bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing Postoperative Opioid-prescribing Following Posterior Lumbar Fusion Does Not Significantly Change Patient Satisfaction
Authors: Bloom David A. , Manjunath Amit K. , Dinizo Michael , Fried Jordan W. , Jazrawi Laith M. , Protopsaltis Themistocles S. , Fischer Charla R. 
Published: June 2021

Study Design.
Retrospective comparative; LOE-3.

Objective.
The purpose of this study was to investigate what effect, if any, an institutional opioid reduction prescribing policy following one- or two-level lumbar fusion has on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results.

Summary of Background Data.
Previous research has demonstrated that high levels of opioid-prescribing may be related, in part, to a desire to produce superior patient satisfaction.

Methods.
A retrospective review of prospectively collected data was conducted on patients who underwent one- or two-level lumbar fusions L3-S1 between October 2014 and October 2019 at a single institution. Patients with complete survey information were included in the analysis. Patients with a history of trauma, fracture, spinal deformity, fusions more than two levels, or prior lumbar fusion surgery L3-S1 were excluded. Cohorts were based on date of surgery relative to implementation of an institutional opioid reduction policy, which commenced in October 1, 2018. To better compare groups, opioid prescriptions were converted into milligram morphine equivalents (MME).

Results.
A total of 330 patients met inclusion criteria: 259 pre-protocol, 71 post-protocol. There were 256 one-level fusions and 74 two-level fusions included. There were few statistically significant differences between groups with respect to patient demographics (P > 0.05) with the exception of number of patients who saw the pain management service, which increased from 36.7% (95) pre-protocol to 59.2% (42) post-protocol; P < 0.001. Estimated blood loss (EBL) decreased from 533 ± 571 mL to 346 ± 328 mL (P = 0.003). Percentage of patients who underwent concomitant laminectomy decreased from 71.8% to 49.3% (P < 0.001). Average opioids prescribed on discharge in the pre-protocol period was 534 ± 425 MME, compared to after initiation of the protocol, that is 320 ± 174 MME (P < 0.001). There was no statistically significant difference with respect to satisfaction with pain control, 4.49 ± 0.85 pre-protocol versus 4.51 ± 0.82 post-protocol (P = 0.986).

Conclusion.
A reduction in opioids prescribed at discharge after one- or two-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.

Level of Evidence: 3
Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population
Authors: Nguyen William , Chang Ki-Eun , Formanek Blake , Ghayoumi Pouriya , Buser Zorica , Wang Jeffrey 
Published: June 2021

Study Design:
This was a large database study.

Objective:
The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion).

Summary of Background Data:
CSM is a major contributor to disability and reduced quality of life worldwide.

Methods:
Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson χ2 analysis with Yate continuity correction was used.

Results:
Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P=0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P=0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P=0.0005), circulatory complications (2.01%, <1%, P=0.0183), and C5 palsy (4.84%, 1.74%, P≤0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P=0.0468), and revision surgery (8.23% 5.85%, P=0.0395). Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P=0.0089) or ACCF (3.93% vs. 8.59%, P<0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P=0.0108), and revision surgery (9.51%, 5.85%, P=0.0086).

Conclusions:
The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.
Significance of Cervical Spine Computed Tomography Hounsfield Units to Predict Bone Mineral Density and the Subsidence After Anterior Cervical Discectomy and Fusion
Authors: Lee Ho Jin , You Soon Tae , Kim Jung Hee , Kim Il Sup , Sung Jae Hoon , Hong Jae Taek 
Published: June 2021

Study Design:
This study was a retrospective review.

Objective:
The purpose of this study was to investigate the correlation analysis between Hounsfield units (HU) and dual x-ray absorptiometry (DXA) based on the clinical results of patients who underwent anterior cervical discectomy and fusion (ACDF) surgery.

