. Patients administered TXA demonstrated a significant reduction in blood loss (mean difference −218.44 mL; 95% CI −379.34 to −57.53; p = 0.018). TXA administration was not associated with statistically significant reductions in operative durations. There were no adverse events reported in either the TXA or non-TXA patient cohorts.

CONCLUSIONS
TXA can significantly reduce perioperative blood loss in cervical, thoracic, and lumbar laminectomy and fusion procedures, while demonstrating a minimal complication profile.
Effects of the difference between lumbar lordosis in the supine and standing positions on the clinical outcomes of decompression surgery for lumbar spinal stenosis
Authors: Nakano Shiho , Inoue Masahiro , Takahashi Hiroshi , Kubota Go , Saito Junya , Norimoto Masaki , Koyama Keita , Watanabe Atsuya , Nakajima Takayuki , Sato Yusuke , Ohyama Shuhei , Orita Sumihisa , Eguchi Yawara , Inage Kazuhide , Shiga Yasuhiro , Sonobe Masato , Nakajima Arata , Ohtori Seiji , Nakagawa Koichi , Aoki Yasuchika 
Published: November 2021

OBJECTIVE
The authors sought to evaluate the relationship between the difference in lumbar lordosis (DiLL) in the preoperative supine and standing positions and spinal sagittal alignment in patients with lumbar spinal stenosis (LSS) and to determine whether this difference affects the clinical outcome of laminectomy.

METHODS
Sixty patients who underwent single-level unilateral laminectomy for bilateral decompression of LSS were evaluated. Spinopelvic parameters in the supine and standing positions were measured preoperatively and at 3 months and 2 years postoperatively. DiLL between the supine and standing positions was determined as follows: DiLL = supine LL − standing LL. On the basis of this determination patients were then categorized into DiLL(+) and DiLL(−) groups. The relationship between DiLL and preoperative spinopelvic parameters was evaluated using Pearson’s correlation coefficient. In addition, clinical outcomes such as visual analog scale (VAS) and Oswestry Disability Index (ODI) scores between the two groups were measured, and their relationship to DiLL was evaluated using two-group comparison and multivariate analysis.

RESULTS
There were 31 patients in the DiLL(+) group and 29 in the DiLL(−) group. DiLL was not associated with supine LL but was strongly correlated with standing LL and pelvic incidence (PI) − LL (PI − LL). In the preoperative spinopelvic alignment, LL and SS in the standing position were significantly smaller in the DiLL(+) group than in the DiLL(−) group, and PI − LL was significantly higher in the DiLL(+) group than in the DiLL(−) group. There was no difference in the clinical outcomes 3 months postoperatively, but low-back pain, especially in the sitting position, was significantly higher in the DiLL(+) group 2 years postoperatively. DiLL was associated with low-back pain in the sitting position, which was likely to persist in the DiLL(+) group postoperatively.

CONCLUSIONS
We evaluated the relationship between DiLL and spinal sagittal alignment and the influence of DiLL on postoperative outcomes in patients with LSS. DiLL was strongly correlated with PI − LL, and in the DiLL(+) group, postoperative low-back pain relapsed. DiLL can be useful as a new spinal alignment evaluation method that supports the conventional spinal sagittal alignment evaluation.
Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review
Authors: Adegeest Charlotte Y. , van Gent Jort A. N. , Stolwijk-Swüste Janneke M. , Post Marcel W. M. , Vandertop William P. , Öner F. Cumhur , Peul Wilco C. , Wengel Paula V. ter 
Published: November 2021

OBJECTIVE
Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI.

METHODS
A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

RESULTS
In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain.

CONCLUSIONS
This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.
Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis
Authors: Huang Jonathan , Rabin Erik E. , Stricsek Geoffrey P. , Swong Kevin N. 
Published: November 2021

OBJECTIVE
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be used to treat degenerative spinal pathologies while reducing risks associated with open procedures. As an increasing number of lumbar fusions are performed in the aging United States population, MIS-TLIF has been widely adopted into clinical practice in recent years. However, its complication rate and functional outcomes in elderly patients remain poorly characterized. The objective of this study was to assess complication rates and functional outcomes in elderly patients (≥ 65 years old) undergoing MIS-TLIF.

METHODS
The PubMed, Embase, and Scopus databases were searched for relevant records in accordance with the PRISMA guidelines. Inclusion criteria were peer-reviewed original research; English language; full text available; use of MIS-TLIF; and an elderly cohort of at least 5 patients. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies—of Interventions) tool. Pooled complication rates were calculated for elderly patients, with subgroup analyses performed for single versus multiple-level fusions. Complication rates in elderly compared to nonelderly patients were also assessed. Postoperative changes in patient-reported outcomes, including Oswestry Disability Index (ODI) and visual analog scale (VAS) back pain (BP) and leg pain (LP) scores, were calculated.

