bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Zero-profile Anchored Spacer Versus Plate-and-Cage After 1-Level ACDF With Complete Uncinate Process Resection
Authors: Noh Sung Hyun , Park Jeong Yoon , Kuh Sung Uk , Chin Dong Kyu , Kim Keun Su , Cho Yong Eun , Kim Kyung Hyun 
Published: February 2021

Study Design:
This is a retrospective study.

Objective:
The purpose of this study is to compare the zero-profile anchored spacer device (Zero-p) and traditional plate-and-cage implant (plate-and-cage) in anterior cervical discectomy and fusion (ACDF) with complete uncinate process resection (UPR) to treat 1-level cervical degenerative disk disease.

Summary of Background Data:
We retrospectively surveyed the data from all patients who underwent single-level ACDF with complete UPR between 2009 and 2013.

Patients and Methods:
In total, 80 patients participated in 3 years of follow-up. Among them, Zero-p (38 patients) and plate-and-cage (42 patients) approaches were used in ACDF with complete UPR. Clinical outcomes and radiographic results were compared between 2 groups and they were followed for 39.1±2.2 months.

Results:
Duration of operation, intraoperative blood loss, and length of hospitalization were significantly lower in the Zero-p group than the plate-and-cage group (P<0.001). The clinical outcomes of visual analog scale, neck disability index, and the Odom criteria were improved after operation in both groups. The fusion rates, C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis, sellar turcica–C7 sagittal vertical axis, and spinocranial angle after single-level ACDF were not significantly different between the 2 groups. Subsidence occurred in 5 cases (13%) in the Zero-p group and 10 cases (37%) in the plate-and-cage group (P<0.05). The horizontal length of the Zero-p implant was longer than that of allograft bone. Fusion occurred in 37 cases (95%) of the Zero-p group and 40 cases (94%) in the plate-and-cage group.

Conclusions:
The Zero-p and plate-and-cage are effective when single-level ACDF with complete UPR was performed. Both groups showed good clinical outcomes, but Zero-p has more benefits than plate-and-cage such as lower duration of operation, intraoperative blood loss, length of hospitalization, and rate of subsidence compared with plate-and-cage. Surgeons should be aware of these results so that postoperative complications such as subsidence can be avoided.
Ameliorated Full-Endoscopic Transforaminal Decompression for L5–S1 Foraminal and Extraforaminal Stenosis
Authors: Yang Chang-Chen , Yeh Kuang-Ting , Liu Keng-Chang , Wu Wen-Tien 
Published: February 2021

Study Design:
This is a retrospective review.

Objective:
To describe a modified surgical technique, full-endoscopic transforaminal decompression (FETD) in patients with L5–S1 foraminal stenosis or extraforaminal stenosis (EFS) and to detail the short-term results.

Summary of Background Data:
Performing FETD surgery for L5–S1 FS and EFS is challenging because of high iliac crests in most cases and the difficulty in accurately differentiating between FS and EFS by images preoperatively.

Material and Methods:
Patients who had solitary unilateral L5–S1 FS or EFS and had undergone FETD between October 2014 and December 2017 were included. In total, 22 patients underwent FETD for L5 root compressions at the L5–S1 levels. All patients were followed up for more than 1 year.

Results:
The mean visual analog scale score for back and leg pain, assessed preoperatively and at 12 months postoperatively, improved from 6.3±1.7 to 1.59±1.30 and from 7.29±0.78 to 1.41±1.20, respectively. The mean Oswestry Disability Index improved from 61.53% preoperatively to 15.8% at 12 months postoperatively. Neurovascular injury–related complications were absent in all these cases.

Conclusion:
Successful short-term clinical outcome is achievable using the ameliorated FETD technique for treating L5–S1 FS and EFS.
Clinical and Radiographic Outcomes Following Management of Benign Bone Lesions of the Hand With Calcium Phosphate Bone Cement
Authors: Jorgensen Anna , Johnson Jeremiah , Rodner Craig 
Published: February 2021

Background:
Enchondromas are benign primary bone tumors that often occur in the hand. Surgical curettage is often indicated for symptomatic lesions, but controversy exists regarding whether and how best to fill the void. Autograft and allograft bone in addition to various types of plaster or cement are common means addressing the postexcision defect. This study reports long-term clinical and radiographic outcomes of excision with calcium phosphate bone cement (CPC) for benign bone lesions of the hand.