Summary of Background Data:
There is no technique to directly measure bone mineral density (BMD) in the cervical spine. As computed tomography is a very popular preoperative planning modality, using the HU value from that analysis to predict osteoporosis is important for patient outcomes and applications in the clinical field.

Materials and Methods:
We reviewed the records for 235 patients who underwent 1-level (n=120) or 2-level (n=115) ACDF surgery. In the 1-level ACDF group, the HU was measured from C3 to C6 vertebra, while that for the 2-level ACDF group was measured from 3 surgical index vertebrae. The correlation patterns were analyzed with the corresponding DXA (T-score) for each patient. Subsidence of fusion segment was defined as change in distance between plate-tip and upper (lower) margin of the vertebra (index level) after 4 months of follow-up. In addition, to determine the relevant factors that influence fusion segment subsidence, other preoperative (C2 slope, C7 slope, C2–C7 angle, and C2–C7 sagittal vertical axis) and postoperative parameters (coronal angle and segmental angle change) were measured.

Results:
The correlation coefficient between HU and DXA ranged from 0.57 to 0.71 in the 1-level ACDF group and from 0.59 to 0.66 in the 2-level ACDF group. The correlation between HU and DXA was statistically significant regardless of the degree of anterior osteophyte (r=−0.65 to 0.78). Total subsidence height was 3.8 mm after ACDF, and both HU and DXA were statistically correlated with total subsidence (r=0.26–0.28). In multivariate analysis, HU (middle vertebra) value was statistically associated with the degree of total subsidence. The high-subsidence group (≥4.5 mm) showed smaller HU values (284.1 vs. 316.0) and T-scores (−0.5 vs. 0.1) compared to the low-subsidence group (<4.5 mm). The discrepancy group, defined as cases with excess plate shift on 1 side, also showed smaller HU values (260.4 vs. 312.4) and higher degrees of total subsidence than the matched group.

Conclusions:
The correlation between HU in cervical computed tomography and lumbar DXA (T-score) was statistically significant in both 1-level and 2-level ACDF. The level of BMD (HU or DXA) is a very important factor for clinically determining the amount and regularity of subsidence after ACDF. Therefore, HU can be a good alternative assessment to accurately reflect as much of the BMD degree as DXA in the cervical spine.
Transitions of Care After Critical Illness—Challenges to Recovery and Adaptive Problem Solving*
Authors: Haines Kimberley J. , Hibbert Elizabeth , Leggett Nina , Boehm Leanne M. , Hall Tarli , Bakhru Rita N. , Bastin Anthony J. , Butcher Brad W. , Eaton Tammy L. , Harris Wendy , Hope Aluko A. , Jackson James , Johnson Annie , Kloos Janet A. , Korzick Karen A. , Mactavish Pamela , Meyer Joel , Montgomery-Yates Ashley , Quasim Tara , Slack Andrew , Wade Dorothy , Still Mary , Netzer Giora , Hopkins Ramona O. , Iwashyna Theodore J. , Mikkelsen Mark E. , McPeake Joanne , Sevin Carla M. 
Published: June 2021

OBJECTIVES:
Investigate the challenges experienced by survivors of critical illness and their caregivers across the transitions of care from intensive care to community, and the potential problem-solving strategies used to navigate these challenges.

DESIGN:
Qualitative design—data generation via interviews and data analysis via the framework analysis method.

SETTING:
Patients and caregivers from three continents, identified through the Society of Critical Care Medicine’s THRIVE international collaborative sites (follow-up clinics and peer support groups).

SUBJECTS:
Patients and caregivers following critical illness.

INTERVENTIONS:
Nil

MEASUREMENTS AND MAIN RESULTS:
From 86 interviews (66 patients, 20 caregivers), we identified the following major themes: 1) Challenges for patients—interacting with the health system and gaps in care; managing others’ expectations of illness and recovery. 2) Challenges for caregivers—health system shortfalls and inadequate communication; lack of support for caregivers. 3) Patient and caregiver-driven problem solving across the transitions of care—personal attributes, resources, and initiative; receiving support and helping others; and acceptance.

