bluuebunny/crossref_metadata_2025_split huggingface dataset:
Connective Tissue Disease Patients Maintain Greater Distraction During Growth Friendly Surgery
Authors: Marrache Majd , Suresh Krishna V. , White Klane K. , Larson A. Noelle , Sponseller Paul D. 
Published: November 2021

Study Design:
Multicenter retrospective study.

Background:
Recent studies have demonstrated diminishing returns in patients with early onset scoliosis (EOS) undergoing repeated lengthening of growing rods. Little is known about whether this same phenomenon occurs in patients with lax connective tissue disease (CTD). The primary purpose of this study is to investigate whether EOS patients with connective tissue laxity disorders have diminishing returns during growth friendly surgery.

Methods:
CTD EOS patients below 10 years old, underwent growth friendly spine surgery with distal anchors and at least 1 proximal spine anchor, and had minimum follow-up of 5 years were included in this study. Coronal T1-S1 height at preindex surgery, postindex, and every available lengthening was assessed. Mean coronal height change during early set distractions and late set distractions were calculated for the cohort. To account for varying distraction intervals, we normalized the distractions by the time interval. The outcome parameter was T1-S1 height gain, mm/year.

Results:
Twenty-one CTD patients were included in this study. Total coronal height (T1-S1) was 26.7MHCcm before index, 32.2 cm at D1-D3, 34.7 cm at D4-D6, and 36.7 cm at D7-L10. There were no significant differences in coronal height gains between early and late distractions (P=0.70). Moreover, when normalized for time, there was no significant difference in net gain per year at different lengthening time points for the CTD group, P=0.59.

Conclusion:
There is no evidence of diminishing returns in coronal T1-S1 height gain in patients with EOS in the setting of CTD.

Level of Evidence:
Level III.
The Feasibility of Utilizing Malunion Criteria to Limit Radiographs After Spica Casting for Pediatric Femur Fractures
Authors: Barnett Scott A. , Song Bryant M. , Yan Justin , Lucak Thomas J. , Leonardi Claudia , Kadhim Muayad , Heffernan Michael J. 
Published: November 2021

Background:
There are no existing guidelines regarding the timing or frequency of postoperative radiographs following spica casting for pediatric femur fractures. The purpose of this study was to evaluate established femoral malunion criteria as a potential screening tool to limit postoperative radiographs by identifying patients at risk for unacceptable alignment in the early treatment period.

Methods:
A retrospective chart review was conducted for pediatric femoral shaft fractures presenting to a tertiary pediatric referral hospital from 2012 to 2017. Pediatric femur malunion criteria were applied to radiographs at initial presentation, first follow-up visit, and final follow-up visit. The primary outcome was a change in management based on radiographic findings in the early postoperative period. Secondary outcomes included radiographic measures, number of follow-up visits, and complications.

Results:
Of 449 consecutive pediatric femur fractures treated at our center, 149 patients aged 1 to 4 years (mean age: 2.5±1.6 y) met inclusion criteria. At initial presentation, 36.9% (55/149) of patients met malunion criteria. Only 4.0% (6/149) of patients had a change in management following initial closed reduction and spica cast application due to radiographic findings at subsequent follow-up. Of these patients, 67% (4/6) were identified on preoperative imaging, and 83.3% (5/6) were identified by their first clinic appointment. Four of the 149 patients were converted to definitive surgical fixation, and 2 patients required cast wedging due to either unacceptable fracture shortening or coronal/sagittal angulation.

Conclusions:
Routine early postoperative radiographs may not be necessary for all pediatric femur fractures managed with closed reduction and spica casting. The value of this study is that it is the first to demonstrate the feasibility of limiting postoperative radiographs using a preoperative screening tool. However, the established femoral malunion criteria utilized in this study were limited in their predictive value, and further work is necessary to improve the sensitivity and specificity before widespread clinical application.

Level of Evidence:
Level IV.
Does the Deformity Index Reliably Predict the Shape of the Femoral Head at Healing of Legg-Calvé-Perthes Disease?
Authors: Shah Hitesh , Singh Kumar A. , Swarup Ishaan , Morris William , Kim Harry K.W. , Joseph Benjamin 
Published: November 2021

Background:
Treatment of Legg-Calvé-Perthes disease (LCPD) aims to preserve the spherical shape of the femoral head. The deformity index (DI) <0.3, measured 2 years from disease onset, is a surrogate measure that predicts that the femoral head will be Stulberg class I or II at skeletal maturity. There is no study that compares the predictive value of DI against a quantitative measure of the shape of the femoral head when the disease heals. We undertook this study to assess the reproducibility of a new method of measurement of DI and see if DI could predict the shape of the femoral head when the disease healed.

