bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes of Minimally Invasive Posterior Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis
Authors: Kobayashi Yuto , Tamai Koji , Toyoda Hiromitsu , Terai Hidetomi , Hoshino Masatoshi , Suzuki Akinobu , Takahashi Shinji , Hori Yusuke , Yabu Akito , Nakamura Hiroaki 
Published: February 2021

Study Design.
Retrospective cohort study.

Objective.
To compare the clinical outcomes 5 years after minimally invasive posterior decompression for lumber spinal stenosis (LSS) between patients with and without degenerative spondylolisthesis (DS).

Summary of Background Data.
Indications for surgical procedures for patients with LSS and DS are still under investigation. Since minimally invasive surgery does not affect most anatomical structures, preoperative DS may not negatively affect the clinical outcomes of minimally invasive posterior decompression.

Methods.
Overall, 198 patients with LSS who underwent microendoscopic or microscopic decompression and were followed up for more than 5 years postoperatively were included in the present study. Patients who showed a segmental kyphosis >5° at the surgical level during flexion were treated with fusion surgery. However, other patients, including those with DS, were treated with posterior decompression. The patients were divided into two groups: the DS group included 82 patients with >3-mm slip and the non-DS group included 112 patients with ≤3-mm slip or without slip. A mixed-effects model adjusted for age and sex was used to compare the improvements in the visual analog scale score for low-back pain and the Japanese Orthopaedic Association score of the two groups. For subgroup analysis (n = 53), the changes in the preoperative physical component summary and the mental component summary of Short Form-36 of the two groups at 5 years after surgery were evaluated.

Results.
There was no significant difference in the improvement of preoperative low-back pain visual analog scale score and Japanese Orthopaedic Association score 5 years after surgery between the two groups. Subgroup analysis showed no significant difference between the two groups in the improvement of preoperative physical component summary and mental component summary 5 years after surgery.

Conclusion.
After carefully eliminating patients with segmental instability, DS did not affect the clinical outcomes of minimally invasive decompression surgery.

Level of Evidence: 3
Pain During Sex Before and After Decompressive Surgery for Lumbar Spinal Stenosis
Authors: Holmberg Siril T. , Vangen-Lønne Vetle , Gulati Agnete M. , Nygaard Øystein P. , Solberg Tore K. , Salvesen Øyvind O. , Gulati Sasha 
Published: February 2021

Study Design.
Observational multicenter study.

Objective.
The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar spinal stenosis (LSS).

Summary of Background Data.
There are limited data available on sexual function in patients undergoing surgery for LSS.

Methods.
Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at 1 year, assessed by item number eight of the Oswestry disability index questionnaire. Secondary outcome measures included Oswestry Disability Index, EuroQol-5D, and numeric rating scale scores for back and leg pain.

Results.
Among the 12,954 patients included, 9908 (76.5%) completed 1-year follow-up. At baseline 9579 patients (73.9%) provided information about pain during sexual activity, whereas 7424 (74.9%) among those with complete follow-up completed this item. Preoperatively 2528 of 9579 patients (26.4%) reported a normal sex-life without pain compared with 4294 of 7424 patients (57.8%) at 1 year. Preoperatively 1007 (10.5%) patients reported that pain prevented any sex-life, compared with 393 patients (5.3%) at 1 year. At baseline 7051 of 9579 patients (73.6%) reported that sexual activity caused pain, and among these 3145 of 4768 responders (66%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, and working until time of surgery were predictors of improvement in pain during sexual activity. Current tobacco smoking, pain duration >12 months, previous spine surgery, and complications occurring within 3 months were negative predictors.

Conclusion.
This study clearly demonstrates that a large proportion of patients undergoing surgery for LSS experienced an improvement in pain during sexual activity at 1 year.

