bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparisons of initial outcomes and cost-effectiveness after total ankle arthroplasty versus bipolar osteochondral allograft transplantation in the ankle: a retrospective cohort study
Authors: Smith Caitlyn J. , Crist Brett D. , Rucinski Kylee , Cook James L. , Leary Emily V. 
Published: March 2021

Background:
Total ankle arthroplasty (TAA) has been a standard-of-care surgical treatment option for patients who are suffering from ankle disorders since the 1960s. It is costly with a limited lifespan; younger, active patients will likely need additional surgeries. Evidence-based advancements in osteochondral allograft (OCA) preservation and transplantation techniques have resulted in improved outcomes, making it a potentially more appropriate treatment option for specific patients. This study compares 90-day clinical and self-reported outcomes for patients who received TAA or bipolar OCA ankle transplantation.

Methods:
Differences in costs and quality-adjusted life years (QALY) for patients were determined using postoperative 1-year follow-up. An institutional review board-approved review of electronic medical records and billing data was conducted for patients who underwent TAA or bipolar OCA ankle transplantation (n=35) at a single institution between 2014 and 2018. Postoperative patient-reported outcome scores and cost comparisons were completed using a two-sample t-test, or nonparametric alternative, or chi-square test.

Results:
Three months after surgery, no statistically significant differences in patient-reported outcomes, postsurgical complications, or value-based care metrics were observed between older TAA (n=18) or younger OCA groups (n=17). Based on data, OCA and TAA were both considered cost-effective treatment options; differences in the incremental cost-effectiveness between OCA and TAA were not statistically significant (P=0.99), and 1-year outcomes were good to excellent.

Conclusions:
These results will guide more robust planning for 90-day postoperative reimbursement guidelines. Ongoing work is needed to assess mid-term and long-term outcomes for patients with respect to morbidity, complications, patient-reported outcomes, costs, and QALY.

Level of Clinical Evidence:
Level III.
Trunnionosis in total knee arthroplasty: an unusual case report in revision knee arthroplasty
Authors: Malhotra Rajesh , Gautam Deepak , Mahato Ajay , Gupta Saurabh , Panday Pushpender , Chawla Anoop 
Published: March 2021

Background:
Trunnionosis has been described as an emerging cause of failure in total hip arthroplasty. However, its role in total knee arthroplasty failure is poorly described.

Case Report:
A case of catastrophic failure of revision total knee arthroplasty at 7 years due to trunnionosis at the femoral extension rod morse-taper junction is described. The possible mechanism of failure is discussed based on a comprehensive finite element analysis.

Conclusions:
The limitations of modularity and trunnionosis must be understood, as many patients have been receiving modular total knee arthroplasty at younger ages.
Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy
Authors: Rethlefsen Susan A. , Hanson Alison M. , Wren Tishya A.L. , Kay Robert M. 
Published: March 2021

Background:
Medial calcaneal sliding (CS) osteotomy and lateral column lengthening (LCL) are often performed to relieve pain and improve transverse plane alignment and gait stability for children with cerebral palsy (CP) and valgus foot deformities. The purpose of this study was to examine the effectiveness of these procedures in this population.

Methods:
Retrospective medical record review (including 3D gait analysis data) of patients with CP who underwent LCL (26 subjects, 46 limbs) or CS (46 subjects, 73 limbs). Data extraction included complications (modified Clavien-Dindo system), change in standing foot position (modified Yoo system), and change in gait kinematics and kinetics preoperatively to postoperatively. Groups were compared using paired t tests, Fisher exact test, and survivorship analysis using Cox proportional hazard models.

Results:
Subjects were 57% male, average age at surgery 11.1 (SD 2.5) years. Average length of follow-up was 3.2 (SD 2.8) years, and was longer in the LCL group (P=0.0004). Complications were minor with similar rates between groups (P=0.14). Prolonged pain and plantar hypersensitivity occurred only in the CS group. Successful maintenance of deformity correction was achieved in 52/73 limbs (71%) in the CS group and 16/44 limbs (36%) in the LCL group (P<0.001). Recurrent pes valgus and need for repeat foot surgery were more common after LCL (P=0.003 and 0.001, respectively). Recurrent pes valgus never occurred when talonavicular fusion was done concomitantly with CS. After accounting for the between group difference in length of follow-up, there was no difference in the rates of recurrent valgus or repeat foot surgery between LCL and CS. None of the variables predicted development of pes varus (P>0.20). Ankle kinematics and kinetics during gait were unchanged in both groups.

