bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laminoplasty Achieves Improved Outcomes Despite Leading to a More Positive Sagittal Balance
Authors: Niu Shuo , Anastasio Albert T. , Rhee John M. 
Published: March 2021

Study Design:
A retrospective study of prospective data.

Objective:
Determine the correlation between cervical sagittal alignment, either preoperative or postoperative, and the outcomes of laminoplasty.

Summary of Background Data:
Cervical laminoplasty is a common surgical treatment for myelopathy. However, the effect of preoperative or postoperative cervical sagittal alignment on outcomes, such as neurological improvement and patient-reported outcomes, remains unclear.

Methods:
A total of 144 consecutive patients (2007–2017) with laminoplasty for myelopathy and a minimum of 1-year postoperative follow-up were reviewed. The severity of myelopathy was assessed by modified Japanese Orthopedic Association (mJOA) scores. Total pain was measured by the visual analog scale. Patient-reported outcome included neck disability index (NDI) and 12-item short-form survey (SF-12). Radiographic measures of cervical sagittal alignment on x-ray images consisted of C2–C7 angle, T1 slope, C2–C7 sagittal vertical axis (SVA), and C2–C7 forward pitch (FP). Patients were also divided into 2 groups based on the postoperative C2–C7 SVA (≥40 or <40 mm) for outcome comparison.

Results:
Laminoplasty yielded improvement in functionality as evidenced by significantly increased mJOA scores, decreased total pain scores, and improved NDI scores at final follow-up. There was a change in sagittal balance postoperatively with significantly increased C2–C7 SVA and FP (7–8 mm increase). However, there was no correlation between preoperative sagittal alignment and outcomes. There was also no correlation between postoperative sagittal alignment and most outcomes, except for a significantly negative correlation between FP and short form-physical component summary (Spearman r=−0.328, P=0.011). When those with postoperative C2–C7 SVA ≥40 mm (n=60) were compared with those with <40 mm (n=84), there was no significant difference in outcomes.

Conclusions:
Cervical laminoplasty yields significant neurological and functional improvement despite a more positive sagittal balance postoperatively, with increased C2–C7 SVA and FP. However, other than a lower short form-physical component summary score, neither preoperative nor postoperative sagittal alignment measures correlated with spine-specific outcomes.

Level of Evidence:
Level II—a retrospective cohort study.
Thoracic Kyphosis and Lumbar Lordosis Distribution After Idiopathic Scoliosis Correction Using Posterior Hybrid Versus Screw Instrumentation
Authors: Charles Yann P. , Marchand Pierre-Luc , Tuzin Nicolas , Steib Jean-Paul 
Published: March 2021

Study Design:
This was a retrospective observational study.

Objective:
The aim of this study was to evaluate kyphosis and lordosis distribution, inflexion points, and the relationship with proximal junctional kyphosis (PJK) comparing hybrid instrumentation (in situ contouring, derotation) versus screw instrumentation (thoracic cantilever reduction, lumbar in situ contouring, and derotation).

Summary of Background Data:
The combination of reduction techniques aims at restoring the levels of lumbar apex and thoracolumbar inflexion point according to Roussouly alignment types. This approach could minimize the PJK risk after adolescent idiopathic scoliosis (AIS) surgery.

Materials and Methods:
The study assessed coronal curve correction, thoracolumbar and spinopelvic sagittal parameters in 86 skeletally mature adolescents and young adults 2.2 years after AIS correction, comparing a hybrid group (HG, n=34) to a screw group (SG, n=52). Segmental kyphosis and lordosis distribution, number of vertebrae included in curves, thoracic and lumbar apex, thoracolumbar inflexion point and Roussouly types were modeled using KEOPS software.

Results:
Global coronal and sagittal correction were similar in both groups. In the SG, lumbar lordosis (LL) decreased from 61.1 to 53.9 degrees (P<0.0001) and matched with pelvic incidence (r=0.69), whereas LL did not change in the HG. Postoperatively, the thoracolumbar inflexion point migrated cranially, resulting in a longer LL in both groups. Postoperative thoracolumbar inflexion point (P<0.0001) and the lumbar apex (P=0.0274) were more caudal in the SG compared with the HG. The PJK rate was 14.7% in the HG and 7.7% in the SG. In patients with PJK, lumbar apex and thoracolumbar inflexion point shifted cranially and were too high according to the Roussouly type.

