bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inpatient Pain Scores and Narcotic Utilization Based on American Society of Anesthesiologists Score Following Anterior Cervical Discectomy and Fusion
Authors: Yoo Joon S. , Brundage Thomas S. , Hrynewycz Nadia M. , Singh Kern 
Published: July 2019

Study Design.
Retrospective.

Objective.
To examine the relationship between American Society of Anesthesiologists (ASA) score and inpatient pain and narcotics consumption following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
Higher ASA scores have been previously linked to increased postoperative complication rates, healthcare costs, length of stay, and hospital readmissions. However, to our knowledge, there have not been previous investigations into the association between ASA scores and postoperative inpatient pain and narcotics utilization following ACDF.

Methods.
Patients who underwent a single-level, primary ACDF were retrospectively reviewed and stratified into two cohorts based on ASA score less than or equal to 2 or ASA score more than 2. ASA score was tested for association with demographic variables and perioperative characteristics using student's t test, chi-squared analysis, and Fisher exact test. Inpatient pain scores and narcotics consumption on each postoperative day were then compared between cohorts using bivariate linear regression.

Results.
Two hundred eleven patients who underwent ACDF were included: 184 had an ASA score less than or equal to 2 and 27 had an ASA score more than 2. Higher ASA score was associated with older age, higher comorbidity burden as measured by the modified Charlson Comorbidity Index (CCI), and lower prevalence of obesity. Higher ASA scores were associated with longer duration of hospital stay, while other perioperative characteristics were similar between ASA score cohorts. There were no differences in inpatient Visual Analog Scale (VAS) pain scores, or hourly, daily, and cumulative inpatient narcotic consumption between cohorts on any postoperative day.

Conclusion.
This retrospective investigation demonstrated that a higher ASA score is associated with increased operative time following ACDF. However, ASA score was determined not to be an independent risk factor that can predict postoperative pain or narcotics consumption among patients who undergo ACDF. Therefore, postoperative pain in the inpatient setting can be managed with similar modalities regardless of ASA score for patients undergoing ACDF.

Level of Evidence: 3
Efficacy and Safety of Atlantoaxial Fluoroscopy-guided Pedicle Screw Fixation in Patients Younger Than 12 Years
Authors: Zhang Yue-Hui , Zhou Fu-Chao , Zhang Jing , Song Jia , Shao Jiang 
Published: July 2019

Study Design.
A retrospective clinical study.

Objective.
The aim of this study was to evaluate the efficacy and safety of fluoroscopy-guided atlantoaxial pedicle screw fixation in patients younger than 12 years.

Summary of Background Data.
C1–C2 pedicle screw fixation is a widely accepted treatment method for atlantoaxial dislocation (AAD). However, data regarding its use for atlantoaxial fusion (AAF) in children are limited.

Methods.
Thirty-six consecutive patients younger than 12 years underwent C1–C2 pedicle screw fixation for AAD between 2007 and 2017. Anatomical parameters of the C1 pedicle were measured on preoperative computed tomography (CT). Accuracy of pedicle screw fixation was assessed on postoperative CT using the following definitions: Type I, screw threads completely within the bone; Type II, less than half the diameter of the screw violating the surrounding cortex; and Type III, clear violation of the transverse foramen or spinal canal. Demographic, surgical, radiation dose, and clinical data were recorded.

Results.
Patients underwent 144 screw fixations (67 C1 pedicle screws, 68 C2 pedicle screws, 5 C1 lateral mass screws, and 4 C-2 laminar screws) for a variety of pediatric AADs, with 36.5 ± 8.5 months of follow-up. Among the 135 pedicle screws, 96.3% were deemed “safe” (Type I or II) and 80.7% (109/135) of the screws were rated as being ideal (Type I); five screws (3.7%) were identified as unacceptable (Type III). Average estimated blood loss (EBL) was 92 mL, and the average total radiation exposure during the operation was 6.2 mGy (in the final 26 cases). There were no neurovascular injuries. All patients showed radiographic stability and symptom resolution.

