bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Authors: Lin Adrian J. , Costandi Andrew J. , Kim Eugene , Skaggs David L. , Andras Lindsay M. , Patel Neha , Lo Carl , Illingworth Kenneth D. 
Published: May 2021

Background:Methylnaltrexone, a peripheral opioid antagonist, is used to decrease opioid-induced constipation; however, there is limited evidence for its use in children. The primary objective of the study is to assess the efficacy of per os (PO) methylnaltrexone in inducing bowel movements (BMs) in patients with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and instrumentation (PSFI). Secondary outcomes include hospital length of stay, postoperative pain scores, and postoperative opioid usage.Methods:Retrospective chart review identified all adolescent idiopathic scoliosis patients above 10 years of age who underwent PSFI with a minimum of 24 hours of postoperative opioid analgesia after the initiation of the new bowel regimen protocol. The bowel regimen included daily administration of PO methylnaltrexone starting on postoperative day 1 until BM is achieved. A case-matched cohort was obtained with patients who did not receive PO methylnaltrexone and otherwise had the same bowel function regimen. Case-matched controls were also matched for age, sex, body mass index, and curve severity.tTests and Pearson χ2tests were used for statistical analysis.Results:Fifty-two patients received oral methylnaltrexone (14±2.6 y) and 52 patients were included in the case-matched control group (14±2.1 y). The methylnaltrexone group had a significantly shorter hospital length of stay (3.09±0.66) compared with controls (3.69±0.80) (P<0.01). 59% (31 of 52) of the methylnaltrexone group had a BM by postoperative day postoperative day 2, compared with 30% (16 of 52) of the control group (P<0.01). In the methylnaltrexone group, 44% (23 of 52) of the patients required a Dulcolax (bisacodyl) suppository and 11% (6 of 52) required an enema, compared with 50% (26 of 52) and 33% (12 of 52) of the control group respectively (P=0.43 and 0.12). In addition, significantly less patients had abdominal distension during their postoperative stay in the methylnaltrexone group (17%, 9 of 52) compared with the control group (40%, 21 of 52) (P<0.01). There was no significant difference in self-reported average FACES pain score (P=0.39) or in opioid morphine equivalents required per hour (P=0.18).Conclusions:Patients who received PO methylnaltrexone after PSFI had decreased length of stay and improved bowel function. Administration of methylnaltrexone did not increase maximum self-reported FACES pain values or opioid consumption compared with controls. The use of oral methylnaltrexone after PSFI reduces postoperative constipation, which has implications for reducing hospital length of stay and overall morbidity.Level of Evidence:Level III—retrospective comparative study.
Predictors of Arthrofibrosis After Pediatric Anterior Cruciate Ligament Reconstruction: What Is the Impact of Quadriceps Autograft?
Authors: Ouweleen Abraham J. , Hall Tyler B. , Finlayson Craig J. , Patel Neeraj M. 
Published: May 2021

Background:
Recent literature on arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) in children and adolescents is limited, especially with regards to quadriceps tendon (QT) autograft. The purpose of this study was to identify predictors of arthrofibrosis after ACLR, with attention to the impact of graft type.

Methods:
Patients that underwent primary ACLR at a tertiary children’s hospital were reviewed for this retrospective case-control study. Those with multiligament reconstructions, lateral extra-articular tenodesis procedures, allografts, or a modified MacIntosh reconstruction were excluded. Arthrofibrosis was defined as a deficit of 10 degrees of extension and/or 20 degrees of flexion at 3 months after ACLR. Univariate analysis was followed by purposeful entry logistic regression to adjust for confounding factors.

Results:
A total of 378 patients (mean age 15.9±1.7 y, 49.7% female) were included in the analysis, of which there were 180 patellar tendon (PT), 103 hamstrings tendon (HT), and 95 QT grafts. The rate of arthrofibrosis was 1.9% for HT, 6.3% for QT, and 10.0% for PT (P=0.04). Females developed arthrofibrosis more frequently than males (10.6% vs. 3.2%, P=0.004). Those that ultimately experienced this complication had lower median flexion at 6 weeks after ACLR (88 vs. 110 degrees, P<0.001). In multivariate analysis, PT graft raised the odds of arthrofibrosis 6.2 times compared to HT [95% confidence interval (CI): 1.4-27.6, P=0.02], but there were no significant differences between QT and other grafts. Females were at 4.2 times higher odds than males (95% CI: 1.6-10.8; P=0.003). Patients that were unable to attain 90 degrees of flexion 6 weeks after ACLR had 14.7 times higher odds of eventually developing arthrofibrosis (95% CI: 5.4-39.8; P<0.001). Finally, those with an extension deficit of ≥5 degrees 6 weeks after ACLR had 4.7 times higher odds of experiencing this complication (95% CI: 1.8-12.2, P=0.001).