Conclusions:
CS and LCL have similar effectiveness in providing long-lasting correction of valgus foot deformities. Concomitant talonavicular fusion is key to success of CS for lower functioning patients with severe deformities, and obligate brace wearers.

Level of Evidence:
Level III, retrospective comparative study.
Mechanical Analysis of Explanted Telescopic Rods in the Management of Osteogenesis Imperfecta: A Multicenter Study
Authors: Nicolaou Nicolas , Luo Quanshun , Giles Stephen N. , Maruthainar Kunalan , Kitchen Matthew P. , Thomas Simon , Fernandes James A. , Roposch Andreas 
Published: March 2021

Background:
Telescopic rods in the management of osteogenesis imperfecta fail frequently. This could be attributed to technical errors, rod design, and rod structure. We aimed to analyze the mechanical properties and tribology of explanted male and female components to identify effects of in vivo telescoping that may relate to observed patterns of successful telescoping or failure.

Methods:
Recruitment took place at 3 of the 4 English centers for osteogenesis imperfecta. Twenty-five rods explanted for growth or failure during revision to a new rod were analyzed in terms of clinical indication and prerevision imaging to identify if there was a technical mode of failure. Laboratory analysis was performed using optical and scanning electrical microscopy, radiograph diffraction analysis, hardness test, bending test, and energy-dispersive x-ray spectroscopy.

Results:
All implants tested were of high-grade stainless steel. Female components had inferior strength [mean Vickers hardness property (HV0.3) at 0.3 to 313 kg] in comparison to male components (HV0.3 406) due to different techniques of manufacture. Female rods also had a higher wear coefficient (7.89×10−12 m3/N/m3) than the male rods (6.46×10−12 m3/N/m3). Abrasive wear, shear deformation, scratches, and wear debris were identified in all rods. Male and female components displayed corrosion contributing to adhesive wear. Intraoperatively cut rods, particularly the female components, had irregular ends leading to more wear.

Conclusions:
Current manufacturing techniques result in inferior material strength in female components compared with males, which combined with wear patterns is likely to lead to implant failure. Intraoperative cutting of rods may increase risk of failure due to wear. Considering techniques to improve strength as well as design in new implants may lead to better outcomes.

Levels of Evidence:
Level IV—cross-sectional study.
Characteristics of Patients Undergoing Surgical Treatment for Spinal Metastases From Colorectal Cancer
Authors: Park Se-Jun , Park Jin-Sung , Nam Yunjin , Lee Chong-Suh 
Published: March 2021

Study Design:
This was a retrospective study.

Objective:
This study aimed to investigate the prognosis and characteristics of patients undergoing surgical treatment for colorectal cancer (CRC) spinal metastasis. To better understand the characteristics of such patients, their results were compared with those with spinal metastasis from non–small cell lung cancer (NSCLC), as the prognosis of these patients is well-studied.

Summary of Background Data:
CRC commonly metastasizes to the liver or lung, while spinal metastases occur infrequently. The literature contains very few studies evaluating the prognosis of patients with spinal metastases from CRC.

Materials and Methods:
A consecutive 155 patients who underwent surgical treatment for spinal metastases from CRC (n=35) or NSCLC (n=120) between 2010 and 2018 were included in this study. Data were collected throughout the disease course, including those concerning all cancer-related treatments for both the primary cancer and spinal metastasis. Categorical variables were divided into patient, tumor, and treatment factors, and postoperative survival times were compared between the CRC and NSCLC groups.

Results:
The mean interval from cancer diagnosis to spinal metastasis was significantly greater in CRC group (32.5 mo) than in NSCLC group (12.9 mo). Concurrent spinal metastasis was more common in NSCLC group than CRC group (45.0% vs. 17.2%; P=0.003). Visceral metastasis was found more frequently in CRC group than NSCLC group (77.1% vs. 42.5%; P<0.001). The proportion of patients undergoing postoperative systemic treatment was significantly higher in NSCLC group than CRC group (59.2% vs. 20.0%; P<0.001). Median survival time after spine surgery was 4.2 months in CRC group and 5.8 months in NSCLC group (P=0.015).

