bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Surgical Outcomes After Total Laparoscopic Hysterectomy or Total Vaginal Hysterectomy for Large Uteri
Authors: Sailofsky Sybil , Darin Christina , Alfahmy Anood , Sheyn David 
Published: February 2021

OBJECTIVE:
To compare surgical outcomes between total laparoscopic hysterectomy and total vaginal hysterectomy with uterine weight greater than 250 g.

METHODS:
We conducted a retrospective cohort study using data from American College of Surgeons’ National Quality Improvement Project Hysterectomy Specific Database. Women with uterine weight greater than 250 g undergoing hysterectomy for benign indications by total laparoscopic hysterectomy or total vaginal hysterectomy were matched by propensity scores, which were calculated using preoperative characteristics and uterine weight. Total vaginal hysterectomy was matched to total laparoscopic hysterectomy at a ratio of 1:2. Pairwise analysis was performed using Wilcoxon rank-sum and Fisher exact tests as appropriate. Multivariable logistic regression was performed to identify the independent effect of total vaginal hysterectomy on surgical outcomes.

RESULTS:
There were 1,870 total vaginal hysterectomies that were matched to 3,740 total laparoscopic hysterectomies. No differences in preoperative demographics and comorbidities were seen for the patients. Uterine weight was similar for both groups: 376 g (interquartile range 293–501) for total vaginal hysterectomy and 384 g (interquartile range 302–515) for total laparoscopic hysterectomy (odds ratio [OR] 0.98, 95% CI 0.92–1.09). The rate of composite major complications was similar between total vaginal hysterectomy and total laparoscopic hysterectomy (4.3% vs 5.3%, OR 0.80, 95% CI 0.61–1.05). Intraoperative cystotomies were higher with total vaginal hysterectomy (0.8% vs 0.3%, OR 2.74, 95% CI 1.17–6.61), and ureteral injuries were more common with total laparoscopic hysterectomy (1.2% vs 0.2%, OR 0.12, 95% CI 0.02–0.38). Total vaginal hysterectomy operating time was significantly shorter compared with total laparoscopic hysterectomy (77 minutes, interquartile range 56–111 vs 122 minutes, interquartile range 91–164; OR 0.69, 95% CI 0.42–0.89). After adjusting for confounders, total vaginal hysterectomy was not found to be independently associated with major morbidity (adjusted odds ratio [aOR] 0.95, 95% CI 0.18–5.11) and was associated with a lower probability of operating times exceeding 2.5 hours (aOR 0.31, 95% CI 0.27–0.43).

CONCLUSION:
In patients matched by uterine size and preoperative characteristics, total vaginal hysterectomy is not associated with an increased composite risk of major surgical morbidity or other adverse surgical outcomes.
Measuring Female Veterans' Prepregnancy Wellness Using Department of Veterans Affairs' Health Record Data
Authors: Quinn Deirdre A. , Mor Maria K. , Sileanu Florentina E. , Zhao Xinhua , Callegari Lisa S. , Zephyrin Laurie C. , Frayne Daniel J. , Borrero Sonya 
Published: February 2021

OBJECTIVE:
To estimate the feasibility of using measures developed by the Clinical Workgroup of the National Preconception Health and Health Care Initiative to assess women's prepregnancy wellness in a large health care system.

METHODS:
We examined Department of Veterans Affairs' (VA) national administrative data, including inpatient, outpatient, fee-basis, laboratory, pharmacy, and screening data for female veterans aged 18–45 who had at least one pregnancy outcome (ectopic pregnancy, spontaneous abortion, stillbirth, and live birth) during fiscal years 2010–2015 and a VA primary care visit within 1 year before last menstrual period (LMP). LMP was estimated from gestational age at the time of pregnancy outcome, then used as a reference point to assess eight prepregnancy indicators from the Workgroup consensus measures (eg, 3 or 12 months before LMP).

RESULTS:
We identified 19,839 pregnancy outcomes from 16,034 female veterans. Most (74.9%) pregnancies ended in live birth; 22.6% resulted in spontaneous abortion or ectopic pregnancy, and 0.5% in stillbirth. More than one third (39.2%) of pregnancies had no documentation of prenatal care within 14 weeks of LMP. Nearly one third (31.2%) of pregnancies occurred in women with obesity. Among pregnancies with a recent relevant screening, 29.2% were positive for smoking and 28.4% for depression. More than half (57.4%) of pregnancies in women with preexisting diabetes did not have documentation of optimal glycemic control. Absence of sexually transmitted infection screening in the year before or within 3 months of LMP was high. Documentation of prenatal folic acid use was also high. Exposure in the same timeframe to six classes of teratogenic medications was low.