Conclusions:
Hybrid and screw instrumentation led to similar global AIS correction, but the use of cantilever reduction in the SG allowed setting the thoracolumbar inflexion point and the lumbar apex lower than in the HG. Cranial migration of these points was identified as PJK risk factor.

Level of Evidence:
Level III.
Genome-wide DNA methylation patterns in monocytes derived from patients with primary Sjogren syndrome
Authors: Luo Xuan , Peng Yu , Chen Ying-Ying , Wang An-Qi , Deng Chui-Wen , Peng Lin-Yi , Wu Qing-Jun , Zhao Yan , Fei Yun-Yun , Zhang Wen 
Published: March 2021

Abstract

Background:
Epigenetics, especially DNA methylation, plays an important role in the pathogenesis of primary Sjogren syndrome (pSS). Our study aimed to reveal the role of DNA methylation in peripheral monocytes of pSS patients.

Methods:
A total of 11 pSS patients and five age-matched healthy controls (HCs) were included in this study. Monocytes were isolated from peripheral blood mononuclear cells using magnetic microbeads. DNA methylation profiles were generated using Human Methylation 850K BeadChips.

Results:
In monocytes from pSS patients, we identified 2819 differentially methylated positions (DMPs), comprising 1977 hypomethylated- and 842 hypermethylated-DMPs, corresponding to 1313 unique genes when compared with HCs. IFI44L, MX1, PAARP9, and IFITM1, which influence the interferon (IFN) signaling pathway, were among the genes hypomethylated in pSS. Functional analysis of genes with a minimum of two DMPs showed involvement in antigen binding, transcriptional regulation, cell adhesion, IFN-γ pathway, type I IFN pathway, antigen presentation, Epstein-Barr virus infection, human T-lymphotropic virus type 1 virus infection, and metabolic disease-related pathways. In addition, patients with higher serum IgG levels exhibited enrichment in Notch signaling and metabolic-related pathways. Upon comparing monocytes with salivary gland epithelial cells, an important overlap was observed in the cell cycle, cell senescence, and interleukin-17 signaling pathways. The differentially methylated genes were more enriched in the ribosome- and AMP-activated protein kinase signaling pathway in anti-Ro/SSA and anti-La/SSB autoantibodies double-positive patients.

Conclusion:
Genome-wide DNA methylation profiling revealed significant differences in DNA methylation in monocytes isolated from patients with pSS.
Solitary CD8-Positive Primary Cutaneous Peripheral T-Cell Lymphoma: A Question of Classification
Authors: Rolim Inês , BakShi Arti , West Elizabeth , Azurdia Richard , Kempf Werner , Robson Alistair 
Published: March 2021

Abstract:
Acral CD8(+) lymphoma is a provisional entity in the latest edition of the WHO Lymphoma Classification and is associated with a highly specific dot-like pattern of immunohistochemical expression of CD68. We report a case of an ulcerated solitary cutaneous lesion arising on the forehead of an adult man, which had a CD8(+) cytotoxic phenotype and areas of dot-like CD68 positivity, but with a number of features that significantly detracted from the classically described acral CD8(+) lymphoma. The nosological status of the lesion is discussed with respect to a preferred diagnosis of peripheral T-cell lymphoma, not otherwise specified.
Social Networks and HIV Care Outcomes in Rural Kenya and Uganda
Authors: Chen Yiqun T. , Brown Lillian , Chamie Gabriel , Kwarisiima Dalsone , Ayieko James , Kabami Jane , Charlebois Edwin , Clark Tamara , Kamya Moses , Havlir Diane V. , Petersen Maya L. , Balzer Laura B. 
Published: March 2021

Background:
Social isolation among HIV-positive persons might be an important barrier to care. Using data from the SEARCH Study in rural Kenya and Uganda, we constructed 32 community-wide, sociocentric networks and evaluated whether less socially connected HIV-positive persons were less likely to know their status, have initiated treatment, and be virally suppressed.

Methods:
Between 2013 and 2014, 168,720 adult residents in the SEARCH Study were census-enumerated, offered HIV testing, and asked to name social contacts. Social networks were constructed by matching named contacts to other residents. We characterized the resulting networks and estimated risk ratios (aRR) associated with poor HIV care outcomes, adjusting for sociodemographic factors and clustering by community with generalized estimating equations.

