bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical features and outcomes after endovascular therapy for penetrating aortic ulcer and intramural hematoma
Authors: Jiang Xiaolang , Liu Yifan , Chen Bin , Jiang Junhao , Shi Yun , Ma Tao , Lin Changpo , Guo Daqiao , Xu Xin , Fu Weiguo , Dong Zhihui 
Published: April 2021

Objectives To identify the differences between clinical features and outcomes after endovascular therapy for penetrating aortic ulcer (PAU) and intramural hematoma (IMH). Methods From January 2009 to March 2020, patients who underwent endovascular therapy for PAU and IMH were enrolled. Information on patient demographics, presentation, PAU and IMH morphology, laboratory examination, and clinical follow-up information was collected and analyzed. Univariate analysis was performed to identify the differences between IMH and PAU, and Kaplan–Meier was used to calculate the cumulative survival rate and freedom from reintervention. Results A total of 114 patients were enrolled; 80 (70.2%) of them were diagnosed with PAU. Compared with PAU, patients with IMH were younger ( p = 0.006), more likely to be admitted emergently ( p = 0.001), had longer hospital stay ( p = 0.028), and had higher levels of C-reactive protein ( p = 0.030). Meanwhile, patients with IMH were more likely to be associated with hypertension ( p = 0.020) and pleural effusion ( p < 0.001) and less likely to have a history of acute coronary syndrome ( p = 0.019) and prior cardiovascular intervention ( p = 0.017). The five-year freedom from reintervention and cumulative survival rate were 94.2% (95% confidential interval, 88.9%–99.9%) and 87.8% (95% confidential interval, 79.5%–96.9%) in PAU patients and 89.6% (95% confidential interval, 75.8%–99.9%) and 85.1% (95% confidential interval, 68.0%–99.9%) in IMH patients, respectively. There was no significant difference in freedom from reintervention ( p = 0.795) or cumulative survival rate ( p = 0.817). Conclusions IMH appeared to occur in younger patients with hypertension and usually had an acute onset, while PAU was more likely to be found incidentally in older patients with atherosclerosis. Endovascular therapy was effective in both IMH and PAU patients with encouraging outcomes.
Comorbidities Known to Affect Physical Function Negatively Impact Baseline Health-Related Quality-of-Life in Patients With Chronic Rhinosinusitis
Authors: Gill Amarbir S. , Ashby Shaelene , Oakley Gretchen M. , Steele Toby O. , Menjivar Dennis , Orlandi Richard R. , Alt Jeremiah A. 
Published: April 2021

Background Medical comorbidities are commonly encountered in chronic rhinosinusitis (CRS) and may impact both physical function and patient reported health-related quality-of-life (HRQOL). The functional comorbidity index (FCI) is designed to elucidate the role of comorbidities on functional prognosis. The objective of this study was to understand the impact of comorbidities known to impact physical function on baseline HRQOL using the FCI. Methodology: Patients meeting diagnostic criteria for CRS were prospectively enrolled in a cross-sectional study. Responses from the Sinonasal Outcomes Test-22 (SNOT-22), a measure of patient HRQOL, as well as the Lund-Kennedy and Lund-Mackay scores were recorded at enrollment. FCI was calculated retrospectively using the electronic medical record. Information was collected and compared for patients without (CRSsNP) and with nasal polyps (CRSwNP) using chi-square and t-tests. Spearman’s correlations, followed by multivariate regression analysis, were used to assess the association between FCI and SNOT-22 scores. Results One hundred and three patients met inclusion criteria for analysis. There were no significant differences in age, gender, and SNOT-22 scores between patients with CRSsNP and those with CRSwNP. FCI was significantly and independently associated with worse SNOT-22 scores ( P = .012). FCI did not correlate with endoscopy and computed tomography scores. The mean FCI for patients with CRSsNP and CRSwNP was 2.02 and 2.24, respectively, and did not differ significantly between the two cohorts ( P = .565). Conclusions Major medical comorbidities known to affect physical function are associated with worse SNOT-22 scores in patients with CRS as measured by the FCI.
Treatment of Patellofemoral Chondral Lesions Using Microfractures Associated with a Chitosan Scaffold: Mid-Term Clinical and Radiological Results
Authors: Calvo Rafael , Figueroa David , Figueroa Francisco , Bravo Jose , Contreras Martin , Zilleruelo Nicolas 
Published: April 2021