CONCLUSION:
Despite limitations of administrative data, monitoring measures of prepregnancy wellness can provide benchmarks for improving women's health across health care systems and communities. Areas for intervention to improve female veterans' prepregnancy wellness include healthy weight, optimizing control of diabetes before pregnancy, and improved use and documentation of key prepregnancy health screenings.
Obesity as a Predictor of Outcomes in Type III and Type IV Supracondylar Humerus Fractures
Authors: Nazareth Alexander , Schur Mathew , Schroeder Amanda J. , Whitlock Patrick W. , Skaggs David L. , Goldstein Rachel Y. 
Published: February 2021

Objectives:
To investigate the association of obesity with fracture characteristics and outcomes of operatively treated pediatric supracondylar humerus fractures.

Design:
Retrospective multicenter.

Setting:
Two Level I pediatric hospitals.

Patients:
Patients (age <18 years) with operatively treated Gartland type III and type IV fractures 2010–2014.

Intervention:
Closed or open reduction and percutaneous pinning of supracondylar humerus fractures.

Main Outcome Measure:
Incidence of Gartland IV fracture, preoperative nerve palsy, open reduction and complication rates.

Results:
Patients in the obese group had a significantly higher likelihood of having a Gartland IV fracture (not obese: 17%; obese: 35%; P = 0.007). There was a significantly higher incidence of nerve palsy on presentation in the obese group (not obese: 20%; obese: 33%; P = 0.03). No significant differences were found between groups regarding incidence of open reduction, compartment syndrome, and rates of reoperation.

Conclusions:
The present study demonstrates that obese children with a completely displaced supracondylar humerus fractures have an increased risk of Gartland type IV and preoperative nerve palsy compared with normal weight children.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Preoperative PROMIS Scores Predict Postoperative Outcomes in Lumbar Spine Surgery Patients
Authors: Snavely Joseph E. , Weiner Joseph A. , Johnson Daniel J. , Hsu Wellington K. , Patel Alpesh A. 
Published: February 2021

Study Design.
Retrospective case series.

Objective.
Our objective was to examine the ability of preoperative Patient-reported Outcomes Measurement Information System (PROMIS) scores to predict postoperative achievement of a minimum clinically important difference (MCID) in outcome scores following lumbar spine surgery.

Summary of Background Data.
PROMIS is a computer adaptive testing system that has been validated in spine surgery patients. PROMIS allows for more efficient and personalized data collection compared to legacy assessment tools.

Methods.
A total of 138 patients who underwent lumbar spine surgery at a single institution completed PROMIS Physical Function (PF) and Pain Interference (PI) scores preoperatively and at 3, 12, and 24 months postoperatively. Univariate and multivariate analyses of PROMIS scores and clinical factors were performed. Receiver-operating characteristic curves were calculated to determine the ability of preoperative scores to predict postoperative achievement of an MCID of 8. PF and PI t score MCID achievement threshold values with 90% specificity were calculated.

Results.
Preoperative PROMIS PF and PI scores were significantly correlated to achievement of postoperative MCID after multivariate analysis. Patients with worse preoperative scores were more likely to achieve MCID. Preoperative PF and PI scores showed strong predictive value in determining ability to achieve postoperative MCID with respective area under the curve of 0.85 and 0.82. A preoperative PF threshold T-score of 31.6 had a 64% chance of achieving postoperative MCID, while a preoperative PI threshold t score of 67.8 had an 86% chance of achieving postoperative MCID.

Conclusion.
Preoperative PROMIS PF and PI scores predicted improvement in postoperative PROMIS scores in lumbar spine surgery patients as worse preoperative scores correlated to improved PROMIS scores postoperatively. The calculated threshold t scores showed the ability to predict improvement in postoperative PROMIS scores. Preoperative PROMIS data may be useful in surgical decision-making and improved patient education regarding postoperative outcomes.

Level of Evidence: 4
Prediction of Recurrence in Pyogenic Vertebral Osteomyelitis by Artificial Neural Network Using Time-series Data of C-Reactive Protein
Authors: Kim Jihye , Ryu Hwan , Kim Seok Woo , Oh Jae-Keun , Kim Tae-Hwan 
Published: February 2021

Study Design.
A retrospective cohort study.