Results:
The sociocentric networks contained 170,028 residents (nodes) and 362,965 social connections (edges). Among 11,239 HIV-positive persons who named ≥1 contact, 30.9% were previously undiagnosed, 43.7% had not initiated treatment, and 49.4% had viral nonsuppression. Lower social connectedness, measured by the number of persons naming an HIV-positive individual as a contact (in-degree), was associated with poorer outcomes in Uganda, but not Kenya. Specifically, HIV-positive persons in the lowest connectedness tercile were less likely to be previously diagnosed (Uganda-West aRR: 0.89 [95% confidence interval (CI): 0.83, 0.96]; Uganda-East aRR: 0.85 [95% CI: 0.76, 0.96]); on treatment (Uganda-West aRR: 0.88 [95% CI: 0.80, 0.98]; Uganda-East aRR: 0.81 [0.72, 0.92]), and suppressed (Uganda-West aRR: 0.84 [95% CI: 0.73, 0.96]; Uganda-East aRR: 0.74 [95% CI: 0.58, 0.94]) than those in the highest connectedness tercile.

Conclusions:
HIV-positive persons named as a contact by fewer people may be at higher risk for poor HIV care outcomes, suggesting opportunities for targeted interventions.
Understanding oocyte ageing: can we influence the process as clinicians?
Authors: Homer Hayden Anthony 
Published: March 2021

Purpose of review
Oocyte quality is rate-limiting for pregnancy success and declines with age. Here, I review animal-study evidence showing dramatic reversal of oocyte ageing with mitochondrial nutrients and explore clinical evidence related to their usage.

Recent findings
Oocyte ageing is strongly tied to mitochondrial dysfunction and oxidative stress. Quality-defining events occur over a protracted period (2—3 months in humans) when oocyte volume increases over 100-fold. Treating mice during the growth phase with mitochondrial modifiers such as CoQ10 combats oocyte ageing. Exciting new work shows that raising oocyte NAD+ levels also dramatically rejuvenate aged oocytes. However, evidence that any of these agents can reproducibly improve quality in humans is lacking. This is largely because there has been a focus on patients with poor ovarian response during IVF and/or low ovarian follicular pool size, rather than patients with poor oocyte quality. In addition, studies have used short-term treatment during ovarian stimulation after oocyte growth is already complete.

Summary
Mitochondrial therapeutics such as NAD+-boosting used during the oocyte's growth phase markedly improve oocyte quality in mice. Evaluating them in humans should focus on patients with poor oocyte quality and utilise per-oocyte (rather than per-cycle) endpoints after adequate treatment that captures the growth phase when quality is defined.
The 100 Most-disruptive Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014)
Authors: Hansdorfer Marek A. , Horen Sydney R. , Alba Brandon E. , Akin Jennifer N. , Dorafshar Amir H. , Becerra Adan Z. 
Published: March 2021

Background:Alternative bibliometrics have recently been the subject of significantly increased interest. The disruption index is a new bibliometric that was recently applied to surgery and urology and identifies papers that shift paradigms and eclipse previous research in a given field.Methods:The 100 most-disruptive publications in the 14 most prominent plastic and reconstructive surgery and subspecialty journals were identified.Results:We present the 100 most-disruptive studies as well as the 100 most-cited studies for comparison in n=14 of the most popular plastic and reconstructive surgery (and subspecialty) journals between 1954 and 2014. The 100 most-disruptive publications in these journals were more disruptive than 99.8% of all PubMed papers. Plastic and Reconstructive Surgery (PRS) had the most papers in the top 100 (n=64) followed by British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery, n=15), and Journal of Oral and Maxillofacial Surgery (n=7). PRS had 9 of the top 10 papers. However, Clinics in Plastic Surgery had the highest average disruption score for all its published papers (0.0029). The correlation coefficient linking disruption scores and citation counts was 0.01 and 0.11, respectively. The most common decade represented in the top 100 was the 1980's (n=31) and the least common was the 2000's (n=9).Conclusions:This is the first application of the disruption index to plastic and reconstructive surgery. The disruption score provides a unique ability to identify research that has shifted paradigms and driven the innovation that defines our specialty.
Associations between anterior segment parameters and rotational stability of a plate-haptic toric intraocular lens
Authors: Yao Yunqian , Meng Jiaqi , He Wenwen , Zhang Keke , Wei Ling , Cheng Kaiwen , Lu Yi , Zhu Xiangjia 
Published: March 2021

Purpose:
To evaluate the associations between anterior segment parameters and the rotational stability of a plate-haptic toric intraocular lens (IOL).

Setting:
Eye and Ear, Nose, Throat Hospital of Fudan University.