Conclusion.
C1–C2 pedicle screw fixation under fluoroscopy is safe and effective for the treatment of AAD in children younger than 12 years. However, it may be technically challenging owing to the special anatomical features of children and should be performed by experienced surgeons.

Level of Evidence: 3
Use of Cell Cycle Arrest Biomarkers in Conjunction With Classical Markers of Acute Kidney Injury
Authors: Joannidis Michael , Forni Lui G. , Haase Michael , Koyner Jay , Shi Jing , Kashani Kianoush , Chawla Lakhmir S. , Kellum John A. 
Published: July 2019

Objectives:
Decreased urine output and/or increased serum creatinine may herald the development of acute kidney injury or reflect normal physiology. In this secondary analysis of the Sapphire study, we examined biomarkers of cell cycle arrest in the settings of oliguria and/or azotemia to improve risk assessment when used with conventional indices in predicting severe acute kidney injury (Kidney Disease: Improving Global Outcomes 3 defined by the need for renal replacement therapy or changes in urine output, serum creatinine or both) or death.

Design:
Prospective, international, Sapphire study.

Setting:
Academic Medical Center.

Patients:
Patients without acute kidney injury Kidney Disease: Improving Global Outcomes stage 2 or 3.

Interventions:
None.

Measurements and Main Results:
The primary endpoint being development of severe acute kidney injury or death within 1 week. Secondary analysis examined the relationship between tissue inhibitor of metalloproteinases-2 ([TIMP-2]) and insulin growth factor binding protein 7 ([IGFBP7]) and 9-month death or dialysis conditioned on progression to stage 2–3 acute kidney injury within 1 week. Seventy-nine patients reached the primary endpoint and were more likely to be surgical, with higher nonrenal Acute Physiology and Chronic Health Evaluation III scores and more chronic kidney disease. Stage 1 urine output, serum creatinine, and urinary [TIMP-2]•[IGFBP7] greater than 2.0 were all predictive of progression to the primary endpoint independent from nonrenal Acute Physiology and Chronic Health Evaluation III score. Combinations of predictors increased the hazard ratios considerably (from 2.17 to 4.14 to 10.05, respectively). In the presence of acute kidney injury (stage 1), [TIMP-2]•[IGFBP7] greater than 2.0 leads to an increased risk of death or dialysis at 9 months even in the absence of progression of acute kidney injury (stage 2–3) within 7 days.

Conclusions:
Cell cycle arrest biomarkers, TIMP-2 and IGFBP7, improve risk stratification for severe outcomes in patients with stage 1 acute kidney injury by urine output, serum creatinine or both, with risk increasing with each acute kidney injury indicator. Longer term outcomes demonstrate that the associated risks of a [TIMP-2]•[IGFBP7] greater than 2.0 is equivalent to acute kidney injury progression even where no progression from stage 1 acute kidney injury is observed.
Efficacy and Safety of 3 New Resilient Hyaluronic Acid Fillers, Crosslinked With Decreased BDDE, for the Treatment of Dynamic Wrinkles: Results of an 18-Month, Randomized Controlled Trial Versus Already Available Comparators
Authors: Rzany Berthold , Converset-Viethel Sophie , Hartmann Melanie , Larrouy Jean-Claude , Ribé Natalia , Sito Giuseppe , Noize-Pin Carole 
Published: July 2019

BACKGROUND
Three new hyaluronic acid (HA)-based fillers made of long chains crosslinked with reduced amounts of 1,4-butanediol diglycidyl ether (BDDE) were developed for the treatment of dynamic facial areas. Their resilience and increased stretching ability were optimized to ease injectors' practice and provide patients with most natural aesthetic results.

OBJECTIVE
This study aimed at evaluating the efficacy, durability, and safety of these resilient HA fillers versus commercially available comparator gels.

METHODS
A prospective, monocentric, split-face, double-blinded, randomized, controlled trial was performed on 90 subjects presenting moderate to severe bilateral nasolabial folds (NLFs). Efficacy parameters were assessed over 18 months, including improvement on the Wrinkle Severity Rating Scale and Global Aesthetic Improvement Scale, as well as quantitative imaging and analysis of NLF correction. Physicians' and subjects' satisfaction, together with safety, were assessed throughout the study.