Objective.
The aim of this study was to develop recurrence-prediction models of pyogenic vertebral osteomyelitis (PVO).

Summary of Background Data.
Prediction of recurrence in PVO is crucial to avoid additional prolonged antibiotic therapy and aggressive spinal surgery and to reduce mortality. However, prediction of PVO recurrence by previously identified, initial risk factors is limited in PVO patients who exceptionally require prolonged antibiotic therapy and experience various clinical events during the treatment. We hypothesized that time-series analysis of sequential C-reactive protein (CRP) routinely measured to estimate the response to the antibiotics in PVO patients could reflect such long treatment process and increase the power of the recurrence-prediction model.

Methods.
A retrospective study was performed to develop a PVO recurrence-prediction model, including initial risk factors and time-series data of CRP. Of 704 PVO patients, 493 and 211 were divided into training and test cohorts, respectively. Conventional stepwise logistic regression and artificial neural network (ANN) models were created from the training cohort, and the predictions of recurrence in the test cohort were compared.

Results.
Prediction models using initial risk factors showed poor sensitivity (4.7%) in both conventional logistic model and ANN models. However, baseline ANN models using time-series CRP data showed remarkably increased sensitivity (55.8%–60.5%). Ensemble ANN model using both initial risk factors and time-series CRP data showed additional benefit in prediction power.

Conclusion.
The recurrence-prediction models for PVO created only using the initial risk factors showed low sensitivity, regardless of statistical method. However, ANN models using time-series data of CRP values and their ensemble model showed considerably increased prediction power. Therefore, clinicians treating PVO patients should pay attention to the treatment response including changes of CRP levels to identify high-risk patients for recurrence, and further studies to develop recurrence-prediction model for PVO should focus on the treatment response rather than initial risk factors.

Level of Evidence: 4
Keratin Biomaterials Improve Functional Recovery in a Rat Spinal Cord Injury Model
Authors: Zabarsky Zachary K. , Dean Gabriella M. , Luo Tianyi David , Marquez-Lara Alejandro , Jinnah Alexander H. , Van Dyke Mark , Smith Thomas L. 
Published: February 2021

Study Design.
Laboratory study using a rat T9 contusion model of spinal cord injury (SCI).

Objective.
The purpose of this study was to evaluate which method of delivery of soluble keratin biomaterials would best support functional restoration through the macrophage polarization paradigm.

Summary of Background Data.
SCI is a devastating neurologic event with complex pathophysiological mechanisms that currently has no cure. After injury, macrophages and resident microglia are key regulators of inflammation and tissue repair exhibiting phenotypic and functional plasticity. Keratin biomaterials have been demonstrated to influence macrophage polarization and promote the M2 anti-inflammatory phenotype that attenuates inflammatory responses.

Methods.
Anesthetized female Lewis rats were subjected to moderate T9 contusion SCI and randomly divided into: no therapy (control group), an intrathecally injected keratin group, and a keratin-soaked sponge group (n = 11 in all groups). Functional recovery assessments were obtained at 3- and 6-weeks post-injury (WPI) using gait analysis performed with the DigiGait Imaging System treadmill and at 1, 3, 7, 14, 21, 28, 35, and 42 days post-injury by the Basso, Beattie, Bresnahan (BBB) locomotor rating scale. Histology and immunohistochemistry of serial spinal cord sections were performed to assess injury severity and treatment efficacy.

Results.
Compared to control rats, applying keratin materials after injury improved functional recovery in certain gait parameters and overall trended toward significance in BBB scores; however, no significant differences were observed with tissue analysis between groups at 6 WPI.

Conclusion.
Results suggest that keratin biomaterials support some locomotor functional recovery and may alter the acute inflammatory response by inducing macrophage polarization following SCI. This therapy warrants further investigation into treatment of SCI.

Level of Evidence: N/A
Infra-adjacent Segment Disease After Lumbar Fusion
Authors: Nessim Adam , Cho Woojin , Yang Xiuyi Alexander , Applebaum Ariella , Sekerak Richard , Brill Sam , Kim Soo Yeon 
Published: February 2021

Study Design.
Cross-sectional observational cohort study.

Objective.
The aim of this study was to determine the incidence and risk factors associated with the development of sacroiliac joint (SIJ) dysfunction following lumbosacral fusion.