Conclusion:
The rate of arthrofibrosis with QT autograft is 6.3% after pediatric ACLR. PT autograft, female sex, and motion deficits at 6 weeks after ACLR were predictive of arthrofibrosis in children and adolescents.

Level of Evidence:
Level III—prognostic study.
Prognosis of Congenital Pseudarthrosis of the Tibia: Effect of Site of Tibial Pseudarthrososis and Fibular Involvement
Authors: Zargarbashi Ramin , Bagherpour Ali , Keshavarz-Fathi Mahsa , Panjavi Behnam , Bagherpour Zarchi Masoud 
Published: May 2021

Background:
Congenital pseudarthrosis of the tibia is a rare condition that has long been one of the most challenging concerns in pediatric orthopedic surgery. When the fracture occurs, a recalcitrant nonunion is expected. This is why successful treatment means maintaining a long-term union. In this study, we aimed to assess the therapeutic outcomes for the middle and distal third fractures of the tibia and to explore whether the treatment of concurrent fibular pseudoarthrosis affects the outcome.

Methods:
We studied 12 patients with congenital pseudarthrosis of the tibia (Crawford type 4) from 2014 to 2019. A combination approach including intramedullary rod, Ilizarov apparatus, corticocancellous bone graft, and periosteal graft was used. In the initial surgery, we did not fix the ankle and subtalar joints.

Results:
As a result, the union was achieved in 67% of the cases after the index surgery. All of the cases with primary nonunion were related to the concurrent fibular and distal third tibial pseudarthrosis. In addition, ignoring the treatment of fibular pseudarthrosis in the index surgery led to ankle valgus deformity both in the middle and in the distal third tibial pseudarthrosis. We finally achieved a 100% union rate in all cases, with no subsequent refracture.

Conclusions:
Surgery at an early age was associated with favorable results and minimized deformity. In concurrent fibular and distal third tibial pseudarthrosis, it is recommended to transfix the ankle and subtalar joints to create a cross-union with fibula so that the intense union can be confidently obtained with more cross-section to prevent ankle valgus deformity.

Level of Evidence:
Level IV—case series.
Risk Factors and Prevention of C5 Palsy After Anterior Cervical Decompression and Fusion
Authors: Nakajima Hideaki , Honjoh Kazuya , Watanabe Shuji , Kubota Arisa , Matsumine Akihiko 
Published: May 2021

Study Design:
This was a retrospective study.

Objective:
The objective of this study was to review clinical and imaging findings after anterior cervical decompression and fusion, as a basis for prevention of C5 palsy.

Summary of Background Data:
C5 palsy is a common postoperative complication in spine surgery, but the mechanistic basis for this condition is unknown.

Materials and Methods:
The subjects were 239 patients with cervical myelopathy who underwent anterior cervical decompression and fusion including at C4–C5 disk level at our hospital from 2001 to 2018. Twelve of these patients (5.0%) had C5 palsy postoperatively. Clinical features and imaging findings were compared in patients with and without C5 palsy.

Results:
In patients with C5 palsy, the sagittal alignment of the cervical spine was kyphotic, the width of the C5 intervertebral foramen was narrower, and the lateral decompressed line was wider beyond the medial part of the Luschka joint. Age, sex, disease, the number of fused segments, decompression width, and anterior shift of the spinal cord did not differ significantly between patients with and without C5 palsy.

Conclusions:
These results indicate that the pathomechanism of C5 palsy may be dependent on the location of the lateral decompression line, especially in patients with cervical kyphosis and a narrow C5 intervertebral foramen. Excessive lateral decompression beyond the Luchka joint might lead to C5 root kinking between the intervertebral foramen and posterior edge of vertebra. This pathomechanism may be similar in anterior and posterior approaches. To prevent C5 palsy, the medial line of the Luschka joint should be confirmed intraoperatively and decompression should be performed within the Luschka joints. Alternatively, medial foraminotomy should be used in cases needing wide decompression, such as those with massive ossification of the posterior longitudinal ligament, lateral osteophytes, and symptomatic foraminal stenosis.