Conclusions:
The prognosis after surgical treatment for CRC spinal metastasis was poor, and worse than that of NSCLC group. These results can be explained by the later development of spinal metastases and the limited chance of postoperative medical treatment in CRC spinal metastasis.
Treatment outcome in children with central nervous system-positive Burkitt lymphoma using only intrathecal and systemic chemotherapy combined with rituximab
Authors: Huang Shuang , Jin Lin , Yang Jing , Duan Yan-Long , Zhang Meng , Zhou Chun-Ju , Zhang Yong-Hong 
Published: March 2021

Abstract

Background:
With current chemotherapy treatment, >90% of survival has been obtained for Burkitt lymphoma (BL). In this study, the demographic characteristics and treatment outcomes are presented for 78 children in China with central nervous system-positive (CNS+) BL.

Methods:
This retrospective study consecutively enrolled 78 CNS+ BL patients in Beijing Children's Hospital (BCH) from 2007 to 2019 who received the BCH B-cell non-Hodgkin's lymphoma regimen (modified by French-American-British mature lymphoma B-cell 96 [FAB/LMB96] C1 arm ± rituximab). Clinical characteristics, methods of disease detection in the CNS, and outcomes were evaluated. Univariate and multivariate analyses were used to assess prognostic factors.

Results:
The median age of 65 boys and 13 girls at the time of diagnosis was 5.7 years (ranging from 1 to 14 years). Patients were followed up for a median time of 34 months (ranging from 1 to 72 months). Bone marrow invasion was found in 38 (48.7%) patients. There were 48 (61.5%), 44 (56.4%), and 25 (32%) patients with cranial nerve palsy, intracerebral mass (ICM), and para-meningeal extension, respectively. Abnormal cerebrospinal fluid (CSF) morphology and CSF immunophenotype appeared in 15 (19.2%) and 15 (19.2%) patients, respectively. There were 69 (88.5%) patients treated with chemotherapy combined with rituximab, and nine patients were treated solely with chemotherapy. Finally, five patients died of treatment-related infection, recurrence occurred for 13, and one developed a second tumor. The 3-year overall survival and event-free survival rates were 78.9% ± 4.7% and 71.4% ± 6.0%, respectively. Treatment with chemotherapy only, ICM positivity, and >4 organs involved at diagnosis were independent risk factors.

Conclusions:
Rituximab combined with a modified LMB96 regimen has greatly increased the efficacy of treatment for Chinese children with CNS+ BL, and with the continuous collection of outcome data, treatment-related complications are decreasing. For further verification, a large sample multicentre randomized controlled study should be performed to explore a treatment scheme for Chinese children with even greater efficacy.
Ambient air pollution exposure and radiographic pulmonary vascular volumes
Authors: Synn Andrew J. , Byanova Katerina L. , Li Wenyuan , Gold Diane R. , Di Qian , Kloog Itai , Schwartz Joel , San José Estépar Raúl , Washko George R. , O’Connor George T. , Mittleman Murray A. , Rice Mary B. 
Published: March 2021

Background:
Exposure to higher levels of ambient air pollution is a known risk factor for cardiovascular disease but long-term effects of pollution exposure on the pulmonary vessels are unknown.

Methods:
Among 2428 Framingham Heart Study participants who underwent chest computed tomography (CT) between 2008 and 2011, pulmonary vascular volumes were calculated by image analysis, including the total vascular volume and small vessel volume (cross-sectional area <5 mm2; BV5 defined as small vessel volume). Using spatiotemporal models and participant home address, we assigned 1-year (2008) and 5-year (2004–2008) average concentrations of fine particulate matter (PM2.5), elemental carbon (EC), and ground-level ozone (O3), and distance to major roadway. We examined associations of 1- and 5-year exposures, and distance to road, with CT vascular volumes using multivariable linear regression models.