Summary of Background Data.
Adjacent segment degeneration to both proximal and distal areas of spinal fusion is a postoperative complication of lumbar fusion. Various studies examined supra-adjacent degeneration following lumbar fusion, but few focused on infra-adjacent degeneration. In lumbosacral fusion, fusion extends to the sacrum, placing increased stress on the SIJ.

Methods.
A total of 2069 sequential patients who underwent lumbosacral fusion surgery from 2008 to 2018 at a single academic medical center were retrospectively reviewed. Patients who subsequently developed SIJ dysfunction were identified. SIJ dysfunction was defined as patients who met the diagnostic criteria with physical examination and received an SIJ injection with clinical evidence of improvement. Controls, without subsequent SIJ dysfunction, were matched with cases based on levels of fusion, age, sex, and body mass index. Pre-and postoperative pelvic parameters were measured, including pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis, lumbosacral angle, L4 incidence and L5 incidence

Results.
Of 2069 patients who underwent lumbosacral fusion, 81 patients (3.9%) met criteria for SIJ dysfunction. Measurements were made for 47 of 81 patients who had SIJ dysfunction, that had both pre- and post-operative imaging. Measurements for 44 matched controls were taken. Postoperative PT was significantly lower in SIJ dysfunction patients compared to controls (20.82° ± 2.19° vs. 27.28° ± 2.30°; P < 0.05), as was L5 incidence (28.64° ± 3.38° vs. 37.11° ± 3.50°; P < 0.05).

Conclusion.
Incidence of the SIJ dysfunction after lumbosacral fusion surgery was 3.9% and these patients had a significantly lower PT and L5 incidence compared to the control group. Significantly low PT may be derived from weak hamstring muscles, predisposing a patient to SIJ dysfunction. Therefore, hamstring muscle strengthening exercise for patients with decreased PT after lumbosacral fusion may decrease the incidence of SIJ dysfunction.

Level of Evidence: 3
Postoperative Cerebral Oxygen Saturation in Children After Congenital Cardiac Surgery and Long-Term Total Intelligence Quotient: A Prospective Observational Study
Authors: Carra Giorgia , Flechet Marine , Jacobs An , Verstraete Sören , Vlasselaers Dirk , Desmet Lars , Van Cleemput Hanna , Wouters Pieter , Vanhorebeek Ilse , Van den Berghe Greet , Güiza Fabian , Meyfroidt Geert 
Published: February 2021

OBJECTIVES:
During the early postoperative period, children with congenital heart disease can suffer from inadequate cerebral perfusion, with possible long-term neurocognitive consequences. Cerebral tissue oxygen saturation can be monitored noninvasively with near-infrared spectroscopy. In this prospective study, we hypothesized that reduced cerebral tissue oxygen saturation and increased intensity and duration of desaturation (defined as cerebral tissue oxygen saturation < 65%) during the early postoperative period, independently increase the probability of reduced total intelligence quotient, 2 years after admission to a PICU.

DESIGN:
Single-center, prospective study, performed between 2012 and 2015.

SETTING:
The PICU of the University Hospitals Leuven, Belgium.

PATIENTS:
The study included pediatric patients after surgery for congenital heart disease admitted to the PICU.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Postoperative cerebral perfusion was characterized with the mean cerebral tissue oxygen saturation and dose of desaturation of the first 12 and 24 hours of cerebral tissue oxygen saturation monitoring. The independent association of postoperative mean cerebral tissue oxygen saturation and dose of desaturation with total intelligence quotient at 2-year follow-up was evaluated with a Bayesian linear regression model adjusted for known confounders. According to a noninformative prior, reduced mean cerebral tissue oxygen saturation during the first 12 hours of monitoring results in a loss of intelligence quotient points at 2 years, with a 90% probability (posterior β estimates [80% credible interval], 0.23 [0.04–0.41]). Similarly, increased dose of cerebral tissue oxygen saturation desaturation would result in a loss of intelligence quotient points at 2 years with a 90% probability (posterior β estimates [80% credible interval], –0.009 [–0.016 to –0.001]).