Objective To assess the clinical and radiological results of patellofemoral osteochondral lesions treated with microfractures associated with a chitosan scaffold. Design A retrospective observational analytical study was performed. Fifteen patients with full-thickness patellofemoral osteochondral lesions were included. Quantity and quality of the reparation cartilage was assessed with the MOCART 2.0 score on a postoperative magnetic resonance imaging (MRI), and clinical outcomes were evaluated with pre- and postoperative Kujala score tests. Shapiro-Wilk test for normality was applied as well as Wilcoxon’s signed rank test and Kruskal-Wallis H test for clinical scores within subjects and patella versus trochlea subgroups comparisons. Analysis of variance test was used for imaging subgroups comparison, with P < 0.05 defined as statistical significance. Results Mean follow-up was 33.36 months (range 24-60 months). Postoperative Kujala scores improved an average of 19 points compared with the preoperative state (SE = 17.6; P < 0.001). No statistical difference was found through the clinical location assessment ( P = 0.756), as well as the cartilage imaging assessment ( P = 0.756). The mean MOCART 2.0 scale was 67.67 (range 50-85). Conclusions Treating full-thickness patellofemoral osteochondral lesions with microfractures associated with a chitosan scaffold proved to be effective regarding defect filling and symptomatic improvement.
Positive predictive value and stroke workflow outcomes using automated vessel density (RAPID-CTA) in stroke patients: One year experience
Authors: Adhya Julie , Li Charles , Eisenmenger Laura , Cerejo Russell , Tayal Ashis , Goldberg Michael , Chang Warren 
Published: April 2021

Purpose Several new techniques have emerged for detecting anterior circulation large vessel occlusion by quantifying relative vessel density including RAPID-CTA, potentially allowing for faster triage and decreased time to mechanical thrombectomy. We present our one-year experience on positive predictive value of RAPID-CTA for the detection of large vessel occlusion in patients presenting with stroke symptoms and its effect on treatment time and clinical outcomes. Materials and methods Three hundred and ten patients presenting with stroke symptoms with relative vessel density <60% on RAPID-CTA were included (average age 70 years, 145 male, 165 female). Examinations were considered positive if there was evidence of large vessel occlusion or high grade stenosis. Computed tomography angiography to groin puncture time was calculated during one-year time intervals before and after RAPID-CTA installation. Ninety-day Modified Rankin Scale scores were obtained for patients in each cohort. Results Of the 310 patients, 270 had large vessel occlusion or high grade stenosis (87% positive predictive value), with 161 having large vessel occlusion. Using 45% relative vessel density threshold, 129/161 large vessel occlusion were detected (80% sensitivity) and 163/172 examinations were positive (95% positive predictive value). Computed tomography angiography to groin puncture time was significantly lower after deployment of RAPID-CTA (93 min vs 68 min, p<0.05). Average 90 day modified Rankin Scale score was lower in the RAPID-CTA group with a higher percentage of patients with functional independence, although the data was not statistically significant. Conclusion RAPID-CTA had high positive predictive value for large vessel occlusion with a 45% relative vessel density threshold, which could facilitate active worklist reprioritization. Time to treatment was significantly lower and clinical outcomes were improved after deployment of RAPID-CTA.
A qualitative study with orthopaedic surgeons on pain catastrophizing and surgical outcomes: shifting from a medical towards a biopsychosocial model of surgery
Authors: Dismore Lorelle , van Wersch Anna , Murty Aradhyula N , Swainston Katherine 
Published: April 2021