Methods:
DI was measured 2 years after disease onset and the Sphericity Deviation Score (SDS) was measured at healing of LCPD on radiographs of 43 children. Reproducibility of measurement was tested. Each healed femoral head was classified as spherical or aspherical based on subjective visual assessment. The DI values were compared with SDS values.

Results:
The reproducibility of measurement of SDS was excellent and superior to that of DI. The mean duration of disease was 3.97±0.96 years. Only 17 of 32 hips with DI values <0.3 at 2 years had spherical femoral heads at healing (SDS <10). Three hips with SDS values <10 had DI values >0.3. The positive and negative predictive values of a DI <0.3 in predicting if the femoral head will be spherical (SDS <10) when the disease healed were 53% and 73%, respectively.

Conclusion:
Though DI can be reproducibly measured the predictive value of a DI <0.3, to accurately identify hips that are likely to heal with spherical femoral heads, is not sufficiently high to justify its use as an outcome measure.
Pedicle Subtraction Osteotomy in Adult Spinal Deformity
Authors: Cho Kyu-Jung , Kim Ki-Tack , Youn Yung-Hun , Song Ju-Sung 
Published: November 2021

Study Design/Setting:
Level III—retrospective radiologic and clinical comparative study.

Objective:
This study compares the results of pedicle subtraction osteotomy (PSO) for fixed versus flexible sagittal imbalance in adult spinal deformity.

Summary of Background Data:
The result of PSO may be different according to the flexibility of the deformity.

Methods:
Sixty-one patients who underwent PSO were enrolled with a minimum 2-year follow-up. Twenty-one patients had fixed imbalance resulting from ankylosing spondylitis and iatrogenic flatback deformity, and 40 patients had flexible imbalance resulting from degenerative spinal deformity and posttraumatic kyphosis.

Results:
The mean age was 54.9±9.2 years in the fixed group and 65.9±10.5 years in the flexible group (P<0.01). PSO achieved about 35 degrees of correction of kyphotic angle in both groups, but the loss of correction (LOC) was higher in the flexible group. The correction of Lumbar Lordosis was similar in both groups, at 31.7±15.4 degrees in the fixed group and 32.3±20.8 degrees in the flexible group, although the LOC was also higher in the flexible group than in the fixed group, at 9.8±12.4 and 2.7±3.5 degrees, respectively (P<0.01). The sagittal vertical axis was much more restored in the fixed group than in the flexible group (P=0.002). Postoperative complications were identified in 4 patients in the fixed group, consisting of neurological deficit and screw loosening, and in 15 patients in the flexible group, consisting of proximal junctional kyphosis, screw pullout, rod fracture, and pseudarthrosis.

Conclusions:
PSO for flexible sagittal imbalance resulted in a higher LOC of the osteotomy angle, Lumbar Lordosis, and sagittal vertical axis relative to the fixed deformity. Furthermore, more complications such as implant failure developed in the flexible group.
Prognostic Significance of Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratio in Rectal Cancer: A Systematic Review, Meta-analysis, and Meta-regression
Authors: Hamid Hytham K.S. , Emile Sameh H. , Davis George N. 
Published: November 2021

BACKGROUND:
The low lymphocyte-to-monocyte ratio and high platelet-to-lymphocyte ratio have been reported to be poor prognostic indicators in various solid tumors, but the prognostic significance in rectal cancer remains controversial.

OBJECTIVES:
We sought to determine the prognostic value of the lymphocyte-to-monocyte ratio and the platelet-to-lymphocyte ratio following curative-intent surgery for rectal cancer.

DATA SOURCES:
Following PRISMA guidelines (PROSPERO, ID: CRD42020190880), PubMed and Embase databases were searched through January 2021 including 3 other registered medical databases.

STUDY SELECTION:
Studies evaluating the impact of pretreatment lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio on overall or disease-free survival in patients undergoing curative rectal cancer resection were selected.

MAIN OUTCOMES MEASURES:
The main outcome measures were overall and disease-free survival.

RESULTS:
A total of 23 studies (6683 patients) were included; lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio were evaluated in 14 and 16 studies. A low lymphocyte-to-monocyte ratio was associated with poorer overall survival (HR, 1.57; 95% CI, 1.29–1.90; p < 0.001) and disease-free survival (HR, 1.29; 95% CI, 1.13–1.46; p < 0.001). However, when the analysis was limited to patients treated with surgery alone or to those with stage I to III tumors, lymphocyte-to-monocyte ratio was not a predictor of overall survival and disease-free survival. The platelet-to-lymphocyte ratio did not predict for overall or disease-free survival, regardless of the treatment modality, studied population, tumor stage, or cutoff value. Finally, a low lymphocyte-to-monocyte ratio, but not a high platelet-to-lymphocyte ratio, was inversely correlated with complete pathologic response rate.

