bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Surgical Outcomes for Distal Rectus Femoris Transfer and Resection Surgeries in Children With Cerebral Palsy With Stiff Knee Gait
Authors: Salazar-Torres Jose J. , Church Chris , Shields Thomas , Lennon Nancy , Shrader M. Wade , Sees Julieanne P. , Miller Freeman 
Published: July 2021

Background:
Children with cerebral palsy (CP) often present with a stiff knee gait pattern because of rectus femoris (RF) spasticity and/or contracture. Rectus femoris transfers (RFTs) and resections are surgical procedures aimed at reducing muscle stiffness, thereby improving knee flexion during the swing phase of gait. Previous research has consistently demonstrated objective benefits of rectus transfer using instrumented gait analysis (IGA). Rectus femoris resection (RFR), a relatively simpler procedure, shows similar improvement in knee range of motion during gait. The objective of this study was to compare surgical outcomes between rectus transfers and resections using 3-dimensional IGA.

Methods:
Children with spastic CP who had RFTs or resections were retrospectively matched by walking speed and preoperative knee kinematics from 3-dimensional IGA (peak and timing of peak knee flexion in swing). Secondary outcomes included knee range of motion and maximum knee extension during gait.

Results:
Twenty-eight children were included in both the transfer group [age 9.4±2 y; Gross Motor Function Classification System (GMFCS) I (3 children), II (15 children), III (8 children), and IV (2 children)] and the resection group [age 10.6±2.5 y; GMFCS I (1 child), II (14 children), and III (13 children)]. Both surgical groups showed statistically significant short-term postsurgical improvements in peak knee flexion during swing (P<0.001 for the transfer group and P=0.003 for the resection group) and Duncan-Ely test (P=0.004 for the transfer group and P<0.001 for the resection group). Further analysis by GMFCS level showed children at GMFCS levels III/IV had a greater tendency to crouch after RFT when compared with children at GMFCS levels I/II. This tendency was not observed in the RFR group.

Conclusions:
Both transfer and resection surgeries significantly improved gait kinematics short-term outcomes in children with spastic CP who present with stiff knee gait pattern. Further studies are required to compare long-term outcomes of both surgeries.

Level of Evidence:
Level III—retrospective matched-cohort study.
Texture Analysis of Magnetic Resonance Images Enables Phenotyping of Potentially Painful Annular Fissures
Authors: Eriksson Stefanie , Waldenberg Christian , Torén Leif , Grimby-Ekman Anna , Brisby Helena , Hebelka Hanna , Lagerstrand Kerstin 
Published: July 2021

Study Design.
Retrospective analysis of prospectively collected data.

Objective.
To investigate whether intervertebral disc (IVD) image features, extracted from magnetic resonance (MR) images, can depict the extension and width of annular fissures and associate them to pain.

Summary of Background Data.
Annular fissures are suggested to be associated with low back pain (LBP). Magnetic resonance imaging (MRI) is a sensitive method, yet fissures are sometimes unobservable in T2-weighted MR-images, even though fissure information is present in the image. Image features can mathematically be calculated from MR-images and might reveal fissure characteristics.

Methods.
Forty four LBP patients who underwent MRI, low-pressure discography (<50 psi), and computed tomography (CT) sequentially in 1 day, were reviewed. After semi-automated segmentation of 126 discs, image features were extracted from the T2-weighted images. The number of image features was reduced with principle component analysis (PCA). CT-discograms were graded and dichotomized regarding extension and width of fissures. IVDs were divided into fissures extending to outer annulus versus short/no fissures. Fissure width was dichotomized into narrow (<10%) versus broad fissures (>10%), and into moderately broad (10%–50%) versus very broad fissures (>50%). Logistic regression was performed to investigate if image features could depict fissure extension to outer annulus and fissure width. As a sub-analysis, the association between image features used to depict fissure characteristics and discography-provoked pain–response were investigated.