RESULTS
The new HA fillers offered efficacy and safety profiles at least equivalent to comparators. These dynamic facial fillers elicited higher satisfaction immediately after injection but also on the long run, according to both investigators and subjects.

CONCLUSION
This pilot trial demonstrated the numerous benefits of 3 new resilient HA fillers with decreased BDDE crosslinking in the treatment of dynamic wrinkles.
Exercise Training in Adults With Congenital Heart Disease
Authors: Li Xin , Chen Nan , Zhou Xuan , Yang Yuqi , Chen Sun , Song Yuanyuan , Sun Kun , Du Qing 
Published: July 2019

Background:
Evidence from many studies demonstrates that regular exercise has a favorable effect on cardiovascular disease, but it is still unclear whether adults with congenital heart disease (ACHD) benefit from exercise training. The aim of this study was to assess the effects of exercise training on ACHD.

Methods:
PubMed, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched. Differences were expressed using mean difference (MD) with 95% CI. The statistical analysis was performed using Review Manager (RevMan 5.3). Outcomes, including cardiorespiratory fitness, neurohumoral activation (NT-proBNP levels), rating of perceived exertion (Borg scale), and safety status, were investigated.

Results:
Nine trials with 403 ACHD were included. The following outcomes were statistically significant: peak

JOURNAL/jcprh/04.03/01273116-201909000-00004/4FSM1/v/2023-09-11T074719Z/r/image-gif

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2 (MD = 1.96, 95% CI, 0.70-3.23; P = .002); maximal workload (MD = 11.46, 95% CI, 7.06-15.87; P < .00001); and maximal exercise duration (MD = 2.04, 95% CI, 1.00-3.07; P = .0001). But no significant decrease was reported regarding neurohumoral activation or the rating of perceived exertion. Furthermore, no major adverse events were reported. The overall quality of evidence ranged from moderate to very low.

Conclusions:
Evidence was underpowered to suggest that exercise training is effective in the management of ACHD. Future studies with longer follow-up are needed.
Effects of Different Rehabilitation Protocols in Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery
Authors: Zanini Maurice , Nery Rosane Maria , de Lima Juliana Beust , Buhler Raquel Petry , da Silveira Anderson Donelli , Stein Ricardo 
Published: July 2019

Purpose:
Patients undergoing coronary artery bypass graft (CABG) surgery typically experience loss of cardiopulmonary capacity in the post-operative period. The purpose of this study was to evaluate the effects of different rehabilitation protocols used in inpatient cardiac rehabilitation on functional capacity and pulmonary function in patient status post-CABG surgery.

Methods:
This was a single-blind randomized controlled trial. The primary endpoint of functional capacity and secondary endpoints of lung capacity and respiratory muscle function were assessed in patients scheduled to undergo CABG. After surgery, 40 patients were randomly assigned across 1 of 4 inpatient cardiac rehabilitation groups: G1, inspiratory muscle training, active upper limb and lower limb exercise training, and early ambulation; G2, same protocol as G1 without inspiratory muscle training; G3, inspiratory muscle training alone; and G4, control. All groups received chest physical therapy and expiratory positive airway pressure. Patients were reassessed on post-operative day 6 and post-discharge day 30 (including cardiopulmonary exercise testing).

Results:
The 6-min walk distance on post-operative day 6 was significantly higher in groups that included exercise training (G1 and G2), remaining higher at 30 d post-discharge (P < .001 between groups). Peak oxygen uptake on day 30 was also higher in G1 and G2 (P = .005). All groups achieved similar recovery of lung function.