CONCLUSIONS:
Increased dose of cerebral tissue oxygen saturation desaturation and reduced mean cerebral tissue oxygen saturation during the early postoperative period independently increase the probability of having a lower total intelligence quotient, 2 years after PICU admission.
Association of Standard Electroencephalography Findings With Mortality and Command Following in Mechanically Ventilated Patients Remaining Unresponsive After Sedation Interruption
Authors: Legouy Camille , Girard-Stein Laura , Wanono Ruben , de Montmollin Etienne , Vellieux Geoffroy , Bouadma Lila , Dupuis Claire , Abid Sonia , Vinclair Camille , Ruckly Stéphane , Rouvel-Tallec Anny , d’Ortho Marie-Pia , Timsit Jean-François , Sonneville Romain 
Published: February 2021

Context:
Delayed awakening after sedation interruption is frequent in critically ill patients receiving mechanical ventilation.

OBJECTIVES:
We aimed to investigate the association of standard electroencephalography with mortality and command following in this setting.

Design, Setting, and Patients:
In a single-center study, we retrospectively analyzed standard electroencephalography performed in consecutive mechanically ventilated patients remaining unresponsive (comatose/stuporous or unable to follow commands) after sedation interruption. Standard electroencephalography parameters (background activity, continuity, and reactivity) were reassessed by neurophysiologists, blinded to patients’ outcome. Patients were categorized during follow-up into three groups based on their best examination as: 1) command following, 2) unresponsive, or 3) deceased. Cause-specific models were used to identify independent standard electroencephalography parameters associated with main outcomes, that is, mortality and command following. Follow-up was right-censored 30 days after standard electroencephalography.

MEASUREMENTS AND MAIN RESULTS:
Main standard electroencephalography parameters recorded in 121 unresponsive patients (median time between sedation interruption and standard electroencephalography: 2 d [interquartile range, 1–4 d]) consisted of a background frequency greater than 4 Hz in 71 (59%), a discontinuous background in 19 (16%), and a preserved reactivity in 98/120 (82%) patients. At 30 days, 66 patients (55%) were command following, nine (7%) were unresponsive, and 46 (38%) had died. In a multivariate analysis adjusted for nonneurologic organ failure, a reactive standard electroencephalography with a background frequency greater than 4 Hz was independently associated with a reduced risk of death (cause-specific hazard ratio, 0.38; CI 95%, 0.16–0.9). By contrast, none of the standard electroencephalography parameters were independently associated with command following. Sensitivity analyses conducted after exclusion of 29 patients with hypoxic brain injury revealed similar findings.

CONCLUSIONS:
In patients remaining unresponsive after sedation interruption, a pattern consisting of a reactive standard electroencephalography with a background frequency greater than 4 Hz was associated with decreased odds of death. None of the standard electroencephalography parameters were independently associated with command following.
Outcomes of Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis
Authors: Farhat Abdelaziz , Ling Ryan Ruiyang , Jenks Christopher L. , Poon Wynne Hsing , Yang Isabelle Xiaorui , Li Xilong , Liu Yulun , Darnell-Bowens Cindy , Ramanathan Kollengode , Thiagarajan Ravi R. , Raman Lakshmi 
Published: February 2021

OBJECTIVE:
The goal of this work is to provide insight into survival and neurologic outcomes of pediatric patients supported with extracorporeal cardiopulmonary resuscitation.

DATA SOURCES:
A systematic search of Embase, PubMed, Cochrane, Scopus, Google Scholar, and Web of Science was performed from January 1990 to May 2020.

STUDY SELECTION:
A comprehensive list of nonregistry studies with pediatric patients managed with extracorporeal cardiopulmonary resuscitation was included.

DATA EXTRACTION:
Study characteristics and outcome estimates were extracted from each article.

DATA SYNTHESIS:
Estimates were pooled using random-effects meta-analysis. Differences were estimated using subgroup meta-analysis and meta-regression. The Meta-analyses Of Observational Studies in Epidemiology guideline was followed and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation system. Twenty-eight studies (1,348 patients) were included. There was a steady increase in extracorporeal cardiopulmonary resuscitation occurrence rate from the 1990s until 2020. There were 32, 338, and 1,094 patients’ articles published between 1990 and 2000, 2001 and 2010, and 2010 and 2020, respectively. More than 70% were cannulated for a primary cardiac arrest. Pediatric extracorporeal cardiopulmonary resuscitation patients had a 46% (CI 95% = 43–48%; p < 0.01) overall survival rate. The rate of survival with favorable neurologic outcome was 30% (CI 95% = 27–33%; p < 0.01).

CONCLUSIONS:
The use of extracorporeal cardiopulmonary resuscitation is rapidly expanding, particularly for children with underlying cardiac disease. An overall survival of 46% and favorable neurologic outcomes add credence to this emerging therapy.