CONCLUSIONS:
Survivors and caregivers experienced a range of challenges across the transitions of care. There were distinct and contrasting themes related to the caregiver experience. Survivors and caregivers used comparable problem-solving strategies to navigate the challenges encountered across the transitions of care.
Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history
Authors: Peng Bo , Wang Li-Li , Dou Li-Ping , Li Fei , Jin Xiang-Shu , Wang Lu , Jia Ming-Yu , Li Yan , Bo Jian , Zhao Yu , Zhu Hai-Yan , Huang Wen-Rong , Liu Dai-Hong 
Published: June 2021

Abstract

Background:
The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes.

Methods:
A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs).

Results:
The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88–40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001).

Conclusions:
These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
Cut-off values of lesion and vessel quantitative flow ratio in de novo coronary lesion post-drug-coated balloon therapy predicting vessel restenosis at mid-term follow-up
Authors: Meng Pei-Na , Liu Bin , Li Long-Bo , Yin De-Lu , Zhang Heng , Pan De-Feng , You Wei , Wu Zhi-Ming , Wu Xiang-Qi , Zhao Lei , Li Zhi-Bo , Wang Jin-Peng , Wang Zhi-Hui , Xu Tian , Huang Xiao-Yu , Gao Ruo-Nan , Ye Fei 
Published: June 2021

Abstract

Background:
Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up.

Methods:
The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student's t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC).

Results:
A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001).

Conclusions:
The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.
Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China
Authors: Hu Nan , Wang Kun , Zhang Li , Liu Zuo-Jing , Jin Zhu , Cui Rong-Li , Zhang He-Jun , He Zhong-Hu , Ke Yang , Duan Li-Ping 
Published: June 2021

Abstract

Background:
Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population.

Methods:
A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses.

Results:
A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028–4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251–0.741).

Conclusions:
The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.

Trial Registration:
ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.
The Impact of Body Mass Index on Freedom From Therapeutic Intervention and Quality of Life in Active Surveillance Prostate Cancer Patients
Authors: Merrick Gregory S. , Galbreath Robert , Fiano Ryan , Scholl Whitney , Bennett Abbey , Butler Wayne M. , Kurko Brian , Adamovich Edward 
Published: June 2021

Objective:
The objective of this study was to evaluate the impact of body mass index (BMI) on overall survival, freedom from distant metastases, rates of therapeutic intervention (TI), and quality of life (QOL) in active surveillance (AS) prostate cancer patients.

Materials and Methods:
Three hundred forty consecutive, prospectively evaluated AS patients underwent a staging transperineal template-guided mapping biopsy before AS enrollment and were stratified by BMI (<25, 25 to 29.9, 30 to 34.9, and >35 kg/m2). Evaluated outcomes included overall survival, freedom from distant metastases, TI, QOL to include urinary, bowel, sexual function and depression and serial postvoid residual urine measurements. The relationship between BMI and anterior prostate cancer distribution was evaluated. Repeat biopsy was based on prostate specific antigen kinetics, abnormal digital rectal examination and patient preference.

Results:
Of the 340 patients, 323 (95%) were Gleason 3+3 and 17 patients (5.0%) were Gleason 3+4. The median follow-up was 5.2 years (range: 1 to 14 y). At 10 years, TI was instituted in 4.7%, 2.2%, 9.5%, and 25.0% of patients in BMI cohorts <25, 25 to 29.9, 30 to 34.9, and ≥35 (P=0.075). No patient has developed distant metastases. The median time to TI was 4.86 years. In multivariate analysis, TI was most closely predicted by prostate specific antigen density (P=0.071). At 8 years, no statistical differences in urinary function, bowel function, depression or postvoid residual were noted. However, a trend for erectile dysfunction was identified (P=0.106).