LIMITATIONS:
The retrospective nature of most included studies was a limitation.

CONCLUSIONS:
Pretreatment lymphocyte-to-monocyte ratio, but not platelet-to-lymphocyte ratio, correlates with tumor response to neoadjuvant chemoradiotherapy and poorer prognosis after curative-intent surgery for rectal cancer, and it potentially represents a simple and reliable biomarker that could help optimize individualized clinical decision-making in high-risk patients.

REGISTRATION:

https://www.crd.york.ac.uk/prospero/; ID: CRD42020190880
Metformin Prevents Low-dose Isoproterenol-induced Cardiac Dilatation and Systolic Dysfunction in Male Sprague Dawley Rats
Authors: Peterson Vernice R. , Norton Gavin R. , Madziva Michael T. , Makaula Siyanda 
Published: November 2021

Abstract:
Myocardial metabolic abnormalities are well-recognized alterations in chronic heart failure, effects that may contribute to progressive cardiac dysfunction. However, whether metabolic alterations in-part mediate their deleterious effects by modifying the chronic impact of excess low-dose sympathetic stimulation on cardiac chamber dilatation is uncertain. We therefore aimed to determine the effect of metformin administration on cardiac function and mitochondrial architectural changes in a rat model of chronic sympathetic-induced left ventricular (LV) remodeling and systolic dysfunction [daily subcutaneous isoproterenol (ISO) injection at a low dose of 0.02 mg/kg for 7 months]. Echocardiography was used to assess in vivo LV dimensions and function, and mitochondrial and myofibril arrangement was assessed using transmission electron microscopy. Seven months of low-dose ISO administration increased LV diastolic diameter (in mm) [control (CONT): 7.29 ± 0.19 vs. ISO: 8.76 ± 0.21; P = 0.001], an effect that was attenuated by metformin (ISO + MET: 7.63 ± 0.29 vs. ISO: P = 0.001) administration. Similarly, ISO increased LV end-systolic diameter (CONT: 4.43 ± 0.16 vs. ISO: 5.49 ± 0.16: P < 0.0001), an effect prevented by metformin (ISO + MET: 4.04 ± 0.25 vs. ISO: P < 0.0001). Moreover, chronic ISO administration reduced LV endocardial fractional shortening (P = 0.0001), midwall fractional shortening (P = 0.0001), and ejection fraction (P = 0.0001), effects similarly prevented by metformin administration. Furthermore, changes in mitochondrial arrangement and relative mitochondrial area (CONT: 37.7 ± 2.2 vs. ISO: 28.1 ± 2.9; P = 0.05) were produced by ISO administration, effects prevented by metformin. In conclusion, metformin offers cardiac protection against chronic sympathetic-induced LV dilatation and systolic dysfunction. These data support a role for myocardial metabolic changes in mediating LV dilatation and LV dysfunction produced by chronic neurohumoral activation in cardiac disease.
Digoxin in Patients With Advanced Heart Failure and Sinus Rhythm Submitted to Cardiac Resynchronization Therapy—Is There Any Benefit?
Authors: Fernandes Cláudia , António Natália , Marinho Vera , Milner James , Madeira Marta , Sousa Pedro A. , Ventura Miguel , Cristóvão João , Elvas Luís , Gonçalves Lino 
Published: November 2021

Abstract:
Digoxin (DG) use in patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm remains controversial. We aimed to assess the prognostic effect of DG in patients in sinus rhythm submitted to cardiac resynchronization therapy (CRT). Retrospective study including 297 consecutive patients in sinus rhythm, with advanced HFrEF submitted to CRT. Patients were divided into 2 groups: with DG and without DG (NDG). During a mean follow-up of 4.9 ± 3.4 years, we evaluated the effect of DG on the composite end point defined as cardiovascular hospitalization, progression to heart transplantation, and all-cause mortality. Previous to CRT, 104 patients (35%) chronically underwent DG and 193 patients (65%) underwent NDG treatment. The 2 groups did not differ significantly regarding HF functional class, HF etiology, QRS, and baseline left ventricular ejection fraction. The proportion of responders to CRT was similar in both groups (54% in DG vs. 56% in NDG; P = 0.78). During the long-term follow-up period, the primary end point occurred in a higher proportion in DG patients (67 vs. 48%; P = 0.002). After adjustment for potential confounders, DG use remained as an independent predictor of the composite end point of CV hospitalization, heart transplantation, and all-cause mortality [hazards ratio = 1.58; confidence interval, 95 (1.01–2.46); P = 0.045]. In conclusion, in patients in sinus rhythm with HFrEF submitted to CRT, DG use was associated with CV hospitalization, progression to heart transplant, and all-cause mortality.
CHARACTERISTICS AND MANAGEMENT OF MYOPIC TRACTION MACULOPATHY IN MYOPIC EYES WITH AXIAL LENGTH LESS THAN 26.5 mm
Authors: Chen Jing , Chen Shida , Zhao Xiujuan , Lian PING , Yu Xiling , Huang Xia , Liu Bingqian , Li Yonghao , Lu Lin 
Published: November 2021