Methods:
This is a retrospective review of symptomatic benign bone lesions treated with curettage and CPC by a single surgeon with long-term follow-up. Following Institutional Review Board approval, consenting patients returned for postoperative research visits, during which radiographs were taken and functional outcome scores were measured.

Results:
Of the 7 patients who consented to participate, all initially presented with pain at the site of the tumor. Average follow-up time was over 6 years and overall functional outcome scores were good with early return to work. Cementation filled nearly the entire lesion on postoperative films and there were no postoperative fractures, infections, wound problems, or revision surgeries.

Conclusions:
This study reports good long-term radiographic and functional outcomes, without recurrences, in a series of patients with symptomatic benign bone lesions of the hand when treated with excision and CPC by a single surgeon.
Use of Machine Learning to Screen for Acute Respiratory Distress Syndrome Using Raw Ventilator Waveform Data
Authors: Rehm Gregory B. , Cortés-Puch Irene , Kuhn Brooks T. , Nguyen Jimmy , Fazio Sarina A. , Johnson Michael A. , Anderson Nicholas R. , Chuah Chen-Nee , Adams Jason Y. 
Published: February 2021

Objectives:
To develop and characterize a machine learning algorithm to discriminate acute respiratory distress syndrome from other causes of respiratory failure using only ventilator waveform data.

Design:
Retrospective, observational cohort study.

Setting:
Academic medical center ICU.

Patients:
Adults admitted to the ICU requiring invasive mechanical ventilation, including 50 patients with acute respiratory distress syndrome and 50 patients with primary indications for mechanical ventilation other than hypoxemic respiratory failure.

Interventions:
None.

Measurements and Main Results:
Pressure and flow time series data from mechanical ventilation during the first 24-hours after meeting acute respiratory distress syndrome criteria (or first 24-hr of mechanical ventilation for non-acute respiratory distress syndrome patients) were processed to extract nine physiologic features. A random forest machine learning algorithm was trained to discriminate between the patients with and without acute respiratory distress syndrome. Model performance was assessed using the area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value. Analyses examined performance when the model was trained using data from the first 24 hours and tested using withheld data from either the first 24 hours (24/24 model) or 6 hours (24/6 model). Area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value were 0.88, 0.90, 0.71, 0.77, and 0.90 (24/24); and 0.89, 0.90, 0.75, 0.83, and 0.83 (24/6).

Conclusions:
Use of machine learning and physiologic information derived from raw ventilator waveform data may enable acute respiratory distress syndrome screening at early time points after intubation. This approach, combined with traditional diagnostic criteria, could improve timely acute respiratory distress syndrome recognition and enable automated clinical decision support, especially in settings with limited availability of conventional diagnostic tests and electronic health records.
Hemophagocytic Lymphohistiocytosis in the Medical ICU: A Single-Institution Cohort Study on Acute Liver Failure and Mortality
Authors: Al Nasrallah Nawar , Al-Hader Ahmad , Samala Niharika , Sears Catherine R. 
Published: February 2021

Objectives:
Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory disorder that is associated with high morbidity and mortality in the ICU. It has also been associated with acute liver failure.

Design:
Retrospective observational study.

Setting:
Tertiary-care medical ICU.

Patients:
Thirty-one patients critically ill with hemophagocytic lymphohistiocytosis.

Interventions:
None.

Measurements and Main Results:
We performed a comprehensive review of critically ill hemophagocytic lymphohistiocytosis patients admitted to a tertiary-care medical ICU from January 2012 to December 2018. Most patients presented with constitutional symptoms and elevated liver enzymes and thrombocytopenia were common upon hospital admission. ICU admission laboratory and clinical variables were used to calculate Acute Physiology and Chronic Health Evaluation II, hemophagocytic syndrome diagnostic score, and model for end-stage liver disease. Mean age of the cohort was 48.1 years, and 45% were male. The mortality rate was 65% at 28 days and 77% at 1 year. About 28-day survivors were younger, had lower mean Acute Physiology and Chronic Health Evaluation II score (16.5 vs 23.0; p = 0.004), and higher mean hemophagocytic syndrome diagnostic score (249.1 vs 226.0; p = 0.032) compared with nonsurvivors. Survivors were less likely to receive mechanical ventilation, renal replacement therapy, or vasopressor support and were more likely to receive chemotherapy for hemophagocytic lymphohistiocytosis. In this ICU cohort, 29% were diagnosed with acute liver failure, of whom only 22% developed acute liver failure early during their hospital stay. Acute liver failure was associated with a higher model for end-stage liver disease score upon hospital admission. Available histology in those that developed acute liver failure showed massive hepatic necrosis, or histiocytic or lymphocytic infiltrates.