RESULTS
Twelve studies were included in the final analysis. Compared to nonelderly patients, MIS-TLIF in elderly patients resulted in significantly higher rates of major (OR 2.15, 95% CI 1.07–4.34) and minor (OR 2.20, 95% CI 1.22–3.95) complications. The pooled major complication rate in elderly patients was 0.05 (95% CI 0.03–0.08) and the pooled minor complication rate was 0.20 (95% CI 0.13–0.30). Single-level MIS-TLIF had lower major and minor complication rates than multilevel MIS-TLIF, although not reaching significance. At a minimum follow-up of 6 months, the postoperative change in ODI (−30.70, 95% CI −41.84 to −19.55), VAS-BP (−3.87, 95% CI −4.97 to −2.77), and VAS-LP (−5.11, 95% CI −6.69 to −3.53) in elderly patients all exceeded the respective minimum clinically important difference. The pooled rate of fusion was 0.86 (95% CI 0.80–0.90).

CONCLUSIONS
MIS-TLIF in elderly patients results in a high rate of fusion and significant improvement of patient-reported outcomes, but has significantly higher complication rates than in nonelderly patients. Limitations of this study include heterogeneity in the definition of elderly and limited reporting of risk factors among included studies. Further study of the impact of complications and the factors predisposing elderly patients to poor outcomes is needed.
Complications of neuroendoscopic septostomy
Authors: Atchley Travis J. , Sowers Blake , Arynchyna Anastasia A. , Rozzelle Curtis J. , Rocque Brandon G. 
Published: November 2021

OBJECTIVE
The advent of neuroendoscopy revolutionized the management of complex hydrocephalus. Fenestration of the septum pellucidum (septostomy) is often a therapeutic and/or necessary intervention in neuroendoscopy. However, these procedures are not without risk. The authors sought to record the incidence and types of complications. They attempted to discern if there was decreased likelihood of septostomy complications in patients who underwent endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) as compared with those who underwent other procedures and those with larger ventricles preoperatively. The authors investigated different operative techniques and their possible relationships to septostomy complications.

METHODS
The authors retrospectively reviewed all neuroendoscopic procedures with Current Procedural Terminology code 62161 performed from January 2003 until June 2019 at their institution. Septostomy, either alone or in conjunction with other procedures, was performed in 118 cases. Basic demographic characteristics, clinical histories, operative details/findings, and adverse events (intraoperative and postoperative) were collected. Pearson chi-square and univariate logistic regression analyses were performed. Patients with incomplete records were excluded.

RESULTS
Of 118 procedures, 29 (24.5%) septostomies had either intraoperative or postoperative complications. The most common intraoperative complication was bleeding, as noted in 12 (10.2%) septostomies. Neuroendocrine dysfunction, including apnea, bradycardia, neurological deficit, seizure, etc., was the most common postoperative complication and seen after 15 (12.7%) procedures. No significant differences in complications were noted between ventricular size or morphology or between different operative techniques or ventricular approaches. There was no significant difference between the complication rate of patients who underwent ETV/CPC and that of patients who underwent septostomy as a part of other procedures. Greater length of surgery (OR 1.013) was associated with septostomy complications.

CONCLUSIONS
Neuroendoscopy for hydrocephalus due to varying etiologies provides significant utility but is not without risk. The authors did not find associations between larger ventricular size or posterior endoscope approach and lower complication rates, as hypothesized. No significant difference in complication rates was noted between septostomy performed during ETV/CPC and other endoscopic procedures requiring septostomy.
Prospective multicenter study of minimally invasive surgery for the treatment of adult spinal deformity
Authors: Mundis Gregory M. , Godzik Jakub , Park Paul , Fu Kai-Ming , Tran Stacie , Uribe Juan S. , Wang Michael Y. , Than Khoi D. , Okonkwo David O. , Kanter Adam S. , Nunley Pierce D. , Anand Neel , Fessler Richard G. , Chou Dean , Lafage Renaud , Eastlack Robert K. , _ _ 
Published: November 2021

OBJECTIVE
Traditional surgery for adult spinal deformity (ASD) is effective but may result in exposure-related morbidity. Minimally invasive surgery (MIS) can potentially minimize this morbidity; however, high-level evidence is lacking. This study presents the first prospective multicenter investigation of MIS approaches for ASD.

