bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wide Laminectomy, Segmental Bilateral Laminotomies, or Unilateral Hemi-Laminectomy for Lumbar Spinal Stenosis
Authors: Bouknaitir Jamal Bech , Carreon Leah Y. , Brorson Stig , Pedersen Casper Friis , Andersen Mikkel Østerheden 
Published: April 2021

Study Design.
Propensity-matched retrospective study of patients prospectively enrolled in Danespine.

Objective.
The aim of this study was to report 5-year patient reported outcome in lumbar spinal stenosis (LSS) patients who underwent wide laminectomy (WL), segmental bilateral laminotomies (SBL), or unilateral hemilaminectomy (UHL) with bilateral decompression.

Summary of Background Data.
The optimal procedure for LSS remains controversial. Studies have shown no difference in short term outcomes among micro-laminectomy, hemi-laminotomies, broad laminectomy, and laminectomy with instrumented fusion.

Methods.
Patients with spinal stenosis who were enrolled in DaneSpine at two spine centers from January 2010 until May 2014 and underwent WL0, SBL, or UHL with bilateral decompression were identified. Patients completed standard questionnaires preoperatively and 1, 2, and 5 years after surgery. Patients in the three cohorts were propensity-matched using age, sex, body mass index (BMI), smoking status, number of surgical levels, American Society of Anesthesiologists (ASA) score, and patient-reported outcome measures (PROMs).

Results.
Propensity matching produced 62 cases in each group. There were no differences in PROM among the three cohorts at five years follow up. Twelve patients were re-operated at the index level. The most frequent indication of reoperation was repeat decompression after SBL. Regression analysis revealed no statistical significant associations between the incidence of reoperation and age, sex, number of operated levels, ASA score, BMI, center, smoking status, or having a dural tear at index operation.

Conclusion.
This study revealed no significant difference PROMs, reoperation rates or time to reoperation at five years follow up between SBLs, UHL, or WL in patients operated for central LSS.

Level of Evidence: 4
Magnetically Controlled Growing Rods Graduation
Authors: Lebel David Eduard , Rocos Brett , Helenius Ilkka , Sigal Amit , Struder Daniel , Yazici Muharrem , Bekmez Senol , Hasler Carol-Claudius , Pesenti Sebastien , Jouve Jen-Luc , Ovadia Dror 
Published: April 2021

Study Design.
A multicenter retrospective review of consecutive series of patients.

Objective.
Long-term experience with using the magnetically controlled growing rods (MCGR) to treat patients with deformity in the growing spine to the conclusion of treatment with posterior spine fusion.

Summary of Background Data.
MCGR treatment for growing spine gained popularity with paucity of long-term follow up data. We hypothesized that final fusion might be more effective in bringing additional correction of the spine deformity after treatment with MCGR than that reported after traditional growing rods (TGR) due to less scarring and auto-fusion.

Methods.
Retrospective review of 47 patients with varied etiology, treated between 2011 and 2017 which graduated treatment were followed in five academic medical centers for average of 50 months (range, 10–88).

Results.
The initial mean coronal deformity of 69.6° (95% CI 65–74) was corrected to 40° (95% CI 36–40) immediately after the MCGR implantation but progressed to 52.8° (95% CI 46–59) prior to the final surgery (P < 0.01). Nevertheless, thoracic spine growth (T1–T12 height) improved from 187.3 mm (95% CI 179–195) following index surgery to 208.9 mm (95% CI 199–218) prior to final fusion (P < 0.01). Significant correction and spinal length were obtained at final fusion, but metallosis was a frequent observation (47%, 22/47). The average growth rate was 0.5 mm/month (95% CI 0.3–0.6). The overall complication rate within our cohort was 66% (31/47) with 45% (21/47) of unplanned returns to the operating theater. 32% (15/47) of the patients had an implant related complication. Unplanned surgery was highly correlated with thoracic kyphosis greater than 40° (OR 5.42 95% CI 1.3–23).

Conclusion.
Treatment of growing spine deformities with MCGR provides adequate control of spine deformity it is comparable to previously published data about TGR. The overall high complications rate over time and specifically implant related complications.

Level of Evidence: 4
At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery?
Authors: Passias Peter G. , Pierce Katherine E. , Naessig Sara , Ahmad Waleed , Passfall Lara , Lafage Renaud , Lafage Virginie , Kim Han Jo , Daniels Alan , Eastlack Robert , Klineberg Eric , Line Breton , Mummaneni Praveen , Hart Robert , Burton Douglas , Bess Shay , Schwab Frank , Shaffrey Christopher , Smith Justin S. , Ames Christopher P. 
Published: April 2021

Study Design.
Retrospective cohort study.