Conclusions:
Patients admitted to the ICU with hemophagocytic lymphohistiocytosis have a high mortality. Those who survived had lower Acute Physiology and Chronic Health Evaluation scores, had higher hemophagocytic syndrome diagnostic scores, are more likely to receive hemophagocytic lymphohistiocytosis specific chemotherapy, and are less likely to have organ failure. Hemophagocytic lymphohistiocytosis can be associated with acute liver failure especially when model for end-stage liver disease score is elevated upon admission.
The Presentation, Pace, and Profile of Infection and Sepsis Patients Hospitalized Through the Emergency Department: An Exploratory Analysis
Authors: Liu Vincent X. , Bhimarao Meghana , Greene John D. , Manickam Raj N. , Martinez Adriana , Schuler Alejandro , Barreda Fernando , Escobar Gabriel J. 
Published: February 2021

Objectives:
To characterize the signs and symptoms of sepsis, compare them with those from simple infection and other emergent conditions and evaluate their association with hospital outcomes.

Design, Setting, Participants, and INTERVENTION:
A multicenter, retrospective cohort study of 408,377 patients hospitalized through the emergency department from 2012 to 2017 with sepsis, suspected infection, heart failure, or stroke. Infected patients were identified based on Sepsis-3 criteria, whereas noninfected patients were identified through diagnosis codes.

MEASUREMENTS AND MAIN RESULTS:
Signs and symptoms were identified within physician clinical documentation in the first 24 hours of hospitalization using natural language processing. The time of sign and symptom onset prior to presentation was quantified, and sign and symptom prevalence was assessed. Using multivariable logistic regression, the association of each sign and symptom with four outcomes was evaluated: sepsis versus suspected infection diagnosis, hospital mortality, ICU admission, and time of first antibiotics (> 3 vs ≤ 3 hr from presentation). A total of 10,825 signs and symptoms were identified in 6,148,348 clinical documentation fragments. The most common symptoms overall were as follows: dyspnea (35.2%), weakness (27.2%), altered mental status (24.3%), pain (23.9%), cough (19.7%), edema (17.8%), nausea (16.9%), hypertension (15.6%), fever (13.9%), and chest pain (12.1%). Compared with predominant signs and symptoms in heart failure and stroke, those present in infection were heterogeneous. Signs and symptoms indicative of neurologic dysfunction, significant respiratory conditions, and hypotension were strongly associated with sepsis diagnosis, hospital mortality, and intensive care. Fever, present in only a minority of patients, was associated with improved mortality (odds ratio, 0.67, 95% CI, 0.64–0.70; p < 0.001). For common symptoms, the peak time of symptom onset before sepsis was 2 days, except for altered mental status, which peaked at 1 day prior to presentation.

Conclusions:
The clinical presentation of sepsis was heterogeneous and occurred with rapid onset prior to hospital presentation. These findings have important implications for improving public education, clinical treatment, and quality measures of sepsis care.
Resources and Costs Associated With Repeated Admissions to PICUs
Authors: Kane Jason M. , Hall Matt , Cecil Cara , Montgomery Vicki L. , Rakes Lauren C. , Rogerson Colin , Stockwell Jana A. , Slain Katherine N. , Goodman Denise M. 
Published: February 2021

Objective:
To determine the costs and hospital resource use from all PICU patients readmitted with a PICU stay within 12 months of hospital index discharge.

Design:
Cross-sectional, retrospective cohort study using Pediatric Health Information System.

Setting:
Fifty-two tertiary children’s hospitals.

Subjects:
Pediatric patients under 18 years old admitted to the PICU from January 1, 2016, to December 31, 2017.

Interventions:
None.

