bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Is as Effective as Intravenous Tranexamic Acid at Reducing Blood Loss in Thoracolumbar Spinal Fusions
Authors: Yu Charles C. , Fidai Mohsin , Washington Travis , Bartol Stephen , Graziano Gregory 
Published: July 2021

Study Design.
A prospective randomized trial at a university affiliated tertiary medical center between February 2017 and March 2020.

Objective.
The aim of this study was to compare perioperative blood loss in patients undergoing elective posterior thoracolumbar fusion who were treated with IV versus PO TXA.

Summary of Background Data.
The use of antifibrinolytic agents such as tranexamic acid (TXA) to decrease operative blood loss and allogenic blood transfusions is well documented in the literature. Although evidence supports the use of intravenous (IV) and topical formulations of TXA in spine surgery, the use of oral (PO) TXA has not been studied.

Methods.
A total of 261 patients undergoing thoracolumbar fusion were randomized to receive 1.95 g of PO TXA 2 hours preoperatively or 2 g IV TXA (1 g before incision and 1 g before wound closure) intraoperatively. The sample was further stratified into three categories based on number of levels fused (one-to two-level fusions, three to five, and more than five). The primary outcome was the reduction of hemoglobin. Secondary outcomes included calculated blood loss, drain output, postoperative transfusion, complications, and length of hospital stay. Equivalence analysis was performed with a two one-sided test.

Results.
One hundred thirty-seven patients received IV and 124 received PO TXA. The average age was 62 ± 13 years (mean ± SD), including 141 females and 120 males. Revision cases comprised of 67% of the total sample. Patient demographic factors were similar between groups except for weight, BMI, and preoperative platelet count. The mean reduction of hemoglobin was similar between IV and PO groups (3.56 vs. 3.28 g/dL, respectively; P = 0.002, equivalence). IV TXA group had a higher transfusion rate compared to PO TXA group (22 patients [19%] vs. 12 patients [10%]; P = 0.03). In addition, IV group had longer length of stay (LOS) than PO group (4.4 vs. 3.7 days; P = 0.02).

Conclusion.
Patients treated with IV and PO TXA experienced the same perioperative blood loss after small and large spinal fusions. In subgroup analysis, the intermediate (three to five level) spinal fusions had less blood loss with PO TXA than IV TXA. Given its lower cost, PO TXA represents a superior alternative to IV TXA in patients undergoing elective posterior thoracolumbar fusion and may improve health care cost-efficiency in the studied population.

Level of Evidence: 1
An Objective Assessment of Lumbar Spine Degeneration/Ageing Seen on MRI Using An Ensemble Method—A Novel Approach to Lumbar MRI Reporting
Authors: Sneath Robert J.S. , Khan Atif , Hutchinson Charles 
Published: July 2021

Study Design.
Retrospective, randomized, radiographic study assessing age-related changes (ARCs) on lumbar magnetic resonance imaging (MRI) using an ensemble method.

Objectives.
This study proposed to develop a novel reporting method to calculate a predicted “age estimate” for the ARC seen on lumbar MRI.

Summary of Background Data.
Lumbar MRI reports include pathological findings but usually not the prevalence data of common findings which has been shown to decrease the need for narcotics in the management of non-specific lower back pain (NSLBP). Comparing the normal age estimation for lumbar spine degenerative changes/ARC on MRI and comparing this to the patient's real age may improve patient outcome in the management of NSLBP.

Methods.
A total of 60 lumbar MRI were taken from patients aged between 0 and 100 years. Lumbar MRI features reported as associated with age on review of the literature were measured on each MRI and statistically evaluated for correlation with age. Factors found to be associated were then entered into an ensemble model consisting of several machine learning techniques. The resulting ensemble model was then tested to predict age for a further 10 random lumbar MRI scans. One further lumbar MRI was then assessed for observer variability.