Results.
Fissure extension could be depicted with sensitivity/specificity = 0.97/0.77 and area under curve (AUC) = 0.97. Corresponding results for width depiction were sensitivity/specificity = 0.94/0.39 and 0.85/0.62, and AUC = 0.86 and 0.81 for narrow versus broad and moderately broad versus very broad fissures respectively. Pain prediction with image features used for depicting fissure characteristics showed sensitivity/specificity = 0.90/0.36, 0.88/0.4, 0.93/0.33; AUC = 0.69, 0.75, and 0.73 respectively.

Conclusion.
Standard MR-images contains fissure information associated to pain that can be depicted with image features, enabling non-invasive phenotyping of potentially painful annular fissures.

Level of Evidence: 2
A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion
Authors: Lim Seokchun , Bazydlo Michael , Macki Mohamed , Haider Sameah , Schultz Lonni , Nerenz David , Fadel Hassan , Pawloski Jacob , Yeh Hsueh-Han , Park Paul , Aleem Ilyas , Khalil Jad , Easton Richard , Schwalb Jason M. , Abdulhak Muwaffak , Chang Victor 
Published: July 2021

Study Design.
This is a retrospective, cohort analysis of multi-institutional database.

Objective.
This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries.

Summary of Background Data.
After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement.

Methods.
The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation.

Results.
We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13–1.34; P < 0.001). There were no significant differences in other outcomes measured.

Conclusion.
Our analysis demonstrated that drain use is associated with significant longer hospital stay.

Level of Evidence: 3
Cauda Equina Syndrome
Authors: Planty-Bonjour Alexia , Kerdiles Gaelle , François Patrick , Destrieux Christophe , Velut Stephane , Zemmoura Ilyess , Cook Ann-Rose , Terrier Louis-Marie , Amelot Aymeric 
Published: July 2021

Study Design.
A prospective patient's database operated on a cauda equina syndrome (CES).

Objective.
The aim of our study was to identify prognosis factors for favorable functional recovery after CES.

Summary of Background Data.
CES is a neurologic impairment of variable symptoms associating urinary, bowel, and sexual dysfunctions with or without motor or sensitive deficits caused by nerve root compression of the cauda equina. The definition of CES remains debated, as well as the prognosis factors for favorable functional recovery and the benefit of early surgery.

Methods.
One hundred forty patients were included between January 2010 and 2019. Univariate and multivariate cox proportional hazard regression models were conducted.

Results.
The patients were young with a median age of 46.8 years (range 18–86 yrs). At presentation, 60% were affected by a motor deficit, 42.8% a sensitive deficit, 70% urinary dysfunctions, and 44% bowel dysfunctions. The mean follow-up was 15.5 months. Bilateral motor deficit (P = 0.017) and an initial deficit severity of 0 to 2 (P = 0.001) represented prognosis factors of poor motor recovery. Initial anal incontinence (P = 0.007) was associated with poor bowel recovery. Only 32.8% of the patients went back to work. Initial motor deficit (P = 0.015), motor sequelae (P = 0.001), sphincter dysfunctions sequelae (P = 0.02), and long LOS (P = 0.02) were poor return-to-work prognosis factors. Time to surgery within an early timing < 24 or 48 hours or later did not represent a prognosis factor of recovery in CES. Incomplete versus complete CES did not show better recovery.

Conclusion.
CES remains a profound disabling syndrome with poor functional prognosis: in the long run, few patients go back to work. The main prognosis factors established in our series regarded the initial severity of deficits whether motor or sphincteral. Early or later surgical cauda equina decompression did not show to represent a prognosis factor for functional recovery.