Objective.
The aim of this study was to investigate the impact of cervical to thoracolumbar ratios on poor outcomes in cervical deformity (CD) corrective surgery.

Summary of Background Data.
Consideration of distal regional and global alignment is a critical determinant of outcomes in CD surgery. For operative CD patients, it is unknown whether certain thoracolumbar parameters play a significant role in poor outcomes and whether addressing such parameters is warranted.

Methods.
Included: surgical CD patients (C2-C7 Cobb >10°, cervical lordosis [CL] >10°, C2-C7 sagittal vertical axis (cSVA) >4 cm, or chin-brow vertical angle >25°) with baseline and 1-year data. Patients were assessed for ratios of preop cervical and global parameters including: C2 Slope/T1 slope, T1 slope minus C2-C7 lordosis (TS-CL)/mismatch between pelvic incidence and lumbar lordosis (PI-LL), cSVA/sagittal vertical axis (SVA). Deformity classification ratios of cervical (Ames-ISSG) to spinopelvic (SRS-Schwab) were investigated: cSVA modifier/SVA modifier, TS-CL modifier/PI-LL modifier. Cervical to thoracic ratios included C2-C7 lordosis/T4-T12 kyphosis. Correlations assessed the relationship between ratios and poor outcomes (major complication, reoperation, distal junctional kyphosis (DJK), or failure to meet minimal clinically important difference [MCID]). Decision tree analysis through multiple iterations of multivariate regressions assessed cut-offs for ratios for acquiring suboptimal outcomes.

Results.
A total of 110 CD patients were included (61.5 years, 66% F, 28.8 kg/m2). Mean preoperative radiographic ratios calculated: C2 slope/T1 slope of 1.56, TS-CL/PI-LL of 11.1, cSVA/SVA of 5.4, CL/thoracic kyphosis (TK) of 0.26. Ames-ISSG and SRS-Schwab modifier ratios: cSVA/SVA of 0.1 and TS-CL/PI-LL of 0.35. Pearson correlations demonstrated a relationship between major complications and baseline TS-CL/PI-LL, Ames TS-CL/Schwab PI-LL modifiers, and the CL/TK ratios (P < 0.050). Reoperation had significant correlation with TS-CL/PI-LL and cSVA/SVA ratios. Postoperative DJK correlated with C2 slope/T1 slope and CL/TK ratios. Not meeting MCID for Neck Disability Index (NDI) correlated with CL/TK ratio and not meeting MCID for EQ5D correlated with Ames TS-CL/Schwab PI-LL.

Conclusion.
Consideration of cervical to global alignment is a critical determinant of outcomes in CD corrective surgery. Key ratios of cervical to global alignment correlate with suboptimal clinical outcomes. A larger cervical lordosis to TK predicted postoperative complication, DJK, and not meeting MCID for NDI.

Level of Evidence: 4
Real-World Observational Review of Andexanet Alfa Prescribing and Utilization Outcomes at a Community Teaching Hospital
Authors: Sobolewski Kristine A. , Brophy Alison , Choi Seohyun (Claudia) , Opsha Yekaterina 
Published: April 2021

Objectives:
Andexanet alfa is the first approved antidote in the management of life-threatening bleeds in patients treated with Xa inhibitors. The ANNEXA-4 study was successful in reducing factor Xa levels during time of administration but lacked correlation to improved patient outcomes. Given its novel mechanism of action, U.S. boxed warning, cost of up to $58,000 per dose, and limited efficacy data compared with standard of care, hospitals are faced with a dilemma with its addition to formulary and process for ensuring optimized use. The objective of this study was to evaluate adherence to institution restriction criteria and the clinical outcomes of treatment for patients for whom andexanet alfa is requested.

Design:
Retrospective cohort study of andexanet alfa requests within a 12-month time period.

Setting:
A 600-bed community teaching hospital.

Patients:
Patients whom pharmacists received request for dispensing andexanet alfa.

Interventions:
None.