Measurements and Main Results:
Patient characteristics and costs of care were compared between those with readmission requiring PICU care and those with only a single PICU admission per annum. In this 2-year cohort, there were 239,157 index PICU patients of which 36,970 (15.5%) were readmitted and required PICU care during the 12 months following index admission. The total hospital cost for all index admissions and readmissions was $17.3 billion, of which 21.5% ($3.71 billion) were incurred during a readmission stay involving care in the PICU; of the 3,459,079 hospital days, 20.3% (702,200) were readmission days including those where PICU care was required. Of the readmitted patients, 11,703 (30.0%) received only PICU care, accounting for $662 million in costs and 110,215 PICU days. Although 43.6% of all costs were associated with patients who required readmission, these patients only accounted for 15.5% of the index patients and 28% of index hospitalization expenditures. More patients in the readmitted group had chronic complex conditions at index discharge compared with those not readmitted (83.9% vs 54.9%; p < 0.001). Compared with those discharged directly to home without home healthcare, patients discharged to a skilled nursing facility had 18% lower odds of readmission (odds ratio 0.82 [95% CI, 0.75–0.89]; p < 0.001) and those discharged home with home healthcare had 43% higher odds of readmission (odds ratio, 1.43 [95% CI, 1.36–1.51]; p < 0.001).

Conclusions:
Repeated admissions with PICU care resulted in significant direct medical costs and resource use for U.S. children’s hospitals.
Emerging role of multiparametric magnetic resonance imaging in identifying clinically relevant localized prostate cancer
Authors: Williams Cheyenne , Daneshvar Michael , Pinto Peter 
Published: February 2021

Purpose of review
To explore the recent advances and utility of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis and risk-stratification of prostate cancer.

Recent findings
Low-risk, clinically insignificant prostate cancer has a decreased risk of morbidity or mortality. Meanwhile, patients with intermediate and high-risk prostate cancer may significantly benefit from interventions like radiation or surgery. To appropriately risk stratify these patients, MRI has emerged as the imaging modality in the last decade to assist in defining prostate cancer significance, location, and biologic aggressiveness. Traditional 12-core transrectal ultrasound-guided biopsy is associated with over-detection, and ultimately over-treatment of clinically insignificant disease, and the under-detection of clinically significant disease. Biopsy accuracy is improved with MRI-guided targeted biopsy and with the use of standardized risk stratification imaging score systems. Cancer detection accuracy is further improved with combined biopsy techniques that include both systematic and MRI-targeted biopsy that aid in detection of MRI-invisible lesions.

Summary
mpMRI is an area of expanding innovation that continues to refine the diagnostic accuracy of prostate biopsies. As mpMRI-targeted biopsy in prostate cancer becomes more commonplace, advances like artificial intelligence and less invasive dynamic metabolic imaging will continue to improve the utility of MRI.
Coffee consumption and colorectal cancer risk: a multicentre case-control study from Italy and Spain
Authors: Rosato Valentina , Guercio Valentina , Bosetti Cristina , Gracia-Lavedan Esther , Villanueva Cristina M. , Polesel Jerry , Toffoluti Federica , Moreno Victor , Martin Vicente , Aragonés Nuria , Dierssen-Sotos Trinidad , Olmedo-Requena Rocío , Guevara Marcela , Amiano Pilar , Salas Dolores , Fernandez-Tardon Guillermo , Alguacil Juan , Chirlaque López María Dolores , Fernandez-Villa Tania , Pérez-Gómez Beatriz , Gomez-Acebo Ines , Jiménez-Moleón Jose J. , Moreno-Iribas Conchi , José Molina Antonio , Castaño Vinyals Gemma , Pollan Marina , Kogevinas Manolis , La Vecchia Carlo , Tavani Alessandra 
Published: February 2021

Background:
Coffee contains many bioactive substances that can play a role on colorectal cancer. Epidemiological evidence of coffee intake and colorectal cancer is, however, inconsistent.

Aim:
To provide further information on the risk of colorectal cancer in relation to coffee consumption.

Methods:
Data derive from two companion case-control studies conducted in Italy and Spain within the European Union Project on Health Impacts of long-term exposure to disinfection by-products in Drinking Water and the Spanish Multi-Case Control study on Cancer. These included a total of 2289 incident cases with colorectal cancer and 3995 controls with information on coffee intake. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were derived from unconditional logistic regression models, adjusted for study centre, sex, age, education, smoking, and other covariates.