Level of Evidence: 4
A Simple Versatile Technique to Retrieve Polyaxial Tulip-head Spinal Pedicle Screws Following Failed Pedicle Screw Removal: A Technical Note With Analysis of Efficacy and Outcomes
Authors: Uvaraj Nalli R. , Bosco Aju 
Published: July 2021

Introduction:
With increase in the number of thoracolumbar spine surgeries using pedicle screw instrumentation, there is a proportionate increase in the number of revision surgeries requiring implant removal. Lack of standardization in manufacturing spinal pedicle screws has led to diverse variations in their design and dimensions. Removal of polyaxial pedicle screws becomes extremely difficult when there is a mismatch between their tulip-head and the screwdriver. With the rapidly changing concepts and designs of spinal pedicle screws this problem may arise when the appropriate pedicle screw instrumentation is out of production. There may be a need for special instruments or an array of screwdrivers of various dimensions/designs to overcome this problem. We describe a simple yet versatile technique to remove polyaxial tulip-head pedicle screws using commonly available instruments in the spinal instrumentation set.

Materials and Methods:
Polyaxial screws were removed after converting them into monoblock screws using the appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, and a counter torque wrench.

Results:
Using this technique we have successfully removed 167 screws in 53 revision surgeries [instrumented fusions for lumbar degenerative diseases (n=21), thoracolumbar fractures (n=15), and scoliosis (n=17)]. No failed retrievals or complications like pedicle breach or neurological deficit were observed.

Discussion:
The described technique is simple to execute, effective, quick, and safe. It is versatile and can be used to remove polyaxial pedicle screws of any design in the thoracic and lumbar spine using the commonly available instruments in the routine spinal instrumentation set (appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, a counter torque wrench).
Advances in management of nonendometrioid endometrial carcinoma, with an emphasis on the sentinel lymph node technique
Authors: Eriksson Ane Gerda Z. , Mueller Jennifer J. 
Published: July 2021

Purpose of review
During the last few years there have been important advances in our understanding of endometrial cancer biology, staging, and therapy. In this article, we discuss updates and controversies in the treatment of nonendometrioid endometrial carcinoma (non-EEC), with an emphasis on the role of sentinel lymph node (SLN) biopsy.

Recent findings
Lymph node involvement is an important factor in determining prognosis and guiding adjuvant therapy in endometrial carcinoma. SLN biopsy has emerged as a less morbid alternative to lymphadenectomy in surgical staging, and it has generally gained acceptance in the setting of low-grade endometrial carcinoma; however, its role in the setting of high-grade disease remains a topic of debate. Several prospective studies have demonstrated the accuracy of SLN biopsy in detecting nodal metastasis in high-grade endometrial carcinoma. Retrospective series have compared oncologic outcomes of patients with high-grade disease, surgically staged by SLN biopsy, to those staged with lymphadenectomy, and have reported similar survival outcomes. Prospective data on survival is lacking.

Summary
Currently, there is sufficient data to support the diagnostic accuracy of SLN biopsy in the surgical staging of non-EEC. The retrospective evidence demonstrates similar survival for SLN biopsy versus lymphadenectomy.
Patient-specific preprocedural planning for tricuspid valve repair and replacement procedures
Authors: Vukicevic Marija , Faza Nadeen N. , Little Stephen H. 
Published: July 2021

Purpose of review
Despite the prevalence of tricuspid valve regurgitation disorders, isolated interventions on tricuspid valves were previously infrequent due to high mortality rates and lack of advanced clinical imaging technology. Due to advancements in cardiovascular imaging and interventional technologies tricuspid valve repairs and replacement interventions became increasingly more attainable.

Recent findings
Noninvasive clinical imaging of the tricuspid valve can be challenging, providing anincomplete assessment of unique tricuspid anatomy. 3D printing technology represents an additional tool for more comprehensive preprocedural planning of tricuspid interventions and observation of tricuspid valve geometry. Patient-specific 3D printed replicas of tricuspid valve apparatus are especially useful in highly complicated cases, where physiological tricuspid replicas allow benchtop observation of individual patient's anatomy, device implantation in physiological tricuspid valves and interactions of devices with native tricuspid tissue, frequently leading to optimization or change in operational strategy.