Design:
Retrospective case series.

Methods:
Patients who underwent uneventful phacoemulsification and plate-haptic toric IOL (AT TORBI 709M IOL) implantation were included. Preoperative axial length (AL) and anterior segment parameters, including the white-to-white (WTW) distance, anterior chamber depth (ACD), lens thickness (LT), and anterior segment length (ASL; the sum of ACD and LT) were recorded. IOL rotation, residual astigmatism (RAS), and visual acuity were evaluated 1 month postoperatively. The associations between the anterior segment parameters and IOL rotation were evaluated.

Results:
A total of 102 eyes of 102 patients were included. The mean AL was 26.43 ± 2.65 mm (range 21.71–34.60 mm). The mean IOL rotation was 4.59 ± 3.18 degrees, and RAS was 0.62 ± 0.39 D postoperatively. No correlation was detected between AL, ACD, or LT and the rotation of the plate-haptic toric IOL (all P > .05). However, its rotation correlated positively with the WTW distance (r = 0.250, P = .011) and ASL (r = 0.214, P = .030). Backward stepwise multiple linear regression revealed that the WTW distance (β = 2.142, P = .014) and ASL (β = 2.060, P = .037) were independent predictors of plate-haptic toric IOL rotation.

Conclusions:
Plate-haptic toric IOLs rotate more in eyes with larger WTW distances and longer ASLs; therefore, toric IOL implantation should be performed with caution in eyes with these characteristics.
The Impact of Malnutrition on the Hospital and Infectious Outcomes of Patients Admitted With Alcoholic Hepatitis
Authors: Lee David U. , Fan Gregory H. , Hastie David J. , Addonizio Elyse A. , Prakasam Vibhav N. , Ahern Ryan R. , Seog Kristen J. , Karagozian Raffi 
Published: March 2021

Goals:
We specifically evaluate the effect of malnutrition on the infection risks of patients admitted with alcoholic hepatitis using a national registry of hospitalized patients in the United States.

Background:
Malnutrition is a common manifestation of alcoholic hepatitis that affects patient outcomes.

Study:
2011 to 2017 National Inpatient Sample was used to isolated patients with alcoholic hepatitis, stratified using malnutrition (protein-calorie malnutrition, sarcopenia, and weight loss/cachexia) and matched using age, gender, and race with 1:1 nearest neighbor matching method. Endpoints included mortality and infectious endpoints.

Results:
After matching, there were 10,520 with malnutrition and 10,520 malnutrition-absent controls. Mortality was higher in the malnutrition cohort [5.02 vs. 2.29%, P<0.001, odds ratio (OR): 2.25, 95% confidence interval (CI): 1.93-2.63], as were sepsis (14.2 vs. 5.46, P<0.001, OR: 2.87, 95% CI: 2.60-3.18), pneumonia (10.9 vs. 4.63%, P<0.001, OR: 2.51, 95% CI: 2.25-2.81), urinary tract infection (14.8 vs. 9.01%, P<0.001, OR: 1.76, 95% CI: 1.61-1.91), cellulitis (3.17 vs. 2.18%, P<0.001, OR: 1.47, 95% CI: 1.24-1.74), cholangitis (0.52 vs. 0.20%, P<0.001, OR: 2.63, 95% CI: 1.59-4.35), and Clostridium difficile infection (1.67 vs. 0.91%, P<0.001, OR: 1.85, 95% CI: 1.44-2.37). In multivariate models, malnutrition was associated with mortality [P<0.001, adjusted odds ratio (aOR): 1.61, 95% CI: 1.37-1.90] and infectious endpoints: sepsis (P<0.001, aOR: 2.42, 95% CI: 2.18-2.69), pneumonia (P<0.001, aOR: 2.19, 95% CI: 1.96-2.46), urinary tract infection (P<0.001, aOR: 1.68, 95% CI: 1.53-1.84), cellulitis (P<0.001, aOR: 1.46, 95% CI: 1.22-1.74), cholangitis (P=0.002, aOR: 2.27, 95% CI: 1.36-3.80), and C. difficile infection (P<0.001, aOR: 1.89, 95% CI: 1.46-2.44).