MEASUREMENTS AND MAIN RESULTS:
Quality outcomes reviewed compliance to restriction criteria. Clinical outcomes evaluated use of adjunctive blood products, ICU length of stay, hospital length of stay, and hospital mortality. Safety outcomes evaluated incidence of thrombotic events.
Andexanet alfa was requested for 16 patients from November 2018 to November 2019. It was administered in nine patients, with compliance to restriction criteria of 66.6%, average ICU length of stay 5.6 days, hospital length of stay 8.6 days, hospital mortality in 44.4%, and thrombotic events in 33.3%. Orders were rejected in seven patients with compliance to restriction criteria of 100%, ICU length of stay 3.2 days, hospital length of stay 5.5 days, hospital mortality in 14%, and thrombotic events in 14%.

Conclusions:
A greater rate of adverse effects and mortality was identified with the use of andexanet alfa compared with clinical trials. This is potentially due to its use in a more severely ill patient population and lack of adherence to restriction criteria.
In Vitro–Administered Dexamethasone Suppresses T Cell Function With Reversal by Interleukin-7 in Coronavirus Disease 2019
Authors: Mazer Monty B. , Davitt Ethan , Turnbull Isaiah R. , Caldwell Charles C. , Brakenridge Scott C. , Remy Kenneth E. , Hotchkiss Richard S. 
Published: April 2021

Objectives:
Corticosteroid therapy has become standard of care therapy for hospitalized patients infected with the severe acute respiratory syndrome coronavirus-2 global pandemic-causing virus. Whereas systemic inflammation is a notably important feature in coronavirus disease 2019 pathogenesis, adaptive immune suppression and the inability to eradicate effectively the virus remain significant factors as well. We sought to evaluate the in vitro effects of dexamethasone phosphate on T cell function in peripheral blood mononuclear cells derived from patients with acute, severe, and moderate coronavirus disease 2019.

Design:
Prospective in vitro laboratory study.

Setting:
Coronavirus disease 2019-specific medical wards and ICUs at a single-center, quaternary-care academic hospital between October 1, 2020, and November 15, 2020.

Patients:
Eleven patients diagnosed with coronavirus disease 2019 admitted to either the ICU or hospital coronavirus disease 2019 unit. Three patients had received at least one dose of dexamethasone prior to enrollment.

Interventions:
Fresh whole blood was collected, and peripheral blood mononuclear cells were immediately isolated and plated onto precoated enzyme-linked immunospot plates for detection of interferon-γ production. Samples were incubated with CD3/CD28 antibodies alone and with three concentrations of dexamethasone. These conditions were also stimulated with recombinant human interleukin-7. Following overnight incubation, the plates were washed and stained for analysis using Cellular Technology Limited ImmunoSpot S6 universal analyzer (ImmunoSpot by Cellular Technology Limited, Cleveland, OH).

Measurements AND MAIN RESULTS:
Functional cytokine production was assessed by quantitation of cell spot number and total well intensity after calculation for each enzyme-linked immunospot well using the Cellular Technology Limited ImmunoSpot Version 7.0 professional software (CTL Analyzers, Shaker Heights, OH). Comparisons were made using t test and using a nonparametric analysis of variance Friedman test. The number of functional T cells producing interferon-γ and the intensity of the response decrease significantly with exposure to 1.2-µg/mL dexamethasone. About 0.12 µg/mL does not significantly affect the functional immune response on enzyme-linked immunospot. Interleukin-7 increases the overall number of activated T cells, including those exposed to dexamethasone.

Conclusions:
Further evaluation of the effect of immunomodulatory therapies is warranted in coronavirus disease 2019. A refined functional, precision medicine approach that evaluates the cellular immune function of individual patients with coronavirus disease 2019 is needed to better define which therapies could have benefit or cause harm for specific patients.
The Characterization of the Toll of Caring for Coronavirus Disease 2019 on ICU Nursing Staff
Authors: Laudanski Krzysztof , Moon Ken , Singh Amandeep , Chen Ying , Restrepo Mariana 
Published: April 2021

Objectives:
Coronavirus disease 2019 pandemic exercised a significant demand on healthcare workers. We aimed to characterize the toll of caring for coronavirus disease 2019 patients by registered nurses.

Design:
An observational study of two registered nurses cohorts.

Setting:
ICUs in a large academic center.

Subjects:
Thirty-nine ICU registered nurses assigned to coronavirus disease 2019 versus noncoronavirus disease 2019 patients.

Interventions:
None.