METHODS
A prospective multicenter study was conducted. Inclusion criteria were age ≥ 18 years, with at least one of the following radiographic criteria: coronal Cobb (CC) angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25°, and thoracic kyphosis > 60°. Additional inclusion criteria were circumferential MIS, including interbody fusion (transforaminal lumbar interbody fusion [TLIF], lateral lumbar interbody fusion [LLIF], or anterior lumbar interbody fusion [ALIF]) with percutaneous posterior fixation on a minimum of 4 intervertebral levels. Radiographic and clinical outcomes (visual analog scale [VAS], Oswestry Disability Index [ODI], and Scoliosis Research Society–22 [SRS-22]) were collected preoperatively and at 12 months postoperatively; preoperative and postoperative values were compared using paired Student t-tests.

RESULTS
Seventy-five patients with a minimum 1-year follow-up were identified (75 of 111; 67.6%). The mean ± SD age was 68.8 ± 9.0 years, and 48 patients (64%) were female. Patients underwent a mean of 6.7 ± 2.9 levels of fusion with LLIF (85%), ALIF (55%), and TLIF (9%); the mean estimated blood loss was 547.6 ± 567.2 mL, and the mean length of stay was 7.0 ± 3.7 days. Significant improvements were observed in ODI (−19 ± 12.9, p < 0.001), SRS-22 (0.8 ± 0.66, p < 0.001), VAS back (−4.3 ± 2.8, p < 0.001), and VAS leg (−3.0 ± 3.2, p < 0.001) scores. Significant decreases in SVA (−26.4 ± 53.6 mm; p < 0.001), pelvic incidence–lumbar lordosis (−11.3° ± 14.9°, p < 0.001), and CC angle (−12.1° ± 11.8°, p < 0.001) were also observed. Complications occurred in 39 patients (52%); 11 patients (15%) experienced major complications, and 16 patients (21%) required reoperation.

CONCLUSIONS
MIS approaches for ASD resulted in meaningful symptomatic improvement. The complication rates were similar to historic norms, with a fairly high reoperation rate at 1 year. Longer follow-up will be necessary to evaluate the durability of this approach in the treatment of ASD.
Care for Chiari malformation type I: the role of socioeconomic disadvantage and race
Authors: Akbari Syed Hassan A. , Oates Gabriela R. , Gonzalez-Sigler Irina , Arynchyna Anastasia A. , McCroskey Justin , Alford Elizabeth N. , Leon Tofey J. , Rutland Sarah , Johnston James M. , Blount Jeffrey P. , Rozzelle Curtis J. , Rocque Brandon G. 
Published: November 2021

OBJECTIVE
There is little research on the effect of social determinants of health on Chiari malformation type I (CM-I). The authors analyzed data on all children evaluated for CM-I at a single institution to assess how socioeconomic factors and race affect the surgical treatment of this population.

METHODS
Medical records of patients treated for CM-I at the authors’ institution between 1992 and 2017 were reviewed. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes for each patient were used to measure neighborhood disadvantage. Non-Hispanic White patients were compared to non-White patients and Hispanic patients of any race (grouped together as non-White in this study) in terms of insurance status, ADI, and RUCA. Patients with initially benign CM-I, defined as not having undergone surgery within 9 months of their initial visit, were then stratified by having delayed symptom presentation or not, and compared on these same measures.

RESULTS
The sample included 665 patients with CM-I: 82% non-Hispanic White and 18% non-White. The non-White patients were more likely to reside in disadvantaged (OR 3.4, p < 0.001) and urban (OR 4.66, p < 0.001) neighborhoods and to have public health insurance (OR 3.11, p < 0.001). More than one-quarter (29%) of patients underwent surgery. The non-White and non-Hispanic White patients had similar surgery rates (29.5% vs 28.9%, p = 0.895) at similar ages (8.8 vs 9.7 years, p = 0.406). There were no differences by race/ethnicity for symptoms at presentation. Surgical and nonsurgical patients had similar ADI scores (3.9 vs 4.2, p = 0.194), RUCA scores (2.1 vs 2.3, p = 0.252), and private health insurance rates (73.6% vs 74.2%, p = 0.878). A total of 153 patients underwent surgery within 9 months of their initial visit. The remaining 512 were deemed to have benign CM-I. Of these, 40 (7.8%) underwent decompression surgery for delayed symptom presentation. Patients with delayed symptom presentation were from less disadvantaged (ADI 3.2 vs 4.2; p = 0.025) and less rural (RUCA 1.8 vs 2.3; p = 0.023) areas than those who never underwent surgery.