Conclusion:
This study shows the presence of malnutrition is an independent risk factor of mortality and local/systemic infections in patients admitted with alcoholic hepatitis.
Recent evidence on the effect of urate-lowering treatment on the progression of kidney disease
Authors: Tiku Anushree , Johnson David W. , Badve Sunil V. 
Published: March 2021

Purpose of review
Several observational studies have shown that hyperuricemia is associated with chronic kidney disease (CKD) progression and is a potential therapeutic target in people with CKD. This review discusses the results of three recently published placebo-controlled randomized trials evaluating the effect of urate-lowering treatment on the progression of CKD with at least 2 years of follow-up.

Recent findings
The Febuxostat versus Placebo Randomized Controlled Trial Regarding Reduced Renal Function in Patients with Hyperuricemia Complicated by Chronic Kidney Disease Stage 3 trial evaluated the effect of febuxostat in 443 patients with stage 3 CKD (mean estimated glomerular filtration rate [eGFR] 45 mL/min/1.73 m2) and asymptomatic hyperuricemia (mean serum urate 7.8 mg/dL). The Controlled trial of slowing of Kidney Disease progression From the Inhibition of Xanthine oxidase and Preventing Early Renal Loss in Diabetes trials respectively evaluated the effect of allopurinol in 369 adults with stage 3 or 4 CKD (mean eGFR 31.7 mL/min/1.73 m2, mean serum urate 8.2 mg/dL) with high progression risk and 530 patients with type 1 diabetes and diabetic kidney disease (mean eGFR 74.7 mL/min/1.73 m2, mean serum urate 6.1 mg/dL). Despite the large and sustained reductions in serum urate levels in all 3 trials, urate-lowering treatment with febuxostat or allopurinol did not result in clinically meaningful improvement in kidney outcomes.

Summary
The results of large and well-designed placebo-controlled trials do not support the use of urate-lowering therapy to slow the progression of CKD.
Towards harmony in defining and reporting glomerular diseases on kidney biopsy
Authors: Haas Mark 
Published: March 2021

Purpose of review
To review recent efforts to develop uniformity and precision in defining individual glomerular histologic and ultrastructural lesions and proposals for developing greater uniformity in reporting of glomerular diseases.

Recent findings
Over the past 2 decades, scoring systems for multiple glomerular diseases have emerged, as have several consortia for the study of glomerular diseases. However, one important limitation faced by renal pathologists and nephrologists has been a lack of uniformity and precision in defining the morphologic lesions seen by light and electron microscopy on which the scoring systems are based. In response to this, the Renal Pathology Society organized a working group that over 4 years arrived at consensus definitions for many such lesions. These definitions can be applied within the context of scoring systems for different glomerular diseases, and recently proposed reporting systems based on pathogenic categories and for defining the overall severity of chronic changes.

Summary
From extensive discussions a panel of 13 renal pathologists reached consensus in defining 47 individual glomerular lesions seen on light microscopy and 56 glomerular lesions and key normal structures seen by electron microscopy. Validation of the impact of these consensus definitions on interobserver agreement in lesion identification is currently underway.
Updated strategies in the management of acute variceal haemorrhage
Authors: Edelson Jerome , Basso Jessica E. , Rockey Don C. 
Published: March 2021

Purpose of review
This article reviews the most recent studies regarding the management of acute esophageal variceal haemorrhage.

Recent findings
New randomized control trials and meta-analyses confirmed the role of early transjugular intrahepatic portosystemic shunt (TIPS) in the management of acute variceal haemorrhage in Child-Pugh C (10–13) and B patients with active bleeding. A recent randomized controlled trial focused on the duration of vasoactive therapy showed no difference between 2 and 5 days of octreotide. A randomized trial showed decreased use of blood products for the correction of coagulopathy using a thromboelastography-guided approach (vs. conventional parameters) as well as decreased bleeding rates when compared with standard of care. A meta-analysis found that for rescue of variceal bleeding, self-expanding metallic stents were more efficacious and safer than balloon tamponade. In addition, studies showed that Child-Pugh C patients and those with hepatic vein pressure gradient more than 20 were at the highest risk of treatment failure, while model for end-stage liver disease was highly predictive of in-hospital mortality.

Summary
In patients with severe coagulopathy and uncontrolled bleeding, TEG-based transfusion strategies are recommended. Antibiotics should be used for all cirrhotic patients presenting with upper gastrointestinal bleeding, but should be tailored in accordance to local resistance patterns. Early TIPS for high-risk patients has been shown to have a significant survival benefit. Certain aspects of the management of variceal bleeding remain poorly studied such as the role of early TIPS in Child-B patients as well as strategies for rescue therapy in patients who are not TIPS candidates, and require further investigation.