Purpose:
To explore the characteristics and underlying mechanisms of myopic traction maculopathy (MTM) with axial length less than 26.5 mm and to assess the effectiveness of macular buckling for the treatment of MTM.

Methods:
Thirty-eight MTM eyes with axial length less than 26.5 mm were prospectively enrolled. Thirty-one eyes received surgery, and they were followed up for at least 6 months. Characteristics of MTM and surgical outcomes were evaluated.

Results:
Of the MTM eyes, 92.11% (35/38) showed posterior staphyloma. Narrow macular staphyloma was the most common type (54.29%, 19/35), followed by peripapillary (37.14%, 13/35). Three cases (8.57%) had wide macular staphyloma, and 44.74% of cases (17/38) had vitreoretinal traction. Twenty-two MTM eyes of type T3 underwent macular buckling surgery, and all the cases achieved foveal reattachment after the surgery. The mean best-corrected visual acuity improved significantly at the 6-month follow-up (P < 0.001). Nine MTM eyes of type T4 or T5 received combined surgery, all macular holes recovered, and the best-corrected visual acuity also improved postoperatively (P = 0.008) as of the 6-month visit.

Conclusion:
Posterior staphyloma might serve as the initial force of the pathogenesis of MTM in eyes with axial length ˂26.5 mm. Macular buckling is a productive way to improve the MTM.
IMPAIRMENTS OF L-CONE/M-CONE AND S-CONE–MEDIATED COLOR DISCRIMINATION IN MACULAR TELANGIECTASIA TYPE II
Authors: Simunovic Matthew P. , Gillies Mark C. 
Published: November 2021

Purpose:
To characterize red–green and tritan color discrimination in eyes with macular telangiectasia Type II (MacTel).

Methods:
Color discrimination was assessed by metameric matching methods using an Oculus MR Anomaloscope. Red–green color discrimination was assessed using the Rayleigh equation, and tritan color discrimination was assessed using the Moreland equation. Results were expressed as anomalquotient (AQ) and tritanomalquotient (TAQ) units, respectively.

Results:
Seventeen eyes with MacTel were compared with 16 control eyes with normal vision. Twelve eyes with MacTel demonstrated abnormal color matches; except for two eyes with red-shifted Rayleigh matches, the primary abnormality evident was reduced color discrimination. On average, Rayleigh matching ranges were significantly widened in MacTel (0.518 ± 0.066 AQ units) compared with normal (0.14 ± 0.03 AQ units; P < 0.0001). Similarly, Moreland matching ranges were significantly wider (0.794 ± 0.109 TAQ units) than normal control subjects (0.204 ± 0.070 TAQ units; P < 0.0001). Losses in color discrimination did not correlate significantly with the best-corrected visual acuity, although Moreland matching ranges were significantly correlated to Rayleigh matching ranges.

Conclusion:
MacTel results in a combined acquired red–green and tritan color vision deficiency. A minority of eyes demonstrated red-shifted Rayleigh matches, consistent with decreases in cone photopigment optical density.
Evaluation of Visual Outcome of 2 Phakic Posterior Chamber Implantable Lenses in High Myopia: A Comparative Study
Authors: Sinha Ayushi , Sinha Rajesh , Gupta Vinay , Agarwal Rinky , Maharana Prafulla K. , Agarwal Tushar , Sharma Namrata , Titiyal Jeewan Singh 
Published: November 2021

Purpose:
To evaluate and compare the visual outcomes of two phakic intraocular lenses in high myopia.

Methods:
A prospective comparative study was undertaken on 50 eyes of 26 patients {age ≥21 years and divided into two groups (implantable collamer lens [ICL] V4c, n=25 eyes and refractive implantable lens [RIL], n=25 eyes)}. Patients were evaluated for uncorrected distance visual acuity (UCVA), best-corrected distance visual acuity, manifest refractive spherical equivalent (MRSE), contrast sensitivity, intraocular pressure, dilated fundus examination, trabecular-iris angle (TIA), anterior chamber depth, horizontal white-to-white diameter, wavefront aberrometry, and endothelial cell (EC) count. All patients were followed up until 6 months and additionally evaluated for anterior chamber inflammation, cataract, and lens vault.