Results.
Features that correlated with age were disc signal intensity, the appearance of paravertebral and psoas muscle, disc height, facet joint size, ligamentum flavum thickness, Schmorl nodes, Modic changes, vertebral osteophytes, and high-intensity zones. With the ensemble model, 80% of estimated spinal age were within 11 years of the subjects’ physical age.

Conclusion.
It would appear that the intervertebral discs, and many other structures that are subjected to loading in and around the lumbar spine change their lumbar MRI appearance in a predictable way with increasing age. ARC on lumbar MRI can be assessed to predict an “expected age” for the subject.

Level of Evidence: 2
Combining Expandable Interbody Cage Technology With a Minimally Invasive Technique to Harvest Iliac Crest Autograft Bone to Optimize Fusion Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery
Authors: Virk Sohrab , Vaishnav Avani S. , Sheha Evan , Urakawa Hikari , Sato Kosuke , Othman Yahya , Chaudhary Chirag , Lee Ryan , Cong Guang-Ting , Chaudhary Saad , Qureshi Sheeraz A. 
Published: July 2021

Study Design:
This was a retrospective cohort review.

Objective:
The objective of this study was to determine the rate of fusion associated with an expandable cage and iliac crest bone graft in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) surgery.

Summary of Background Data:
MI-TLIF is a commonly performed procedure, but challenges inherent in MI-TLIF technique can make achieving an interbody fusion difficult.

Methods:
A retrospective review was performed on consecutive patients treated with an MI-TLIF for degenerative lumbar pathology. Patients that completed patient-reported outcome measures and 1-year computed tomography (CT)-scans for fusion analysis were included. Fusion morphology was analyzed by evaluating CT scans for location of bridging trabecular bone in relation to the cage. Patients with bridging bone were considered fused. Preoperative and postoperative health-related quality of life scores were compared. A Kolmogrov-Smirnoff test was used to determine normality of health-related outcome scores. A Friedman 2-way analysis of variance by ranks with pairwise comparisons to determine statistical significance of differences between the date of a follow-up examination and preoperative examination was done.

Results:
Of 75 patients evaluated 23 patients were excluded due to loss to follow-up, adjacent segment degeneration, inability to obtain a CT scan, or reoperation for nonfusion related symptoms. Of 61 disk spaces that were included, 55 had bridging bone through the intervertebral cage, resulting in an overall fusion rate of 90.2%. There was a higher rate of fusion at L5−S1 as compared to L4−L5. There was mean improvement in patient-reported outcome measures for Oswestry Disability Index, Short Form-12 Physical Component Score, Visual Analog Scale Back/Leg pain, and Patient-Reported Outcome Measurement Information System Physical Function. There were no complications associated with iliac crest bone graft harvesting.

Conclusion:
Combining an expandable cage with iliac crest autograft bone harvested through a minimally invasive technique can allow for improved fusion rates without graft-site complications in MI-TLIF surgery.
Regionalization of Critical Care in the United States: Current State and Proposed Framework From the Academic Leaders in Critical Care Medicine Task Force of the Society of Critical Care Medicine*
Authors: Leung Sharon , Pastores Stephen M. , Oropello John M. , Lilly Craig M. , Galvagno Samuel M. , Badjatia Neeraj , Jacobi Judith , Herr Daniel L. , Oliveira Jason David ,   for the Academic Leaders in Critical Care Medicine Task Force of the Society of Critical Care Medicine
Published: July 2021

Objectives:
The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions.

Data Sources and Study Selection:
Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product.

Data Extraction and Synthesis:
The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations.

Conclusions:
Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively.
Factors Associated With Prolonged Mechanical Ventilation in Patients With Subarachnoid Hemorrhage—The RAISE Score*
Authors: Rass Verena , Ianosi Bogdan-Andrei , Lindlbauer Moritz , Lindner Anna , Kofler Mario , Schiefecker Alois J. , Pfausler Bettina , Beer Ronny , Helbok Raimund 
Published: July 2021

OBJECTIVES:
Patients suffering from spontaneous subarachnoid hemorrhage frequently require mechanical ventilation. Here, we aimed to identify factors associated with prolonged mechanical ventilation in subarachnoid hemorrhage patients and to create a new predictive score for prolonged mechanical ventilation.