Summary
Comprehensive use of clinical imaging including echocardiography, computed tomography, and cardiac magnetic resonance along with 3D printed modeling is key to successful tricuspid repair and replacements. Patient-specific 3D printed models of tricuspid anatomy can facilitate preprocedural planning, educate patients and clinicians, and improve device design, leading to the overall improvement of patients’ outcomes and care.
The current landscape of lipoprotein(a) in calcific aortic valvular disease
Authors: Hsieh Grace , Rizk Theresa , Berman Adam N. , Biery David W. , Blankstein Ron 
Published: July 2021

Purpose of review
Calcific aortic stenosis (CAVS) is the most common form of valvular heart disease in developed countries, increasing in prevalence with the aging population. Surgical or transcatheter aortic valve replacement is the only treatment available for CAVS. However, these interventions are typically reserved for severe symptomatic aortic stenosis (AS). The purpose of this review is to summarize the recent literature in uncovering the underlying pathophysiology of CAVS in the setting of lipoprotein (a) [Lp(a)] and emerging therapies targeting Lp(a) which may help halt disease progression in CAVS.

Recent findings
Pathophysiologic, epidemiological, and genetic studies over the past two decades have provided strong evidence that Lp(a) is an important mediator of calcific aortic valvular disease (CAVD). Studies suggest that Lp(a) is a key carrier of pro-calcifying oxidized phospholipids (OxPL). The metabolism of OxPL results in a pro-inflammatory state and subsequent valvular thickening and mineralization through pro-osteogenic signaling. The identification of Lp(a) as a causal mediator of CAVD has allowed for opportunities for emerging therapeutic agents which may slow the progression of CAVD (Fig. 1

JOURNAL/cocar/04.03/00001573-202109000-00007/figure1/v/2023-09-11T232128Z/r/image-jpeg

).

Summary
This review summarizes the current knowledge on the association of Lp(a) with CAVD and ongoing studies of potential Lp(a)-lowering therapies. Based on the rate-limiting and causal role of Lp(a) in progression of CAVS, these therapies may represent novel pharmacotherapies in AS and inform the developing role of Lp(a) in the clinical management of CAVD.
Accuracy of a new instrument for noninvasive evaluation of pulse wave velocity: the Arterial sTiffness faitHful tOol aSsessment project
Authors: Leone Dario , Buraioli Irene , Mingrone Giulia , Lena Davide , Sanginario Alessandro , Vallelonga Fabrizio , Tosello Francesco , Avenatti Eleonora , Cesareo Marco , Astarita Anna , Airale Lorenzo , Sabia Luca , Veglio Franco , Demarchi Danilo , Milan Alberto 
Published: July 2021

Background:
Large artery stiffness, assessed by carotid--femoral pulse wave velocity (cfPWV), is a major risk factor for cardiovascular events, commonly used for risk stratification. Currently, the reference device for noninvasive cfPWV is SphygmoCor but its cost and technically challenging use limit its diffusion in clinical practice.

Aim:
To validate a new device for noninvasive assessment of cfPWV, ATHOS (Arterial sTiffness faitHful tOol aSsessment), designed in collaboration with the Politecnico di Torino, against the reference noninvasive method represented by SphygmoCor.

Methods:
Ninety healthy volunteers were recruited. In each volunteer, we assessed cfPWV, using SphygmoCor (PWVSphygmoCor) and ATHOS (PWVATHOS) devices in an alternate fashion, following the ARTERY Society guidelines. The accuracy was assessed by Bland--Altman plot, and reproducibility was assessed by interoperator correlation coefficient (ICC).

Results:
Mean PWVATHOS and mean PWVSphygmoCor were 7.88 ± 1.96 and 7.72 ± 1.95 m/s, respectively. Mean difference between devices was 0.15 ± 0.56 m/s, with a high correlation between measurements (r = 0.959, P < 0.001). Considering only PWV values at least 8 m/s (n = 30), mean difference was 0.1 ± 0.63 m/s. The ICC was 97.7% with ATHOS

Conclusion:
ATHOS showed an excellent level of agreement with SphygmoCor, even at high PWV values, with a good reproducibility. Its simplicity of use could help increase clinical application of PWV assessment, improving patients’ cardiovascular risk stratification.
Football beats hypertension: results of the 3F (Fit&Fun with Football) study
Authors: Schrader Bastian , Schrader Joachim , Vaske Bernhard , Elsässer Albrecht , Haller Hermann , del Vecchio Alessandro , Koziolek Michael , Gehlenborg Eugen , Lüders Stephan 
Published: July 2021

Objective(s):
Football as the most popular sport could improve insufficient physical activity in patients with cardiovascular risk factors. A modified ‘healthy’ football training format could motivate hypertensive patients to return to sport and improve risk factors.