Level of Evidence: 2
A Novel Classification of 3D Rib Cage Deformity in Subjects With Adolescent Idiopathic Scoliosis
Authors: Assi Ayman , Karam Mohamad , Skalli Wafa , Vergari Claudio , Vialle Raphael , Pietton Raphael , Bizdikian Aren J. , Kharrat Khalil , Dubousset Jean , Ghanem Ismat 
Published: February 2021

Study Design:
This was a multicentric cross-sectional descriptive study.

Objective:
To analyze patterns of 3D rib cage deformity in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with the spinal deformity.

Summary of Background Data:
Subjects with AIS present with rib cage deformity that can affect respiratory functions. The 3D rib cage deformities in AIS and their relationship to the spinal deformity are still unelucidated.

Methods:
A total of 200 AIS and 71 controls underwent low-dose biplanar x-rays and had their spine and rib cage reconstructed in 3-dimensional (D). Classic spinopelvic parameters were calculated in 3D and: rib cage gibbosity, thickness, width, volume and volumetric spinal penetration index (VSPI). Subjects with AIS were classified as: group I with mild rib cage deformity (n=88), group II with severe rib cage deformity (n=112) subgrouped into IIa (high gibbosity, n=48), IIb (high VSPI, n=48), and IIc (both high gibbosity and VSPI, n=16).

Results:
Groups IIa and IIb had a higher Cobb angle (33 vs. 54 degrees and 46 degrees, respectively) and torsion index (11 vs. 14 degrees and 13 degrees, respectively) than group I. Group IIb showed more severe hypokyphosis (IIb=21 degrees; IIa=33 degrees; I=36 degrees; control=42 degrees) with a reduced rib cage volume (IIb=4731 cm3; IIa=4985 cm3; I=5257 cm3; control=5254 cm3) and thickness (IIb=135 mm; IIa=148 mm; I=144 mm; control=144 mm). Group IIa showed an increasingly large local gibbosity descending from proximal to distal levels and did not follow the axial rotation of the spine. Group IIc showed characteristics of both groups IIa and IIb.

Conclusions:
This new classification of 3D rib cage deformity in AIS shows that the management of cases with high VSPI (groups IIb and IIc) should focus on restoring as much kyphosis as possible to avoid respiratory repercussions. Treatment indications in groups I and IIa would follow the consensual basic principles reported in the literature regarding bracing and surgery.
Breath-Synchronized Nebulized Surfactant in a Porcine Model of Acute Respiratory Distress Syndrome
Authors: DiBlasi Robert M. , Kajimoto Masaki , Poli Jonathan A. , Deutsch Gail , Pfeiffer Juergen , Zimmerman Joseph , Crotwell David N. , Malone Patrik , Fink James B. , Ringer Coral , Uthamanthil Rajesh , Ledee Dolena , Portman Michael A. 
Published: February 2021

Objectives:
Effective treatment options for surfactant therapy in acute respiratory distress syndrome and coronavirus disease 2019 have not been established. To conduct preclinical studies in vitro and in vivo to evaluate efficiency, particle size, dosing, safety, and efficacy of inhaled surfactant using a breath-synchronized, nebulized delivery system in an established acute respiratory distress syndrome model.

Design:
Preclinical study.

Setting:
Research laboratory.

Subjects:
Anesthetized pigs.

Intervention:
In vitro analysis included particle size distribution and inhaled dose during simulated ventilation using a novel breath-synchronized nebulizer. Physiologic effects of inhaled aerosolized surfactant (treatment) were compared with aerosolized normal saline (control) in an adult porcine model (weight of 34.3 ± 0.6 kg) of severe acute respiratory distress syndrome (Pao
2/Fio
2 <100) with lung lavages and ventilator-induced lung injury during invasive ventilation.