DESIGN:
Prospective cohort study with retrospective data analysis.

SETTING:
Neurocritical care unit at a tertiary academic medical center.

PATIENTS:
Two hundred ninety-seven consecutive nontraumatic adult subarachnoid hemorrhage patients.

METHODS:
In patients with mechanical ventilation, we identified factors associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days compared with mechanical ventilation less than or equal to 48 hours, less than or equal to 7 days, or less than or equal to 14 days in multivariable generalized linear models. Ventilated patients who died before 48 hours, 7 days, or 14 days and those never ventilated were excluded from the respective analysis. We incorporated those factors into a new prognostic score (the RAISE score) to predict prolonged mechanical ventilation greater than 7 days. The calculation was based on a random dataset of 60% of subarachnoid hemorrhage patients and was internally validated.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Patients were 57 years old (interquartile range, 47–68 yr) and presented with a median Hunt and Hess grade of 3 (1–5). Two hundred forty-two patients (82%) required mechanical ventilation for 9 days (2–20 d). In multivariable analysis, a higher Acute Physiology Score was associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days, a higher Hunt and Hess grade with greater than 7 days and greater than 14 days. Early neuroimaging findings were associated with mechanical ventilation greater than 48 hours (hydrocephalus; high-grade Subarachnoid Hemorrhage Early Brain Edema Score), greater than 7 days (high-grade Subarachnoid Hemorrhage Early Brain Edema Score, co-occurrence of intracerebral bleeding) but not with prolonged mechanical ventilation greater than 14 days. The RAISE score, including age, Acute Physiology Score, Hunt and Hess grade, Subarachnoid Hemorrhage Early Brain Edema Score, and the co-occurrence of intracerebral hemorrhage accurately stratified patients by prolonged mechanical ventilation greater than 7 days (C-statistic 0.932). A RAISE score of 12 predicted 60% likelihood of mechanical ventilation greater than 7 days.

CONCLUSIONS:
Initial disease severity and neuroimaging findings detected within 24 hours after ICU admission were associated with the need for prolonged mechanical ventilation in patients with subarachnoid hemorrhage. These results may be helpful for patient families and caregivers to better anticipate the course of therapy.
Mobile health in preventive cardiology: current status and future perspective
Authors: Kozik Michael , Isakadze Nino , Martin Seth S. 
Published: July 2021

Purpose of review
Despite cutting edge acute interventions and growing preventive strategies supported by robust clinical trials, cardiovascular disease (CVD) has stubbornly persisted as a leading cause of death in the United States and globally. The American Heart Association recognizes mobile health technologies (mHealth) as an emerging strategy in the mitigation of CVD risk factors, with significant potential for improving population health. The purpose of this review is to highlight and summarize the latest available literature on mHealth applications and provide perspective on future directions and barriers to implementation.

Recent findings
While available randomized controlled trials and systematic reviews tend to support efficacy of mHealth, published literature includes heterogenous approaches to similar problems with inconsistent results. Some of the strongest recent evidence has been focused on the use of wearables in arrhythmia detection. Systematic reviews of mHealth approaches demonstrate benefit when applied to risk factor modification in diabetes, cigarette smoking cessation, and physical activity/weight loss, while also showing promise in multi risk factor modification via cardiac rehabilitation.