Methods:
The 3F study: ‘Fit and Fun with Football’ a prospective interventional study with 1 year follow-up. Football group: n = 103, structured ‘health’-football training (1×/week, 90 min) led by Deutscher Fußball Bund-licensed football coaches. Hypertensive patients at least 45 years who have not exercised for several years were compared with a control group (n = 105).

Primary study objective:
Reduction of office (OBP) and/or 24-h ambulatory blood pressure (BP) monitoring (ABPM) and/or reduction of number or dosage of antihypertensive medication.

Main results:
OBP values decreased significantly in the football group from 142.6/87.9 to 130.8/81.8 mmHg (P < 0.001), in the control group the values increased slightly (NS). ABPM values decreased significantly in the football group, while a slight increase was found in the control group. At the end of the study, the mean values in the football group of both OPB (P < 0.001) and ABPM (systolic P < 0.001, diastolic P = 0.017) were significantly lower than in the control group. Significantly more people in the football group were able to reduce antihypertensive patients than in the control group (football group:16, control group:6), while more participants in the control group intensified antihypertensive therapy (football group:3, control group:14) (P < 0.001). Among the secondary endpoints, there was a weight loss of 3 kg in the football group and an increase of 1.7 kg in the control group (P < 0.001).

Conclusion:
Offering modified ‘healthy’ football-training to middle-aged hypertensive patients can lead to better BP control and a reduction of antihypertensive medication. Therefore, the offer of ‘health football’ should be established and supported by clubs, insurances and authorities.
Relation Between Body Mass Index and Dry Eye Disease: The Japan Public Health Center–Based Prospective Study for the Next Generation
Authors: Yamanishi Ryutaro , Sawada Norie , Hanyuda Akiko , Uchino Miki , Kawashima Motoko , Yuki Kenya , Tsubota Kazuo , Kato Tadahiro , Saito Isao , Arima Kazuhiko , Mizukami Satoshi , Tanno Kozo , Sakata Kiyomi , Yamagishi Kazumasa , Iso Hiroyasu , Yasuda Nobufumi , Shimazu Taichi , Yamaji Taiki , Goto Atsushi , Inoue Manami , Iwasaki Motoki , Tsugane Shoichiro ,   for the JPHC-NEXT Group
Published: July 2021

Objective:
To investigate the relation between body mass index (BMI) and dry eye disease (DED).

Methods:
We conducted a cross-sectional questionnaire-based survey in 85,264 Japanese men and women aged 40 to 74 years who participated in the Japan Public Health Center–based Prospective Study for the Next Generation (JPHC-NEXT Study). Dry eye disease was defined as the presence of severe symptoms or clinical diagnosis. A multivariable logistic regression model was used to estimate the odds ratios (ORs) of DED associated with BMI and their two-sided 95% confidence intervals (CIs). We adjusted for age, cohort area, visual display terminal time, smoking status, alcohol intake, education status, income status, as well as history of hormone replacement therapy for women.

Results:
Prevalence of DED was 23.4% (n = 19,985; 6,289 men, 13,696 women). Higher BMI was correlated with a lower prevalence of DED in a dose–response fashion, with an adjusted OR of DED (95% CI) per 1 kg/m2 increment of BMI of 0.98 (95% CI: 0.97–0.99) for men and 0.97 (95% CI: 0.97–0.98) for women.

Conclusions:
This large population-based study showed an inverse relationship between BMI and prevalence of DED in a Japanese population. Underestimation of DED is warned, especially for participants with high BMI.