Background: Pain catastrophizing (PC) moderates surgical outcomes and behavioural interventions are recommended to optimise post-operative results. Less is known about surgeons’ experiences of providing care and their attitudes towards the use of interventions in practice. Objective: It is therefore invaluable to understand surgeons’ views on how best to support patients who may be at risk of suboptimal recovery. Eleven surgeons and three registrar orthopaedic practitioners took part in semi-structured interviews within a hospital setting. The surgical decision-making process, views of PC and the use of behavioural interventions in surgical practice were explored. Results: Thematic analysis identified five themes: pain expressions and pain behaviours affect the surgeons’ decision-making process, when pathologies and symptoms do not match, psychological factors pertaining to unsatisfactory outcomes, a service gap in surgical care and the acceptability of using a screening tool in surgical practice to identify patients at risk of suboptimal recovery. Conclusion: Orthopaedic surgeons face challenges in identifying who is likely to reach optimal versus suboptimal outcome. Surgeons are becoming increasingly aware of patient psychological distress being detrimental to outcomes, and they support the use of behavioural interventions to optimise post-operative outcomes or stop unnecessary treatments. The surgeons accept the use of a screening tool in surgical practice with better access to support services with input from allied health professionals. A screening tool may provide great utility for identifying at risk patients, to allow for modification of surgical patients care plans.
Use of item response theory to investigate disability-related questions in the National Health and Nutrition Examination Survey
Authors: Terman Samuel W , Burke James F 
Published: April 2021

Objectives: Accurately measuring disability is critical toward policy development, economic analyses, and determining individual-level effects of health interventions. Nationally representative population surveys such as the National Health and Nutrition Examination Survey provide key opportunities to measure disability constructs such as activity limitations. However, only very limited work has previously evaluated the item response properties of questions pertaining to limitations in National Health and Nutrition Examination Survey. Methods: This was a cross-sectional study. We included participants ⩾20 years old for the 2013–2018 National Health and Nutrition Examination Survey cycles. Activity limitations, and a smaller number of body function impairments or participation restrictions, were determined from interview questions. We performed item response theory models (a two-parameter logistic and a graded response model) to characterize discriminating information along the latent continuum of activity limitation. Results: We included 17,057 participants. Although each particular limitation was somewhat rare (maximally 13%), 7214 (38%) responded having at least one limitation. We found a high amount of discriminating information at 1–2 standard deviations above average limitation, though essentially zero discrimination below that range. Items had substantial overlap in the range at which they provided information distinguishing individuals. The ordinal graded response model including 20 limitations provided greater information than the dichotomous two-parameter logistic model, though further omitting items from the graded response model led to loss of information. Conclusion: National Health and Nutrition Examination Survey disability-related questions, mostly specifically activity limitations, provided a high degree of information distinguishing individuals with higher than average limitations on the latent continuum, but essentially zero resolution to distinguish individuals with low or average limitations. Future work may focus on developing items which better distinguish individuals at the “lower” end of the limitation spectrum.
The Feasibility of 3D Intraoperative Navigation in Lateral Lumbar Interbody Fusion: Perioperative Outcomes, Accuracy of Cage Placement and Radiation Exposure
Authors: Urakawa Hikari , Sivaganesan Ahilan , Vaishnav Avani S. , Sheha Evan , Qureshi Sheeraz A 
Published: April 2021

Study Design: Retrospective cohort study. Objectives: To evaluate perioperative outcomes, accuracy of cage placement and radiation exposure in lateral lumbar interbody fusion (LLIF) using 3D intraoperative navigation (ION), compared to conventional 2D fluoroscopy only. Methods: The perioperative outcomes and accuracy of cage placement were examined in all patients who underwent LLIF using ION (ION group) or fluoroscopy only (non-ION group) by a single surgeon. The radiation exposure was examined in patients who underwent stand-alone LLIF. Results: A total of 87 patients with 154 levels (ION 49 patients with 79 levels/ non-ION 38 patients with 75 levels) were included. There were no significant differences in operative time (ION 143.5 min vs. non-ION 126.0 min, P = .406), time from induction end to surgery start (ION 31.0 min vs. non-ION 31.0 min, P = .761), estimated blood loss (ION 37.5 ml vs. non-ION 50.0 ml, P = .351), perioperative complications (ION 16.3% vs. non-ION 7.9%, P = .335) and length of stay (ION 50.6 hours vs. non-ION 41.7 hours, P = .841). No significant difference was found in the accuracy of cage placement ( P = .279). ION did not significantly increase total radiation dose (ION 51.0 mGy vs. non-ION 47.4 mGy, P = .237) and tended to reduce radiation dose during the procedure (ION 32.2 mGy vs. non-ION 47.4 mGy, P = .932). Conclusions: The perioperative outcomes, accuracy of cage placement and radiation exposure in LLIF using ION were comparable to those using fluoroscopy only. The use of ION in LLIF was feasible, safe and accurate and may reduce radiation dose to the surgeon and surgical team.
Effectiveness of a Gelatin–Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study
Authors: Nomura Kazunori , Yoshida Munehito , Okada Motohiro , Nakamura Yosuke , Yawatari Kenichi , Nakayama Enshi 
Published: April 2021