Summary
Evidence supports efficacy of mHealth in a variety of applications for CVD prevention and management, but continued work is needed for further validation and scaling. Future directions will focus on platform optimization, data and sensor consolidation, and clinical workflow integration. Barriers include application heterogeneity, lack of reimbursement structures, and inequitable access to technology. Policies to promote access to technology will be critical to evidence-based mHealth technologies reaching diverse populations and advancing health equity.
Subtype-specific trends in the clinical picture of primary aldosteronism over a 13-year period
Authors: Saito Kohei , Kurihara Isao , Itoh Hiroshi , Ichijo Takamasa , Katabami Takuyuki , Tsuiki Mika , Wada Norio , Yoneda Takashi , Sone Masakatsu , Oki Kenji , Yamada Tetsuya , Kobayashi Hiroki , Tamura Kouichi , Ogawa Yoshihiro , Kawashima Junji , Inagaki Nobuya , Yamamoto Koichi , Yamada Masanobu , Kamemura Kohei , Fujii Yuichi , Suzuki Tomoko , Yasoda Akihiro , Tanabe Akiyo , Naruse Mitsuhide 
Published: July 2021

Objective:
Primary aldosteronism has two main clinically and biologically distinct subtypes: unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). We aimed to evaluate the changes of each subtype's clinical characteristics over a 13-year period.

Methods:
This retrospective study involved time-trend analyses to identify changes in the clinical features of APA and BAH at diagnosis (2006–2018). A nationwide database from 41 Japanese referral centers was searched, which identified 2804 primary aldosteronism patients with complete baseline information and adrenal venous sampling (AVS) data.

Results:
The proportion of patients with APA decreased from 51% in 2006–2009 to 22% in 2016–2018. Among the 1634 patients with BAH, trend analyses revealed decreases in hypertension duration (median 7--3 years; P < 0.01) and hypokalemia prevalence (18--11%; P < 0.01). However, among the 952 patients with APA, there were no significant changes in hypertension duration (median 8 years) and hypokalemia prevalence (overall 70%). Furthermore, the APA group had a trend towards increased use of multiple hypertensive drugs at diagnosis (30--43%; P < 0.01). When subtypes were reclassified according to the precosyntropin stimulation AVS data, APA patients tended to be diagnosed earlier and at milder forms, consistent with the trend in overall primary aldosteronism patients.

Conclusion:
During 2006–2018, we identified marked subtype-specific trends in the clinical findings at the diagnosis of primary aldosteronism. Our results suggested that the emphasis on the implementing cosyntropin stimulation during AVS might lead to under-identification of APA, especially in patients with mild or early cases.
Meibomian Gland Dysfunction and Lipid Profile: A Study Among Pregnant Women
Authors: Kyei Samuel , Asiedu Kofi , Ephraim Richard K.D. , Animful Stephen , Adanusa Madison , Ali-Baya Stephen Karim , Akorsah Belinda , Sekyere Mabel Antwiwaa 
Published: July 2021

Purpose:
This study aimed to estimate the frequency of meibomian gland dysfunction (MGD) and its associated factors among pregnant women.

Methods:
This was a hospital-based cross-sectional study of consecutive pregnant women visiting the University of Cape Coast hospital's antenatal clinic. Meibomian gland assessment and tear function test were performed along with the administration of a symptom questionnaire. Correlation, analysis of variance, and logistic regression analyses were used to examine predictors of MGD.

Results:
All 201 pregnant women who met the inclusion criteria and gave informed consent were included in the study. The mean age of the entire sample was 29.96 (±4.74) years. The frequency of MGD among the cohort of pregnant women was 22.9% (95% confidence interval, 17.4%–28.9%). Univariate logistic regression revealed that the following factors were significantly associated with MGD: high-density lipoprotein (HDL) (odds ratio [OR] 1.017; 95% confidence interval [CI], 1.001–1.034; P=0.042), total cholesterol (TC) (OR 1.009; 95% CI, 1.003–1.016; P=0.006), and low-density lipoprotein (LDL) (OR 1.008; 95% CI, 1.00–1.016; P=0.049). In multivariate analysis, the model confirmed that MGD was not significantly associated with TC, LDL, and HDL.