Measurements and Main Results:
Mass median aerosol diameter was 2.8 µm. In vitro dose delivered distal to the endotracheal tube during mechanical ventilation was 85% ± 5%. Nebulizers were functional up to 20 doses of 108 mg of surfactant. Surfactant-treated animals (n = 4) exhibited rapid improvement in oxygenation with nearly full recovery of Pao
2/Fio
2 (~300) and end-expiratory lung volumes with nominal dose less than 30 mg/kg of surfactant, whereas control subjects (n = 3) maintained Pao
2/Fio
2 less than 100 over 4.5 hours with reduced end-expiratory lung volume. There was notably greater surfactant phospholipid content and lower indicators of lung inflammation and pathologic lung injury in surfactant-treated pigs than controls. There were no peridosing complications associated with nebulized surfactant, but surfactant-treated animals had progressively higher airway resistance post treatment than controls with no differences in ventilation effects between the two groups.

Conclusions:
Breath-synchronized, nebulized bovine surfactant appears to be a safe and feasible treatment option for use in coronavirus disease 2019 and other severe forms of acute respiratory distress syndrome.
Impact of Blood Product Transfusions on the Risk of ICU-Acquired Infections in Septic Shock*
Authors: Péju Edwige , Llitjos Jean-François , Charpentier Julien , François Anne , Marin Nathalie , Cariou Alain , Chiche Jean-Daniel , Mira Jean-Paul , Lambert Jérôme , Jamme Matthieu , Pène Frédéric 
Published: February 2021

OBJECTIVES:
Transfusions of blood products are common in critically ill patients and have a potential for immunomodulation. The aim of this study is to address the impact of transfusion of blood products on the susceptibility to ICU-acquired infections in the high-risk patients with septic shock.

DESIGN:
A single-center retrospective study over a 10-year period (2008–2017).

SETTING:
A medical ICU of a tertiary-care center.

PATIENTS:
All consecutive patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients who were discharged or died within the first 48 hours were excluded.

INTERVENTIONS:
RBC, platelet, and fresh frozen plasma transfusions collected up to 24 hours prior to the onset of ICU-acquired infection.

MEASUREMENTS AND MAIN RESULTS:
During the study period, 1,152 patients were admitted for septic shock, with 893 patients remaining alive in the ICU after 48 hours of management. A first episode of ICU-acquired infection occurred in 28.3% of the 48-hour survivors, with a predominance of pulmonary infections (57%). Patients with ICU-acquired infections were more likely to have received RBC, platelet, and fresh frozen plasma transfusions. In a multivariate Cox cause-specific analysis, transfusions of platelets (cause-specific hazard ratio = 1.55 [1.09–2.20]; p = 0.01) and fresh frozen plasma (cause-specific hazard ratio = 1.38 [0.98–1.92]; p = 0.05) were independently associated with the further occurrence of ICU-acquired infections.

CONCLUSIONS:
Transfusions of platelets and fresh frozen plasma account for risk factors of ICU-acquired infections in patients recovering from septic shock. The occurrence of ICU-acquired infections should be considered as a relevant endpoint in future studies addressing the indications of transfusions in critically ill patients.
Osteoclast-Like Giant Cells: Focus on Entities Relevant to Dermatopathology and Underlying Pathogenesis
Authors: Hamie Lamiaa , Abbas Ossama , Kurban Mazen , Bhawan Jag 
Published: February 2021

Abstract:
Osteoclast-like giant cells (OLGCs) resemble osteoclasts with their abundant cytoplasm and well-developed organelles. OLGCs are characteristic features of giant cell tumor of the tendon sheath and giant cell tumor of soft tissue but they have also been described in numerous other cutaneous conditions. The diagnostic and prognostic significance of the presence of OLGCs is unknown. Here, we summarize the clinical entities that can exhibit these cells to avoid a histological overlap, affecting diagnosis and management.
Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis
Authors: Mongelli Francesco , Treglia Giorgio , La Regina Davide , Di Giuseppe Matteo , Galafassi Jacopo , Majno-Hurst Pietro E. , Christoforidis Dimitrios 
Published: February 2021

BACKGROUND:
Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting.

OBJECTIVE:
The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy.

DATA SOURCES:
PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020.

STUDY SELECTION:
Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected.

INTERVENTIONS:
Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed.