Study Design: Retrospective cohort study. Objectives: To investigate the effectiveness and safety of a gelatin–thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). Methods: This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. Results: The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B ( P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). Conclusions: The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.
Neuromuscular Training Warm-up Prevents Acute Noncontact Lower Extremity Injuries in Children’s Soccer: A Cluster Randomized Controlled Trial
Authors: Hilska Matias , Leppänen Mari , Vasankari Tommi , Aaltonen Sari , Kannus Pekka , Parkkari Jari , Steffen Kathrin , Kujala Urho M. , Konttinen Niilo , Räisänen Anu M. , Pasanen Kati 
Published: April 2021

Background: Prevention of sports injuries is essential in youth, as injuries are associated with less future physical activity and thus greater all-cause morbidity. Purpose: To investigate whether a neuromuscular training warm-up operated by team coaches is effective in preventing acute lower extremity (LE) injuries in competitive U11-U14 soccer players. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Twenty top-level U11 to U14 soccer clubs in Finland were randomized into intervention and control groups and assessed for 20 weeks. Participants included 1403 players (280 female, 1123 male; age range, 9-14 years): 673 players (44 teams) in the intervention group and 730 players (48 teams) in the control group. The intervention group team coaches were introduced to a neuromuscular training warm-up to replace the standard warm-up 2 to 3 times per week. The control teams were asked to perform their standard warm-up. Injury data collection was done via weekly text messages. The primary outcome measure was a soccer-related acute LE injury, and the secondary outcome measure was an acute noncontact LE injury. Results: A total of 656 acute LE injuries occurred: 310 in the intervention group and 346 in the control group. The overall acute LE injury incidence was 4.4 per 1000 hours of exposure in the intervention group and 5.5 per 1000 hours of exposure in the control group, with no significant difference between groups (incidence rate ratio [IRR], 0.82 [95% CI, 0.64-1.04]). There were 302 acute noncontact LE injuries: 129 in the intervention group (incidence, 1.8 per 1000 hours) and 173 in the control group (2.7 per 1000 hours). A significant reduction in acute noncontact LE injuries of 32% (IRR, 0.68 [95% CI, 0.51-0.93]) was observed in the intervention group compared with the control group. Furthermore, significant reductions in injury incidence in favor of the intervention group were seen in the subanalyses of acute noncontact LE injuries, leading to ≤7 days of time loss and fewer ankle and joint/ligament injuries. Conclusion: A neuromuscular training warm-up operated by team coaches was found to be effective in preventing acute noncontact LE injuries in children’s soccer, but this was not seen in all acute LE injuries. Clinical Relevance: We encourage children’s soccer coaches and health care professionals to implement neuromuscular training warm-up in youth sports. Registration: ISRCTN14046021 (ISRCTN registry).
Changes in Pediatric Sports Injury Presentation During the COVID-19 Pandemic: A Multicenter Analysis
Authors: Johnson Mitchell A. , Halloran Kenny , Carpenter Connor , Pascual-Leone Nicolas , Parambath Andrew , Sharma Jigyasa , Seltzer Ryan , Ellis Henry B. , Shea Kevin G. , Ganley Theodore J. 
Published: April 2021