Results:
There was a consistent negative association of higher O3 with lower small vessel volumes, which persisted after adjustment for distance to road. Per interquartile range (IQR) of 2008 O3, BV5 was 0.34 mL lower (95% confidence intervals [CI], −0.61 to −0.06; P = 0.02), with similar results for 5-year exposure. One-year EC exposure and closer proximity to road were weakly associated with small vessel volumes; BV5 was 0.18 mL higher per IQR of 2008 EC (95% CI, −0.05 to 0.42; P = 0.13) and 0.40 mL higher per IQR closer proximity to road (95% CI: −0.10 to 0.89; P = 0.12). PM2.5 was not associated with small vascular volumes; BV5 was 0.26 mL lower per IQR of 2008 PM2.5 (95% CI: −0.68 to 0.16; P = 0.22).

Conclusions:
Among community-dwelling adults living in the northeastern United States, higher exposure to O3 was associated with lower small pulmonary vessel volumes on CT.
The University of Pennsylvania Flap Course Enters Virtual Reality: The Global Impact
Authors: Klifto Kevin M. , Azoury Saïd C. , Muramoto Lorna M. , Zenn Michael R. , Levin L. Scott , Kovach Stephen J. 
Published: March 2021

Background:The purpose of this study was to evaluate participants from the in-person Penn Flap Course (PFC) and virtual PFC to determine if the virtual PFC increased diversity in culture, sex, education, and surgical specialties internationally and within the United States. Our hypothesis is that the virtual PFC increases diversity internationally and within the United States.Methods:A retrospective descriptive comparison was performed between participants from the in-person PFC from the years 2017 to 2019 and virtual PFC in 2020. Frequency maps were generated to determine differences in participation of cultures, sexes, education, and specialties internationally and within the United States. Net Promoter Scores (NPSs) were used to assess participant satisfaction with the virtual course.Results:The in-person PFC included 124 participants from the years 2017 to 2019, whereas the virtual PFC included 770 participants in the year 2020. Compared to the in-person course, the virtual course included more cultures (countries: 60 versus 11; states: 35 versus 22), women (countries: 38 versus 7; states: 23 versus 9), students/researchers (countries: 24 versus 0; states: 9 versus 0), residents (countries: 44 versus 5; states: 26 versus 15), fellows (countries: 21 versus 2; states: 21 versus 9), attendings (countries: 34 versus 8; states: 16 versus 11), plastic surgery (countries: 54 versus 9; states: 31 versus 18), orthopedic surgery (countries: 12 versus 5; states: 11 versus 9), and other specialties (countries: 19 versus 1; states: 8 versus 2). Our overall NPS for the virtual PFC totaled 75%, categorized as “world class” based on global NPS.Conclusion:A virtual interface for a flap course increased participation and diversity of culture, sex, education, and specialties internationally and within the United States with “world class” participant satisfaction.
Drug adherence and psychosocial characteristics of patients presenting with hypertensive urgency at the emergency department
Authors: Lauder Lucas , Ewen Sebastian , Glasmacher Julius , Lammert Frank , Reith Wolfgang , Schreiber Naemi , Kaddu-Mulindwa Dominic , Ukena Christian , Böhm Michael , Meyer Markus R. , Mahfoud Felix 
Published: March 2021

Objective:
To identify potentially targetable psychosocial factors associated with nonadherence to prescribed antihypertensive medications in patients presenting with hypertensive urgencies at an emergency department.

Methods:
This prospective study included patients treated with antihypertensive drugs who presented with hypertensive urgencies (SBP ≥180 mmHg and/or DBP ≥110 mmHg) at the emergency department of a tertiary referral clinic between April 2018 and April 2019. Health literacy was assessed using the Newest Vital Sign test. The Hospital Anxiety and Depression Scale (HADS) was used to quantify symptoms of anxiety and depression. Patients were classified nonadherent if less than 80% of the prescribed antihypertensive drugs were detectable in urine or plasma using liquid chromatography-high-resolution mass spectrometry.