Results:
Compared with never coffee drinkers, the OR was 0.99 (95% CI 0.95–1.02) for total coffee consumption. There was no significant trend in risk with dose or duration, the ORs being 0.95 (95% CI 0.72–1.25) for an amount of five or more cups per day of coffee and 0.95 (95% CI 0.75–1.19) for a duration of consumption of 50 years or longer. The OR was 1.04 (95% CI 0.87–1.25) for two or more cups per day of decaffeinated coffee. There were no heterogeneity across strata of various covariates, as well as no apparent differences between various anatomical subsites.

Conclusion:
This large pooled analysis of two studies shows no association of coffee and decaffeinated coffee with colorectal cancer risk.
Cerebral amyloid angiopathy-related inflammation: current status and future implications
Authors: Wu Juan-Juan , Yao Ming , Ni Jun 
Published: February 2021

Abstract
Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a rare but increasingly recognized subtype of CAA. CAA-RI consists of two subtypes: inflammatory cerebral amyloid angiopathy and amyloid β (Aβ)-related angiitis. Acute or subacute onset of cognitive decline or behavioral changes is the most common symptom of CAA-RI. Rapid progressive dementia, headache, seizures, or focal neurological deficits, with patchy or confluent hyperintensity on T2 or fluid-attenuated inversion recovery sequences and evidence of strictly lobar microbleeds or cortical superficial siderosis on susceptibility-weighted imaging imply CAA-RI. The gold standard for diagnosis is autopsy or brain biopsy. However, biopsy is invasive; consequently, most clinically diagnosed cases have been based on clinical and radiological data. Other diagnostic indexes include the apolipoprotein E ε4 allele, Aβ and anti-Aβ antibodies in cerebral spinal fluid and amyloid positron emission tomography. Many diseases with similar clinical manifestations should be carefully ruled out. Immunosuppressive therapy is effective both during initial presentation and in relapses. The use of glucocorticoids and immunosuppressants improves prognosis. This article reviews the pathology and pathogenesis, clinical and imaging manifestations, diagnostic criteria, treatment, and prognosis of CAA-RI, and highlights unsolved problems in the existing research.
Tumor Necrotic Debris and High Nuclear Grade
Authors: Holloway Steven B. , Colon Glorimar R. , Zheng Wenxin , Lea Jayanthi S. 
Published: February 2021

Objective:
Invasive pattern of endocervical adenocarcinomas (EACs) is known to influence lymph node metastasis and cancer recurrence. In this study we describe the prognostic significance of necrotic tumor debris (NTD) and tumor nuclear grade on recurrence risk stratification of early-stage cervical adenocarcinoma.

Methods:
Patients who underwent surgery from 2007 to 2018 for International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IB2 EAC, for whom pathology was available for review were included in this study. Clinico-pathologic variables and clinical recurrence risk stratification (low, intermediate, or high risk) were correlated to intraluminal NTD and tumor nuclear grade (N3).

Results:
Among 50 patients meeting inclusion criteria, all were managed surgically and clinically risk stratified as low (n=33), intermediate (n=13), and high risk (n=4). Twenty-three patients (46%) were NTD-N3 negative and 27 (54%) were NTD-N3 positive. NTD-N3 was significantly associated with higher stage, tumor grade, larger tumor size, positive lymphovascular space invasion, and recurrence of disease (P=0.025). Patients with stage IB1 EAC who were stratified as intermediate or high-risk for recurrence were positive for NTD-N3. Lack of NTD-N3 had 100% negative predictive value for disease recurrence.

Conclusions:
NTD-N3, a novel pathologic finding, may be used to further stratify overall recurrence risk, and may play a role in individualization of patient care in early-stage EAC.
Cutaneous Keratocyst With D2-40 Immunoreactivity in Basal Cell Nevus Syndrome
Authors: Goggins Clare A. , Zerah Michele L. , Anatelli Florencia , Norton Scott A. 
Published: February 2021

Abstract:
Although not a diagnostic criterion for basal cell nevus syndrome (BCNS, OMIM#109400), cutaneous cysts, particularly epidermoid cysts, are common in this condition. Cutaneous keratocysts, on the other hand, are extremely rare in general and have been identified in only 5 patients with BCNS. Here, we describe a BCNS patient with a cutaneous keratocyst that demonstrated D2-40 (podoplanin) immunoreactivity, which has been detected in odontogenic keratocysts but not cutaneous keratocysts. This finding suggests that cutaneous keratocysts may be developmentally homologous to odontogenic keratocysts and may behave similarly in terms of invasion and growth pattern.