Background: The current coronavirus 2019 (COVID-19) pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. Purpose: To examine the impact of COVID-19 and corresponding public health measures on the characteristics of common pediatric musculoskeletal injuries associated with sports. Study Design: Cohort study; Level of evidence, 3. Methods: This was a multicenter retrospective cohort study comparing patients with sports injuries presenting to 3 geographically diverse level I pediatric trauma hospitals and outpatient orthopaedic surgery clinics in the United States during the COVID-19 pandemic and a prepandemic period at the same institutions. Patients were included if they presented for care between February 15 and July 15 in 2020 (pandemic cohort) or between March 15 and April 15 in 2018 and 2019 (prepandemic cohort). Results: Included were 1455 patients with an average age of 12.1 ± 4.5 years. When comparing patients presenting in 2018 and 2019 with those presenting in 2020, we observed a decrease in mean age during the pandemic (12.6 ± 4.0 vs 11.0 ± 5.2 years; P = .048). Additionally, a decrease in the proportion of injuries attributed to sports (48.8% vs 33.3%; P < .001) and those occurring at school (11.9% vs 4.0%; P = .001) was observed. The proportion of injuries attributable to clavicle fractures increased during the early stages of the pandemic (13.2% vs 34.7%; P < .001). There was no statistically significant delay to care in injuries presenting during the pandemic (41.5 ± 141.2 vs 19.23 ± 79.1 days; P = .175). Conclusion: Across 3 tertiary care institutions, patients were seen without significant delay during the pandemic. We observed a significant decline in pediatric musculoskeletal injuries associated with sports during the COVID-19 pandemic. This decrease has been accompanied by a shift in both injury type and mechanism.
Prothrombotic immune thrombocytopenia after COVID-19 vaccination
Authors: Tiede Andreas , Sachs Ulrich J. , Czwalinna Andreas , Werwitzke Sonja , Bikker Rolf , Krauss Joachim K. , Donnerstag Frank , Weißenborn Karin , Höglinger Günter , Maasoumy Benjamin , Wedemeyer Heiner , Ganser Arnold 
Published: April 2021

AbstractWe report 5 cases of prothrombotic immune thrombocytopenia after exposure to the ChAdOx1 vaccine (AZD1222, Vaxzevria) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients presented 5 to 11 days after first vaccination. The spectrum of clinical manifestations included cerebral venous sinus thrombosis, splanchnic vein thrombosis, arterial cerebral thromboembolism, and thrombotic microangiopathy. All patients had thrombocytopenia and markedly elevated D-dimer. Autoantibodies against platelet factor 4 (PF4) were detected in all patients, although they had never been exposed to heparin. Immunoglobulin from patient sera bound to healthy donor platelets in an AZD1222-dependent manner, suppressed by heparin. Aggregation of healthy donor platelets by patient sera was demonstrated in the presence of buffer or AZD1222 and was also suppressed by heparin. Anticoagulation alone or in combination with eculizumab or intravenous immunoglobulin (IVIG) resolved the pathology in 3 patients. Two patients had thromboembolic events despite anticoagulation at a time when platelets were increasing after IVIG. In summary, an unexpected autoimmune prothrombotic disorder is described after vaccination with AZD1222. It is characterized by thrombocytopenia and anti-PF4 antibodies binding to platelets in AZD1222-dependent manner. Initial clinical experience suggests a risk of unusual and severe thromboembolic events.
Treating lymphoma is now a bit EZ-er
Authors: Morin Ryan D. , Arthur Sarah E. , Assouline Sarit 
Published: April 2021

Abstract
Tazemetostat represents the first epigenetic therapy approved for the treatment of follicular lymphoma (FL). It inhibits the activity of the enhancer of zeste homolog 2 (EZH2) histone methyltransferase, the first of a multitude of epigenetic regulators that have been identified as recurrently mutated in FL and germinal center diffuse large B-cell lymphoma. In this review, we discuss the initial discovery and ongoing exploration of the functional role of EZH2 mutations in lymphomagenesis. We also explore the path from the preclinical development of tazemetostat to its approval for the treatment of relapsed FL, and potential future therapeutic applications. We discuss the clinical data that led to the approval of tazemetostat and ongoing research into the function of EZH2 and of tazemetostat in lymphomas that derive from the germinal center, which could increase the applicability of this drug in the future.