MAIN OUTCOME MEASURES:
Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model.

RESULTS:
The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292–0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, –0.935; 95% CI, –1.280 to –0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, –1.862; 95% CI, –2.495 to –1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, –0.742; 95% CI, –1.145 to –0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062–0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged “high.”

LIMITATIONS:
Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study.

CONCLUSIONS:
This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.
Trends from 2008 to 2018 in Electricity-dependent Durable Medical Equipment Rentals and Sociodemographic Disparities
Authors: Casey Joan A. , Mango Marriele , Mullendore Seth , Kiang Mathew V. , Hernández Diana , Li Bonnie H. , Li Kris , Im Theresa M. , Tartof Sara Y. 
Published: February 2021

Background:
Duration and number of power outages have increased over time, partly fueled by climate change, putting users of electricity-dependent durable medical equipment (hereafter, “durable medical equipment”) at particular risk of adverse health outcomes. Given health disparities in the United States, we assessed trends in durable medical equipment rental prevalence and individual- and area-level sociodemographic inequalities.

Methods:
Using Kaiser Permanente South California electronic health record data, we identified durable medical equipment renters. We calculated annual prevalence of equipment rental and fit hierarchical generalized linear models with ZIP code random intercepts, stratified by rental of breast pumps or other equipment.

Results:
243,559 KPSC members rented durable medical equipment between 2008 and 2018. Rental prevalence increased over time across age, sex, racial–ethnic, and Medicaid categories, most by >100%. In adjusted analyses, Medicaid use was associated with increased prevalence and 108 (95% confidence interval [CI] = 99, 117) additional days of equipment rental during the study period. ZIP code-level sociodemographics were associated with increased prevalence of equipment rentals, for example, a 1 SD increase in percent unemployed and <high school diploma (prevalence ratio [PR] = 1.1, 95% CI = 1.1, 1.1 and PR = 1.1, 95% CI = 1.1, 1.2, respectively). Increased Supplemental Nutrition Assistance Program usage was associated with decreased breast pump rentals (PR = 0.83, 95% CI = 0.78, 0.88).

Conclusions:
We observed some socioeconomic disparities among a growing electricity-dependent population. Our findings are consistent with the hypothesis that reliable electricity access is increasingly required to meet the health needs of medically disadvantaged groups. See video abstract at http://links.lww.com/EDE/B793.
Tacrolimus Measured in Capillary Volumetric Microsamples in Pediatric Patients—A Cross-Validation Study
Authors: Kindem Ingvild Andrea , Bjerre Anna , Åsberg Anders , Midtvedt Karsten , Bergan Stein , Vethe Nils Tore 
Published: February 2021

Background:
Therapeutic drug monitoring of tacrolimus (Tac) is mandatory in solid organ transplant (SOT) recipients. Finger-prick microsampling is more flexible and tolerable during the therapeutic drug monitoring of tacrolimus and has been shown to be applicable in adult SOT recipients. In this study, a previously validated method applying volumetric absorptive microsampling (VAMS) to measure Tac in adults was cross-validated in a pediatric population.

Methods:
Patients with SOT scheduled for standard posttransplant follow-up visits were recruited. Blood samples were obtained by trained phlebotomists using standard venipuncture and capillary microsampling, before the morning dose of Tac as well as 2 and 5 hours after dosing. Tac concentrations were quantified using liquid chromatography–tandem mass spectrometry. Concordance between Tac concentrations obtained with venipuncture and VAMS was evaluated using Passing–Bablok regression, calculation of absolute and relative differences, and percentage of samples within ±20% and ±30% difference.