Level of Evidence:
Level III.
Do the 2013 United States Preventive Services Task Force guidelines for lung cancer screening fail high-risk African American smokers? An institutional retrospective observational cohort study
Authors: Thurlapati Aswani , Velez-Martinez Carol S. , Hirani Samina , Abad Jade , Shi Runhua , Beedupalli Kavitha , Mansour Richard P. 
Published: May 2021

Background
Lung cancer cause nearly 1.76 million deaths worldwide in 2018. In 2011, the National-Lung-Cancer-Screening-Trial showed 20% relative risk reduction with LDCT and subsequently led to the current USPSTF screening guidelines. However, the predominant focus on elderly, Caucasian questions its generalizability to communities with young, African Americans such as our institution. Hence, the objective of our study is to investigate the need to modify the current screening guidelines at our institution by assessing the applicability of newer individual risk-based prediction models for LDCT screening.

Methods
This is a retrospective observational cohort study of newly diagnosed lung cancer patients at LSU Health Sciences Center Shreveport from 2011 to 2015. One-third of the patients did not meet the current USPSTF screening guidelines. We categorized them into high-risk (groups1 and 2), moderate-risk, and low-risk according to 2018 NCCN Lung Cancer Screening Guidelines Version 1.2020. The high-risk groups were differentiated using the Tammemagi lung cancer risk calculator.

Results
Among those who did not meet the screening guidelines, nearly 50% were African American, 95% with known smoking history, and 80% diagnosed at advanced stage at the time of diagnosis. After employing the Tammemagi Risk based calculator, 12.5% were categorized into high-risk group 2, who are also eligible for annual LDCT.

Conclusion
The current USPSTF guidelines have failed in our population consisting of young African American smokers, questioning the health disparity in medicine. By employing individual risk-based prediction models, we could potentially identify tailored high-risk populations leading to appropriate use of LDCT screening.
Risk factors for cardiovascular mortality and melanoma-specific mortality among patients with melanoma: a SEER based study
Authors: Elshanbary Alaa Ahmed , Zaazouee Mohamed Sayed , Abdelmonem Mohamed , Mohammed Yasmine Adel , Abdel-Aziz Walid 
Published: May 2021

Objective
This study aims to identify the risk factors for cardiovascular mortality in melanoma patients.

Methods
Data of melanoma patients were obtained from the Surveillance, Epidemiology, and End Results database. We used Person’s chi-square test to assess the relationships between categorical variables. We used Kaplan–Meier test in the univariate analysis and Cox regression test for the multivariate analysis. Analyses were conducted using the SPSS software.

Results
We analyzed data of 194 503 melanoma patients. Among them, 28 818 (14.8 %) died due to cardiovascular diseases. Cardiovascular-specific survival was higher in younger patients, women, married, localized disease, superficial spreading melanoma and in patients who had surgery. It was lower in patients who received chemotherapy or radiotherapy. The multivariate analysis revealed a higher risk of cardiovascular mortality in patients aged 50–64 years [hazard ratio (HR), 7.297; 95% confidence interval (CI), 6.68–7.97], patients aged ≥65 years (HR, 43.309; 95% CI, 39.706–47.240), men (HR, 1.535; 95% CI, 1.475–1.597), Blacks (HR, 1.29; 95% CI, 1.044–1.594), separated (HR, 1.286; 95% CI, 1.058–1.562), widowed (HR, 1.829; 95% CI, 1.706–1.961), patients with no or unknown history of chemotherapy (HR, 1.302; 95% CI, 1.071–1.583) or radiotherapy (HR, 1.477; 95% CI, 1.217–1.793) and patients with no surgery (HR, 1.468; 95% CI, 1.264–1.706).

Conclusions
In patients with melanoma, the risk of cardiovascular death is higher in older patients, men, Blacks, separated, widowed and patients with nodular or lentigo maligna melanoma. The risk is lower in married, patients with superficial spreading or acral lentiginous melanoma, and patients who had chemotherapy, radiotherapy or surgery.
Equal prevalence of severe cervical dysplasia by HPV self-sampling and by midwife-collected samples for primary HPV screening: a randomised controlled trial
Authors: Hellsten Caroline , Ernstson Avalon , Bodelsson Gunilla , Forslund Ola , Borgfeldt Christer 
Published: May 2021

Objectives
HPV self-sampling is an option for cervical screening. The aim of this randomised study was to investigate the compliance, prevalence of HPV, and prevalence of severe dysplasia in a vaginal self-sampling group in comparison to cervical samples collected by midwives (control arm). The hypothesis was that there would be no difference between vaginal self-sampling and cervical sampling to find high-grade cervical dysplasia or cancer.