Conclusion:
At 10 years, BMI did not statistically predict for TI, geographic distribution of prostate cancer or QOL parameters.
Transversus abdominis plane block versus local anaesthetic wound infiltration for analgesia after caesarean section
Authors: Grape Sina , Kirkham Kyle Robert , Albrecht Eric 
Published: June 2021

BACKGROUND
Transversus abdominis plane (TAP) block and local anaesthetic wound infiltration are used to relieve pain after caesarean section.

OBJECTIVES
To determine whether TAP block or local anaesthetic wound infiltration is the better analgesic option after caesarean section.

DESIGN
Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES
MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science up to June 2020.

ELIGIBILITY CRITERIA
We retrieved randomised controlled trials comparing TAP block with wound infiltration after caesarean section. Primary outcome was pain score during rest (analogue scale, 0 to 10) at 2 h postoperatively, analysed according to the TAP block technique (ultrasound-guided/landmark-guided), anaesthetic strategy (spinal/general), intrathecal fentanyl (yes/no) and multimodal analgesia (yes/no). Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, and total intravenous morphine consumption at 2, 12 and 24 h. We sought rates of block complications, including postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity.

RESULTS
Seven trials, totalling 475 patients, were identified. There was no difference in pain score during rest at 2 h between groups. Subgroup analyses revealed no differences related to TAP block technique (P = 0.64), anaesthetic strategy (P = 0.53), administration of intrathecal fentanyl (P = 0.59) or presence of multimodal analgesia (P = 0.57). Pain score during rest at 12 h and intravenous morphine consumption at 2 and 12 h were identical in both groups. Data were insufficient to compare block complications. Overall quality of evidence was moderate.

CONCLUSION
There is moderate level evidence that TAP block and wound infiltration provide similar postoperative analgesia after caesarean section.

TRIAL REGISTRY NUMBER
PROSPERO CRD42020208046.
Curcumin-mediated Photodynamic Therapy Inhibits the Phenotypic Transformation, Migration, and Foaming of Oxidized Low-density Lipoprotein-treated Vascular Smooth Muscle Cells by Promoting Autophagy
Authors: Wang Gailan , Zhu Ying , Li Kaiting , Liao Bo , Wang Fang , Shao Lan , Huang Liyi , Bai Dingqun 
Published: June 2021

Abstract:
Vascular smooth muscle cells (VSMCs) are becoming a hot spot and target of atherosclerosis research. This study aimed to observe the specific effects of curcumin (CUR)-mediated photodynamic therapy (CUR-PDT) on oxidized low-density lipoprotein (ox-LDL)-treated VSMCs and confirm whether these effects are mediated by autophagy. In this study, the mouse aortic smooth muscle cell line and A7r5 cell lines were used for parallel experiments. VSMC viability was evaluated by Cell Counting Kit-8 assay. VSMCs were treated with ox-LDL to establish a model of atherosclerosis in vitro. The autophagy level and the expression of proteins related to phenotypic transformation were detected by western blotting. The migration ability of the cells was detected by using transwell assay. The presence of intracellular lipid droplets was detected by Oil Red O staining. The results showed that VSMCs transformed from the contraction phenotype to the synthetic phenotype when stimulated by ox-LDL, during which autophagy was inhibited. However, CUR-PDT treatment significantly promoted the level of autophagy and inhibited the process of phenotypic transformation induced by ox-LDL. In addition, ox-LDL significantly promoted VSMC migration and increased the number of lipid droplets, whereas CUR-PDT treatment significantly reduced the ox-LDL-induced increase in the migration ability of, and lipid droplet numbers in, VSMCs. When the VSMCs were pretreated with the autophagy inhibitor 3-methyladenine for 24 hours, the effects of CUR-PDT were reversed. Therefore, our study indicated that CUR-PDT can inhibit the phenotypic transformation, migration, and foaming of ox-LDL–treated VSMCs by inducing autophagy.