Results:
The baseline parameters (UCVA, MRSE, and EC count) and postoperative improvement in UCVA, contrast sensitivity, MRSE, EC loss, safety index, and efficacy index were comparable between both the lenses. The improvement in aberrometric profile was significantly better in the ICL group. The mean postoperative vault was higher in RIL group (434.88±162.48 μm vs. 547.24±159.83 μm, P=0.0173); however, the vault was within normal range in both the groups. The decrease in mean TIA was significantly higher in RIL group (8.58 vs. 13.45 μm, P=0.0073).

Conclusion:
Acrylic phakic lens can be considered as a suitable alternative to collamer lens for refractive correction of high myopia. The collamer lenses showed slight superiority in some qualitative visual parameters; however, collamer lenses do not present with subjective complaints in the patients.
Comparison of Corneal Tissue Profile of Pseudophakic and Phakic Donors
Authors: Sahoo Sonali , Jamil Zeeshan , Sahu Srikant K. , Ali Mohammad H. , Priyadarshini Smruti R. , Das Sujata 
Published: November 2021

Purpose:
To compare the endothelial quality of corneas obtained from pseudophakic donors with age-matched phakic controls.

Methods:
Retrospective analysis of 100 corneas each from pseudophakic and phakic eyes with donor age ≥60 years in both the groups was performed. The endothelial cell density, coefficient of variation, and percentage of hexagonal cells obtained by specular microscopy were compared between the two groups. The cut-off level of endothelial cell density (ECD) taken for optical keratoplasty was 2,000 cells/mm2.

Results:
The male and female donors constituted 60% (n=120) and 40% (n=80), respectively. The mean age of the donors was 66.9±7.3 years in the phakic group and 69.9±7.7 years in pseudophakic group. The mean ECD in the phakic group was 2757.6±328.5 cells/mm2 and that in the pseudophakic group was 2225.5±471.9 cells/mm2 (P<0.0001). The mean coefficient of variation in the phakic group was 37.1±5.0 and that in the pseudophakic group was 38.6±11.1 (P=0.234). The mean percentage of hexagonality in the phakic group and the pseudophakic group was 52.0±6.4% and 51.2±7.2%, respectively (P=0.414). Both in univariate and multivariate linear regression analysis, age of the donor was found to be negatively associated in predicting ECD (P=0.002 and P=0.003, respectively). Sixty-nine and thirty-three corneas from the phakic and pseudophakic donor pool were used respectively.

Conclusion:
Difference in ECD between the phakic and the pseudophakic donor group was found to be statistically significant. The ECD in the pseudophakic group was found to be above the cut-off limit required for keratoplasty. Hence, pseudophakic corneas may also be used for transplantation.
Evaluation of the vitreolenticular interface with intraoperative OCT
Authors: Vael Arnout , Van Os Luc , Melis Kirsten , Tassignon Marie-José 
Published: November 2021

Purpose:
To determine the prevalence of anterior vitreous detachment (AVD) in routine bag-in-the-lens (BIL) cataract cases and possibly to identify risk factors for its presence.

Setting:
University Hospital of Antwerp, Belgium.

Design:
Prospective cross-sectional study.

Methods:
Patients having routine BIL cataract surgery were included. Patients with traumatic cataract, previous intraocular surgeries, YAG laser treatment, intravitreal injection, or medical conditions that might affect normal ophthalmologic anatomy were excluded. Several parameters were collected from the patients’ records, and their surgical videos/photographs/optical coherence tomography were evaluated.

Results:
99 eyes of 99 patients were included. Detectable AVD was observed in 62 eyes (63%). AVD was not present in 37 eyes (37%). The difference in prevalence of AVD between men and women was not statistically significant (P = .55, Pearson χ2 test). The Mann-Whitney U test for axial length was not statistically significant (P = .38). However, it was statistically significant for age (P < .005). A logistic regression model to ascertain the effect of age on the likelihood that patients had AVD did reach statistical significance (χ2 (1) = 8.246, P < .005).

Conclusions:
The prevalence of AVD in a routine cataract population was 63%. Age was identified as a risk factor. This study model determined that the odds for AVD increase 5.3% with each year of patient age. These data allowed for better preoperative and postoperative assessment of complications. The BIL, by its mandatory primary posterior continuous curvilinear capsulorhexis, did not increase the risk for postoperative ocular complications in the posterior segment of the eye.