Results:
A total of 39 SOT patients aged 4–18 years (22 male) were included. The median (range) predose venous blood concentration was 4.8 (2.6–13.6) mcg/L, with a difference between VAMS and venous blood samples of −0.2 ± 0.7 mcg/L. The relative mean difference was −1.3% [95% confidence interval (CI), −5.9% to 3.4%]. Ninety-two percent and 97% of the sample pairs demonstrated differences within ±20% and ±30%, respectively. Postdose (2 hours and/or 5 hours, n = 17) median concentration in venous blood was 7.9 (4.8–19.2) mcg/L. The difference between VAMS and venous blood samples was 0.1 ± 1.0 mcg/L, with a relative mean difference of −2.5% (95% confidence interval, −8.8% to 3.8%). Eighty-eight percent of the postdose sample pairs were within ±20% difference, and all were within ±30% difference.

Conclusions:
Tac concentrations can be accurately measured using VAMS technology in pediatric SOT recipients. This makes home-based Tac monitoring feasible in the pediatric population.
Safety of Copolyamide Filler Injection for Breast Augmentation
Authors: Nomoto Shunichi , Hirakawa Keiko , Ogawa Rei 
Published: February 2021

Background:
Although injections with copolyamide fillers (Aquafilling/Los Deline and Aqualift/Activegel) are currently used widely for breast augmentation, many complications have been reported. A recent position statement by a Korean aesthetic/reconstructive breast surgery society indicated these fillers are the same as polyacrylamide gel (PAAG), which is widely prohibited due to complications. To test this statement, this retrospective cohort study examined the clinical complications after breast augmentation with copolyamide fillers. Nuclear magnetic resonance (NMR) analysis of copolymer and PAAG fillers was also conducted.

Methods:
All consecutive patients with concerns about or sequelae from copolyamide fillers who visited our hospital in 2018–2020 were identified. The injected formulation, complications, and intraoperative findings were recorded. Copolyamide fillers were compared with PAAG and 2 PAAG fillers (Amazingel and Aquamid) by NMR.

Results:
Of the 29 patients (all women; average age, 42 years), 17 complained of breast deformity. Eight had puncture site infections and mammary gland inflammation. Five exhibited induration (single large/small lumps). In 4 cases, the filler had migrated outside of the breast, including to the back and vulva; these cases had severe symptoms. NMR showed that the copolyamide and PAAG fillers bore all of the characteristic peaks of PAAG.

Conclusions:
Our clinical/intraoperative and NMR findings showed, respectively, that copolyamide fillers cause the same complications as PAAG fillers and have the same composition. Thus, the risks of copolyamide fillers for breast augmentation are equivalent to those for PAAG fillers. It is strongly recommended not to use copolyamide fillers until their long-term safety is established.
A Novel Technique for Single-stage Reconstruction of Nipple-Areola Complex following Central Lumpectomy
Authors: Huang Yinglai , Jogeland Karin , Ivanova Mariya 
Published: February 2021

Summary
Several oncoplastic techniques have been proposed for subareolar breast cancer, some of which may require contralateral operation for symmetry, or more than one operation for delayed reconstruction of the nipple-areola complex (NAC). We herein developed a simple and effective oncoplastic approach following central quadrantectomy, aiming to achieve the following: (1) preservation of breast shape and contour for patients who are not accepting of a notably smaller breast or bilateral operation; (2) single procedure with advantages of single anesthetic and the ability to reconstruct a breast that has not yet been affected by radiation; (3) no autologous grafts with disadvantage of an extra donor site; (4) creation of natural neo-NAC with only incision within the region of the areola complex; and (5) maintaining long-term nipple projection. In this technique, the medial and lateral peri-areolar flap was advanced and rotated to restore partial neo-NAC, and to fill the defect after central tumor and NAC resection. The whole neo-NAC margin was created using the “round block” technique. Additionally, the nipple reconstruction was performed at the mitten of the neo-areola area using the C-V nipple flaps with an internal strut of rolled dermal grafts harvested from excised skin during the round block procedures. Lastly, a purse-string suture is placed in the outer skin margin for control of areola diameter and project. Six patients with central tumors of the breast were treated in this easily achieved approach. Patient satisfaction was noted as high, and the cosmetic results were evaluated as good to excellent.