Methods
Vaginal HPV self-sampling kits were sent by regular mail to 14 765 randomly selected women aged 30–64 years old in the screening programme. HPV-positive women were invited for a follow-up examination by their midwife in which they provided a cervical sample for cytological and HPV co-testing. The control arm consisted of 14 839 women who met the same inclusion criteria and were invited to have cervical sampling by midwives for primary HPV screening. All HPV samples were analysed by the Aptima HPV assay (Hologic Inc.).

Main results
The participation rate was 33.5% in the self-sampling arm and 47.5% in the cervical sampling arm, (P < 0.0001). HPV was detected in 17.1% (95% confidence interval (CI), 16.1–18.23%) in the self-sampling arm and 4.5% (95% CI, 4.0–5.0%) in the cervical sampling arm. Histological, severe dysplasia was observed among 0.48% (95% CI, 0.3–0.72%) and 0.47% (95% CI, 0.3–0.66%) of the self-sampling and the cervical sampling groups, respectively.

Conclusion
The self-sampling approach detects a similar proportion of severe dysplasia as regular screening. Thus, our study indicates that self-sampling could replace primary HPV screening of cervical samples.
Histologic Patterns of Cutaneous Metastases of Breast Carcinoma: A Clinicopathologic Study of 232 Cases
Authors: Ronen Shira , Suster David , Chen Wei-Shen , Ronen Natali , Arudra Sri Krishna C. , Trinidad Celestine , Ivan Doina , Prieto Victor G. , Suster Saul 
Published: May 2021

Abstract:
Cutaneous metastasis may be the initial sign of internal malignancy but more often represents a late manifestation of widely disseminated disease. Breast carcinoma is the most common malignancy to metastasize to the skin. Although several studies have detailed the histopathologic patterns of cutaneous metastasis from internal malignancies, very little has been published regarding metastases of breast carcinoma to the skin. Furthermore, the histopathologic and clinical features observed in the cases of breast carcinoma with local skin involvement as opposed to cases exhibiting distant cutaneous metastases have not been adequately investigated. We have reviewed 232 cases of breast carcinoma with cutaneous metastases from 2 large institutions. All cases of carcinoma of the breast with involvement of the skin of the anterior chest wall were compared with those with distant cutaneous metastases. Two hundred thirty-two cases in 199 patients were included, of which 126 had skin involvement exclusively involving the ipsilateral anterior chest, and 106 had biopsy-proven distant cutaneous metastases. Twelve patients had both local and distal spread. Distant cutaneous metastases showed a predilection for the contralateral anterior chest wall area, followed by the head and neck, back, and abdomen. Histologically, most of the tumors presented in this series showed features of infiltrating ductal carcinoma. In both ipsilateral and distant metastases, the tumors demonstrated little change in histologic features from the primary lesion; however, the distant metastases showed a tendency to display more poorly differentiated features. The mean patient survival when cutaneous involvement was localized to the skin of the anterior chest wall was 23 months as compared with 20.6 months when distant sites were affected. A comparison of the clinicopathologic features of the patients presented in this series suggests that alternate biological mechanisms may apply for local and distant skin metastases from breast carcinoma.
White blood cell count and clinical outcomes after left main coronary artery revascularization: insights from the EXCEL trial
Authors: Claessen Bimmer E. , Ben-Yehuda Ori , Mehran Roxana , Sorrentino Sabato , Guedeney Paul , Chen Shmuel , Dressler Ovidiu , Kini Annapoorna S. , Sharma Samin K. , Mansour Samer , Noiseux Nicolas , Li Ditian , Kappetein Arie Pieter , Sabik Joseph F. , Serruys Patrick W. , Stone Gregg W. 
Published: May 2021

Background
Prior studies have reported an association between elevated white blood cell count (WBCc) and worse clinical outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). We assessed the prognostic impact of WBCc in patients undergoing revascularization for left main coronary artery disease (LMCAD).

Methods
In Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL), 1905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. The 1895 patients with baseline WBCc available were grouped in tertiles of WBCc (mean 5.6 ± 0.8, 7.5 ± 0.5, and 10.1 ± 1.6 × 109/L).