Measurements and Main Results:
Skin temperature (t [°C]), galvanic skin stress response (GalvStress), blood pulse wave, energy expenditure (Energy [cal]), number of steps (hr–1), heart rate (min–1), and respiratory rate (min–1) were collected using biosensors during the shift. National Aeronautics and Space Administration Task Loading Index measured the subjective perception of an assignment load. Elevated skin temperatures during coronavirus disease 2019 shifts were recorded (ΔtCOVID vs tnon-COVID = +1.3 [°C]; 95% CI, 0.1–2.5). Registered nurses staffing coronavirus disease patients self-reported elevated effort (ΔEffortCOVID vs Effortnon-COVID = +28.6; 95% CI, 13.3–43.9) concomitant with higher energy expenditure (ΔEnergyCOVID vs Energynon-COVID = +21.5 [cal/s]; 95% CI, 4.2–38.7). Galvanic skin stress responses were more frequent among coronavirus disease registered nurse (ΔGalStressCOVID vs GalvStressnon-COVID = +10.7 [burst/hr]; 95% CI, 2.6–18.7) and correlated with self-reported increased mental burden (ΔTLXMentalCOVID vs ΔTLXMentalnon-COVID = +15.3; 95% CI, 1.0–29.6).

Conclusions:
There are indications that registered nurses providing care for coronavirus disease 2019 in the ICU reported increased thermal discomfort coinciding with elevated energy expenditure and a more pronounced self-perception of effort, stress, and mental demand.
Patient Adherence in an Academic Medical Center’s Low-dose Computed Tomography Screening Program
Authors: Mortman Keith D. , Devlin Joseph , Giang Brian , Mortman Ryan , Sparks Andrew D. , Napolitano Michael A. 
Published: April 2021

Objectives:
Low-dose computed tomography (LDCT) screening is an important tool for reducing lung cancer mortality. This study describes a single center’s experience with LDCT and attempts to identify any barriers to compliance with standard guidelines.

Materials and Methods:
This is a retrospective review of a single university-based hospital system from 2015 to 2019. All individuals who met eligibility for lung cancer screening were entered into a database. The definition of adherence with the screening program was determined by the recommended timeline for the follow-up LDCT. Cohorts were split by adherence and demographics were compared.

Results:
A total of 203 LDCTs were performed in 121 patients who met eligibility for LDCT and had appropriate surveillance from 2015 to 2019. The average age was 64 years old. The overall adherence rate for prescribed LDCTs was 59.1%. Patients with Lung-RADS score 2 had 2.43 times higher odds of adherence relative to patients with Lung-RADS score 1 (odds ratio [OR]=2.43; 95% confidence interval [CI]: 1.23-4.83; P=0.011). African American patients had 42% lower odds of adherence relative to white patients (OR=0.58; 95% CI: 0.32-1.06; P=0.076). Patients with non–District of Columbia zip codes had 57% higher odds of adherence relative to those with District of Columbia zip codes, although this did not reach statistical significance (OR=1.57; 95% CI: 0.87-2.82; P=0.136).

Conclusions:
Despite the implementation of a multidisciplinary, academic LDCT screening program, overall adherence rate to prescribed follow-up scans was suboptimal. Socioeconomic disparities and African American race may negatively affect adherence to lung cancer screening LDCT guidelines. Patients with concerning findings on initial LDCT had a higher association of adherence to guidelines.
Impact of Integrase inhibitors and tenofovir alafenamide on weight gain in people with HIV
Authors: Lake Jordan E. , Trevillyan Janine 
Published: April 2021

Purpose of review
Obesity is increasing in people with HIV (PWH). This review aims to summarise the recent evidence investigating the associations between the use of integrase inhibitors and tenofovir alafenamide (TAF) with weight gain and the mechanisms by which this may occur. Understanding the role that antiretroviral therapies play in promoting weight gain is critical in making informed treatment decisions.

Recent findings
Weight gain is common with antiretroviral therapies and can lead to significant medical complications for PWH. Antiretroviral regimens containing an integrase inhibitor in conjunction with TAF are associated with the greatest degree of weight gain. This weight gain is greatest with dolutegravir and bictegravir compared with other integrase inhibitors. Some of the measured weight gain attributed to TAF may actually reflect a loss of weight suppressant effects of tenofovir disoproxil fumarate, and thus the exact proportional contribution of TAF remains to be seen. The mechanisms by which advent of antiretroviral therapy may be promoting weight gain is still being determined but underlying genetic risks factors and gender are very important determinants of the degree of weight gained.