Results:
A total of 104 patients (62% women) presenting with hypertensive urgencies with a median SBP of 200 mmHg (IQR 190–212) and DBP of 97.5 mmHg (IQR 87–104) were included. Twenty-five patients (24%) were nonadherent to their antihypertensive medication. Nonadherent patients were more often men (66 versus 23%, P = 0.039), prescribed higher numbers of antihypertensive drugs (median 3, IQR 3–4 versus 2, IQR 1–3; P < 0.001), and more often treated with calcium channel blockers (76 versus 25%; P < 0.001) and/or diuretics (64 versus 40%; P = 0.030). There was no difference in health literacy (P = 0.904) or the scores on the HADS subscales for depression (P = 0.319) and anxiety (P = 0.529) between adherent and nonadherent patients.

Conclusion:
Male sex, higher numbers of antihypertensive drugs, and treatment with diuretics and/or calcium channel blockers were associated with nonadherence. We did not identify a specific psychosocial characteristic associated with nonadherence.
Repeatability of 2 swept-source OCT biometers and 1 optical low-coherence reflectometry biometer
Authors: Fişuş Andreea D. , Hirnschall Nino D. , Ruiss Manuel , Pilwachs Caroline , Georgiev Stefan , Findl Oliver 
Published: March 2021

Aim:
To compare the repeatability of 2 swept-source optical coherence tomography (SS-OCT) biometers, IOLMaster 700 (biometer A, Carl Zeiss Meditec AG) and ANTERION (biometer B, Heidelberg Engineering GmbH) and 1 optical low-coherence reflectometry (OLCR) device (biometer C, LENSTAR, LS900; Haag-Streit AG).

Setting:
Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery—Karl Landsteiner Institute, Vienna, Austria.

Design:
Prospective study that included patients scheduled for cataract surgery.

Method:
Three consecutive measurements were performed with 2 SS-OCT devices and 1 OLCR device. The repeatability of the following biometry variables was compared: keratometry, central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), and axial eye length (AL). To assess the repeatability of each parameter, the within-subject SD (Sw) and coefficient of variation (CoV) were calculated.

Result:
Fifty eyes of 50 patients were included. The CoV values were below 0.5 for all variables, except for ACD and LT for biometer C. The Sw values for mean keratometry were 0.018 for biometer A, 0.083 for biometer B, and 0.137 for biometer C. For the ACD, the Sw values were 0.039 and 0.004 for biometer A and biometer B, respectively, and 0.134 for biometer C. For the AL, the values were 0.006 for biometer A, 0.008 for biometer B, and 0.012 for biometer C.

Conclusions:
All biometry devices included in the analysis presented a high repeatability. The SS-OCT devices showed a higher repeatability performance compared with the OLCR device.
Use of social determinants of health codes in home-based primary care
Authors: Coppa Denise , Winchester Suzy Barcelos , McAlvin Elizabeth , Roberts Mary B. , Maestri Xristin 
Published: March 2021

ABSTRACT

Background:
The Affordable Care Act created funding for nurse practitioner education programs to transform the primary health care workforce through student awareness of how social, political, economic, and environmental factors influence individual and population health. Funding established Academic Clinical Partnerships (ACPs) that created value-based health care models, which improved patient outcomes and decreased hospital and emergency department admissions and health care costs. The ACP established a home-based primary health care (HBPC) program to deliver primary care and collect patient data.

Purpose:
The purposes were to describe the incidence of chronic conditions for HBPC patients and determine associations between chronic conditions and presence of social determinants of health (SDoH).

Methodology:
Nurse practitioner students were assigned to HBPC clinical placements. A convenience sample of 102 high-risk, homebound patients was identified. Nurse practitioners and students recorded deidentified patient data, including ICD-10-CM codes into a Health Insurance Portability and Accountability Act compliant platform. Secondary analysis of patient records assessed for SDoH through Z codes.

Results:
Patients had high incidences of hypertension, diabetes, pulmonary disease, heart disease, chronic pain, mood, and substance abuse disorders. Secondary analysis revealed that 92% of patients had indications for the use of Z codes, but these were not recorded.

Conclusions:
Common Z codes were personal risk factors, housing/economic circumstances, care provider dependency, lifestyle, and family support.

Implications for practice:
By coding for SDoH, providers and agencies can realize higher reimbursement rates in HBPC settings. Nurse practitioners can use this information to provide better treatment recommendations, more accurate diagnoses, and referrals to enhance primary care services to a patient population negatively affected by SDoH.