Results
Five-year rates of the primary endpoint (death, myocardial infarction or stroke) were similar across increasing WBCc tertiles (21.2, 18.9, and 21.6%; P = 0.46). Individual components of the primary endpoint, Bleeding Academic Research Consortium (BARC) 3–5 bleeding, stent thrombosis or graft occlusion and ischemia-driven revascularization were all similar across WBCc tertiles. By multivariable analysis, WBCc as a continuous variable was not an independent predictor of adverse events (hazard radio per 1 × 109/L: 1.02; 95% CI, 0.97–1.08; P = 0.43). Results were consistent in the PCI and CABG arms individually.

Conclusion
There was no association between baseline WBCc and 30-day or 5-year clinical outcomes after PCI or CABG. The absence of a clear incremental increase in events with increasing WBCc in the current analysis indicates that WBCc should not routinely be used as a prognostic marker or to guide revascularization decisions in patients with LMCAD.
Impact of renin-angiotensin system inhibitors after revascularization of patients with left main coronary artery disease
Authors: Chen Shmuel , Redfors Björn , Serruys Patrick W. , Pieter Kappetein Arie , Crowley Aaron , Ben-Yehuda Ori , Srdanovic Iva , Lembo Nicholas J. , Brown W. Morris , Sabik Joseph F. , Stone Gregg W. 
Published: May 2021

Background
There is a paucity of data regarding the effect of inhibition of the renin-angiotensin system on outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). We sought to examine long-term outcomes of patients with left main coronary disease (LMCAD) randomized to PCI with fluoropolymer-based cobalt–chromium everolimus-eluting stents or CABG according to treatment at discharge with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in the large-scale, multicenter, randomized EXCEL trial.

Methods
EXCEL randomized 1905 patients with LMCAD of low and intermediate anatomical complexity (visually-assessed SYNTAX score ≤32) to PCI (n = 948) versus CABG (n = 957). Patients were categorized according to whether they were treated with ACEI/ARB at discharge; their outcomes from discharge to 5 years were examined using multivariable logistic regression with an offset for follow-up time.

Results
Among 1775 patients discharged alive with known ACEI/ARB treatment status, 896 (50.5%) were treated with one of these agents. Among those treated with ACEI/ARB, the 5-year rate of all-cause death was similar after PCI or CABG (10.7% versus 9.8% respectively, adjOR, 0.94; 95% CI, 0.56–1.57) in contrast to patients not treated with ACEI/ARB (15.0% versus 7.8%, respectively, adjOR, 2.20; 95% CI, 1.32–3.67) (P
interaction = 0.02). Significant interactions between treatment arm (PCI versus CABG) and ACEI/ARB treatment status were also found for cardiovascular death (P
interaction = 0.03), ischemia-driven revascularization (P
interaction = 0.03), target vessel revascularization (P
interaction = 0.007) and target vessel failure (P
interaction = 0.0009).

Conclusion
In the EXCEL trial, the postdischarge rates of death and revascularization after 5 years were similar after PCI and CABG in patients with LMCAD treated with ACEI/ARB at discharge. In contrast, event rates were higher after PCI versus CABG in those not so treated.
Predictive value of spiral shape in coronary plaque progression: an intraindividual comparative study
Authors: Wang Zhao-qian , Yuan You-sheng , Wang Hao , Dou Ya-na , Jia Chong-fu 
Published: May 2021

Objective
We conducted a pilot study to explore the value of spiral-shaped sign of plaque from coronary computed tomographic angiography (CCTA) in predicting plaque progression by intraindividual comparison.

Methods
A total of 30 patients with a total of 60 plaques who received serial CCTA were retrospectively included and intraindividual compared. The spiral shape was defined as plaques coursing along the long axis of a coronary artery and encircling it at an angle of ≥ 180 degrees. The high-risk and other plaque signs were recorded.

Results
On baseline CCTA, the spiral shape (P < 0.01) and length (P < 0.05) of plaques were more frequently seen in the progression group than in the nonprogression group; however, there was no difference between two groups in terms of high-risk plaque signs. In the progression group, plaque length, volume, and napkin-ring sign on follow-up CCTA were significantly greater than at baseline (P < 0.05). In the nonprogression group, there were fewer low-attenuation and positive remodeling plaques on follow-up CCTA than at baseline (P < 0.05). The spiral shape (standardized β = –4.55; P < 0.01) was an independent risk factor for plaque progression. There were 24 spiral plaques in the progression group, of which 16 (66.7%) had progression below the twist point of the spiral shape.

Conclusions
The baseline spiral shape is more frequently found in those lesions that progress than in those that do not in patients with multiple coronary lesions, and the spiral shape is an independent predictor of which plaques will progress.