Summary
Integrase inhibitors and TAF contribute to weight gain in PWH. This places them at risk for potentially serious medical complications.
Heparin-Induced Bullous Hemorrhagic Dermatosis: A Report of an Exceptionally Exuberant Case and Literature Review
Authors: Cortez de Almeida Rita Fernanda , Vita Campos Clarissa , Daxbacher Egon Luiz , Jeunon Thiago 
Published: April 2021

Introduction:
Heparin-induced bullous hemorrhagic dermatosis (HBHD) is an unusual cutaneous adverse reaction to heparin characterized by acute onset of hemorrhagic bullae.

Methodology:
An exuberant case of HBHD is reported, and a revision of previously reported cases indexed on PubMed is provided. Cases were tabulated to the following parameters: sex, age, type of heparin and route of administration, associated medical procedure, number of days between heparin start and onset of lesions, site of the lesions, level of blister on histopathology, inflammatory infiltrate on histopathology, direct immunofluorescence findings, heparin-related intervention, number of days to resolution of skin lesions, associated hemorrhagic event, and outcome.

Case report:
A 21-year-old woman with end-stage renal disease was receiving intravenous unfractioned heparin (UFH) during hemodialysis section for the past 3 months. Four hours after using for the first time an arteriovenous fistula punctured on her right wrist, the patient noticed the onset of vesicles and blisters on the right forearm containing citrus or serohemorrhagic exudate, which became overt hemorrhagic in 24 hours. Histopathology depicted a nonacantholytic subcorneal blister containing erythrocytes and plasma without any significant dermal inflammatory infiltrate.

Results:
Sixty cases of HBHD were included. HBHD affected predominantly men, with a male/female rate of 2.75. The age range was from 21 to 94 years, with an average of 70.8 and a median of 72 years. Nine patients used UFH, and 54 patients used low molecular weight heparins (3 patients used both). The lapse of time between the start of heparin and the onset of skin lesion varied from 6 hours to 240 days, with an average of 17.3 days and a median of 7 days. Limbs were affected in most of the cases. The level of the blister was subcorneal in 10 patients, intraepidermal in 30, subepidermal in 8, and both intraepidermal and subepidermal in 1. In 33 cases, there was no significant dermal inflammatory infiltrate. Pure lymphocytic inflammatory infiltrate was present in 10 cases. Eosinophils were found within the dermal inflammatory infiltrate in 2 cases, neutrophils in 2, and a mixture of eosinophils and neutrophils in other 2. Direct immunofluorescence was performed in 18 cases, all of them with negative results.

Discussion:
We hypothesize that mechanical trauma, skin fragility, and the anticoagulation effect of heparin might contribute concomitantly to the development of the lesions and speculate that subepidermal blisters in HBHD could be formed by rupture of the floor of a former intraepidermal blister.
Eruptive Xanthoma With Dermal Mucin Deposition
Authors: Kim So Min , Lee Heera , Kim You Chan 
Published: April 2021

Abstract:
Xanthomas present clinically as eruptive, tuberoeruptive, tuberous, tendinous, or planar forms. Among these, eruptive xanthoma (EX) is characterized by sudden development of multiple, red-to-yellow papules, each less than 5 mm in diameter, on the extensor surface of the extremities and the buttock area. EX is often associated with severe hypertriglyceridemia, underlying diabetes, obesity, or excessive alcohol intake. Histologically EX is characterized by foamy cells, which are lipid-laden macrophages surrounded by lymphoid cells, histiocytes, and neutrophils; however, mucin deposition is not a typical feature. Herein, we report a rare case of xanthoma with diffuse, abundant mucin deposition.
Rate of Immunohistochemistry Utilization in the Diagnosis of Cutaneous Melanocytic Lesions
Authors: Chen Tony C. , Hitchcock Michael G. 
Published: April 2021

Abstract:
Melanocytic lesions represent a large portion of the workload in many laboratories. Although many melanocytic nevi can be confidently diagnosed based on routine hematoxylin and eosin light microscopy, ancillary testing is often warranted. Various immunohistochemical (IHC) stains are routinely used in the diagnosis of melanocytic lesions. Because melanocytic lesions are frequently encountered in skin specimens, the use of IHC is likely to represent a significant area of resource utilization in dermatopathology laboratories. Our study investigates the rate of IHC utilization in the diagnosis of melanocytic lesions in a high-volume, government-funded, not-for-profit laboratory. Of the 1230 cases of melanocytic lesions investigated, including benign as well as malignant entities, 300 cases involved the utilization of IHC. IHC was used in a larger percentage of melanomas than nevi and in a larger percentage of melanoma in situ cases than invasive melanomas. SOX10 was overwhelmingly the most frequently used IHC.