Conclusions:
In summary, this study showed a high frequency of MGD in pregnant women but comparable with that reported in the normal population. Clinicians examining pregnant women for dry eye disease may need to pay attention to other causative instigators aside MGD to enable the clinicians to make an appropriate etiology-based diagnosis.
Novel Bacterial Cellulose Membrane to Reduce Fibrosis Following Trabeculectomy
Authors: Yazgan Serpil , Tekin Ishak Ozel , Akpolat Nusret , Koc Ozhan 
Published: July 2021

Purpose:
The aim was to evaluate the effectiveness of bacterial cellulose membrane (BCM) in preventing fibrosis in trabeculectomy and the biocompatibility of BCM with conjunctiva and sclera.

Materials and Methods:
Twenty-one eyes of 21 adult rabbits underwent fornix-based trabeculectomy. Standard surgery was done to control group (CG, n=7). Mitomycin-C (MMC) (0.3 mg/mL, 3 min) was applied to MMC group only (MMCG, n=7). BCM (~100 µm thick, 10×10 mm, single layer) was covered on the sclerotomy area before conjunctiva was closed in BCM group (BCMG, n=7). Intraocular pressures (IOP) were measured before, and 7, 14, 28, and 45 days after surgery (IOP-POD7, POD14, POD28, POD45). The IOP decrease were expressed as DIOP%-POD7, DIOP%-POD14, DIOP%-POD28, and DIOP%-POD45. The rabbits were sacrificed on the 45th day. Conjunctival vessel number, degrees of fibrosis, total inflammation, foreign body reaction, inflammatory cell types (B cells, T cells, plasma cells), macrophages, bleb spaces and the expression of α-smooth muscle actin were studied using histopathology and immunohistochemistry techniques. The groups were compared using nonparametric tests.

Results:
There was no statistically significant difference between the groups regarding baseline IOP and DIOP%-POD7 (P>0.05). While DIOP%-POD14, 28 and 45 were similar between BCMG and MMCG, they were significantly lower in CG (P<0.05). The lowest conjunctival vessel number was detected in the MMCG but the difference was not significant. There was no difference between BCMG and CG with regard to the numbers of B cells, T cells, and macrophages, however, these cells were significantly lower in MMCG (P<0.05). Five cases had mild and 2 cases had moderate foreign body reaction in the BCMG. There was mild to moderate inflammation in all BCM cases. While fibrosis and α-smooth muscle actin staining were higher in the CG (P<0.001), they were minimal in the BCM and MMCGs.

Conclusions:
BCM showed good biocompatibility and provided better control of IOP with minimal fibrosis at the trabeculectomy site compared with the control group.
Chronic Kidney Disease as a Predictor of Postoperative Choroidal Effusions After Glaucoma Surgery
Authors: Ford Richard L. , Klifto Meredith R. , Knight O’Rese J. , Jain Koyal , Wiesen Chris , Fleischman David 
Published: July 2021

Précis:
Patients with chronic kidney disease (CKD) are at increased risk for choroidal effusion development following glaucoma surgery.

Purpose:
Choroidal effusion is a postoperative complication of glaucoma surgery that results from a transudative fluid collection in the suprachoroidal space. Kidney disease alters bodily fluid dynamics through a variety of mechanisms. The relationship between CKD and choroidal effusion following glaucoma surgery has not previously been studied. The purpose of this study was to determine the relationship between CKD and choroidal effusion development after glaucoma surgery.

Patients and Methods:
This retrospective cohort study consisted of 86 eyes from 86 patients who received glaucoma filtering surgery or transscleral cyclophotocoagulation within the study timeframe. Forty-three patients had CKD, and 43 patients did not have kidney disease. The main outcome of this study was the development of choroidal effusion measured by the Pearson χ2 test and multivariate analysis using a binomial regression with a log link.

Results:
Ten patients (23.3%) in the CKD group developed choroidal effusion, while 2 patients (4.7%) in the no-kidney disease group developed choroidal effusion (relative risk, 5.0; 95% confidence interval: 1.16-21.5; P=0.013). The association between CKD and choroidal effusion showed mixed results in the multivariate analysis, with some analyses showing a significant association and others showing no significant association.

Conclusions:
In both the univariate and multivariate analyses, CKD was found to be significantly associated with choroidal effusion after glaucoma surgery.