CONCLUSIONS
Although non-White patients were more likely to be socioeconomically disadvantaged, race and socioeconomic disadvantage were not associated with undergoing surgical treatment. However, among patients with benign CM-I, those undergoing decompression for delayed symptom presentation resided in more affluent and urban areas.
Long-term response planting method on wheat under conservation agriculture
Authors: Escobosa-García María Isabel , Escoboza-García Luis Fernando , Soto-Ortiz Roberto , Ruelas-Islas Jesús del Rosario , Ruiz-Espinoza Francisco Higinio , Núñez-Ramírez Fidel 
Published: November 2021

Objective: To compare different bed planting systems: narrow beds (80 cm), wide beds (100 cm), and flat soil, on the growth and yield of wheat under conservation system.
Design/methodology/approach: Treatments were established on a complete block design with three replicates; also, wheat crop was grown during five seasons. Treatments were as follow: A) wide beds (furrows at 100 cm), B) narrow beds (furrows at 80 cm) and C) flat soil. Response variables were dry weight of 50 stems, weight of 1000 grains, number of spikes (m2), harvest index and yield. Also, the relationship between relative yield and cold units and degree-days were measured.
Results: Flat soil reach the highest dry weight of 50 stems, whereas narrow beds had the maximum number of spikes per m2. Yield was equal between flat soil and narrow beds. No differences were found in the harvest index (HI) among the evaluated treatments. When comparing results between years, dry weight of 50 stems increased and the HI index decreased, affecting negatively the yield. A negative association was found between chill hours and yield.
Findings/conclusions: Despite yield was equal between flat soil and narrow beds, reduction on yields was mainly associated with of reduction in chill hours occurring in each season.
Encouragement and Contracting Factors for Implementation of Dynamic Village Institutional Program and Adaptive Culture in Minahasa Tenggara District
Authors: Tampongangoy Deysi L. N. , Gerungan Lusy K. R. R. , Tampongangoy Grace H. 
Published: November 2021

One of the programs of the Ministry of Villages, Development of Disadvantaged Regions and Transmigration of the Republic of Indonesia based on sustainable development (Sustainable Development Goals) globally which consists of 17 goals which are then added one point as a foothold for the community, namely a dynamic village institutional program and adaptive culture that involves the local government as a working partner. The program of dynamic village institutions and adaptive culture aims at village development that is based on the cultural roots of the local community with the intention that everything built on a cultural basis will have extraordinary resilience and have good deterrence. This study uses Edwards III theory by considering four indicators as a factor in implementing public policies consisting of: Communication, Resources, Implementing Disposition, and Bureaucratic Structure. Factors that are considered as supporting factors in the implementation of the dynamic village institutional program and adaptive culture in Southeast Minahasa Regency are communication and the disposition of the implementer. Factors that are considered as inhibiting factors in the implementation of dynamic village institutional programs and adaptive culture in Southeast Minahasa Regency are resources and bureaucratic structure. Human and financial resources need to be improved. It is necessary to make standard operating procedures specifically for dynamic village institutional programs and an adaptive culture that has a clear position base in carrying out the program.
PEMANFAATAN SITUS SEJARAH KESULTANAN TERNATE DALAM PEMBELAJARAN SEJARAH LOKAL BERBASIS MULTIKULTURAL (Studi Naturalistik Inquiri di SMA Negeri 5 Kota Ternate)
Authors: Far Gazali Far 
Published: November 2021

Abstrak
Pada pembelajaran sejarah lokal tentu sangat berperan sebagai alat dalam mengembangkan nilai-nilai multikultural. Situs sejarah Kesultanan Ternate tentu memiliki sarat akan makna/ nilai-nilai multikultural yang tekandung di dalamnya. Olehnya itu, telah dimanfaatkan oleh SMA Negeri 5 Kota Ternate. Fakta tersebut setidaknya menjadi magnet (menarik) bagi penulis sehingga melakukan penelitian mengenai pemanfaatan situs Kesultanan Ternate dalam pembelajaran sejarah lokal berbasis multikultural. Metode yang digunakan dalam penelitian ini yakni, kualitatif deskriptif naturalistik dengan tehnik pengumpulan data yaitu, tahapan observasi (pengamatan) inteview (wawancara), dokumentasi dan gabungan ketiganya. Sesuai dengan hasil penelitian yang telah diperoleh, pembelajaran sejarah lokal berbasis multikultural dengan memanfaatkan situs sejarah Kesultanan Ternate, telah memberikan dampak positif bagi pengetahuan, kreatifitas dan sikap siswa. Selain dari pengetahuan dan pemahaman terhadap aspek historis Kesultanan Ternate, kondisi masyarakat dan situs-situs peninggalan sejarah Kesultanan Ternate secara kritis, siswa juga dapat menerapkan sikap yang menjunjung nilai-nilai multikulturalisme sesuai dengan materi sejarah Kesultanan Ternate. Seperti sikap toleransi, tolong-menolong, menghargai pendapat orang lain dan berprasangka baik antar sesama tanpa melihat perbedaan etnis, suku, ras dan agama.