Conclusion:
Protocols G1 and G2, which included a systematic plan for early ambulation and upper and lower limb exercise, attenuated fitness losses while in the hospital and significantly enhanced recovery 1 mo after CABG.
Wearable Cardioverter Defibrillator–Guided 6-Min Walk Test Performed at Home Is Accurate and Reliable
Authors: Burch Ashley E. , Scherr Daniel , Rieth Andreas , Griffin John , Bianco Nicole R. , Odeneg Tanja , Sears Samuel F. 
Published: July 2019

Purpose:
The 6-min walk test (6MWT) is broadly used to evaluate the functional ability of patients with heart failure (HF). The purpose of this study was to evaluate the accuracy and reliability of the wearable cardioverter defibrillator (WCD)–guided 6MWT performed at home by patients with HF versus in-clinic testing.

Methods:
Patients (n = 197) with HF and a low ejection fraction prescribed a WCD were randomized to 2 groups. Group 1 completed an in-clinic clinician-guided 6MWT while wearing the WCD; results were recorded by the clinician. Group 2 completed a WCD-guided 6MWT, also performed in the clinic; results were recorded by the WCD accelerometer. Both groups performed weekly unsupervised WCD-guided 6MWTs at home, with results recorded by the WCD.

Results:
The initial in-clinic 6MWT showed no significant group difference in distance walked (group 1 = 306 m; group 2 = 297 m). For patients in group 2 who completed at least one 6MWT at home, there was a 15-step decrease between the in-clinic WCD-guided 6MWT and the first at-home 6MWT, 558 and 543 median steps (P = .001), respectively. Among patients with at least 8 weekly home WCD-guided 6MWTs (n = 70), there was no significant difference in the number of steps walked during the 6MWT from week to week.

Conclusions:
Results of the in-clinic 6MWT are similar between clinician-guided and WCD-guided patients across objective distances. Distances walked with a WCD-guided walk test were consistent whether conducted in the clinic or at home and were reliable over time.
PERSISTENT PLACOID MACULOPATHY-LIKE FINDINGS IN PATIENTS WITH GIANT CELL ARTERITIS
Authors: Starr Matthew R. , Fairbanks Aaron M. , Geraets Ryan , Chen John , Pulido Jose S. 
Published: July 2019

Purpose:
To describe two patients with giant cell arteritis who presented with macular lesions mimicking persistent placoid maculopathy.

Methods:
Retrospective case reports.

Patient:
Two patients, a 74-year-old man and an 85-year-old woman both were diagnosed with biopsy-confirmed giant cell arteritis with vision loss in one eye due to arteritic ischemic optic neuropathy. Both presented many years later with acute vision loss in the remaining eye.

Results:
Both patients had bilateral retinal whitening in the parafovea, and the second also had sectoral optic disk swelling. On fluorescein angiography, these areas of retinal whitening in both patients were hypofluorescent early with late hyperfluorescence staining. On indocyanine green angiography, there were areas of foveal hypocyanescence bilaterally in both patients that persisted throughout the imaging and were more apparent late. These findings can be seen in patients with bilateral persistent placoid maculopathy.

Conclusion:
Giant cell arteritis should be included in the differential diagnosis of persistent placoid maculopathy.
Unusual Case of Concurrent Retroperitoneal Congenital Infantile Fibrosarcoma and Cellular Type Congenital Mesoblastic Nephroma
Authors: Monsereenusorn Chalinee , Supakul Nucharin , Satayasoontorn Kantang , Traivaree Chanchai , Rujkijyanont Piya 
Published: July 2019

Background:
Although congenital infantile fibrosarcoma (cIFS) is a rare soft tissue sarcoma among children, it constitutes one of the most common soft tissue sarcomas during the first year of life. Congenital mesoblastic nephroma (CMN) is the most common benign renal tumor usually developing during the first 3 months of life. cIFS and cellular type CMN (cCMN) share not only similar histopathologic features but identical molecular genetic abnormality including the ETV6/NTRK3 fusion gene. Here, we report an unusual case of cIFS occurring with cCMN.

Case Presentation:
An 18-month-old girl presented with a 1-month history of abdominal distension and a few days’ history of a palpable abdominal mass. A large heterogenous mass sized 9.0×11.2×11.6 cm on the right side of the abdomen and an isolated heterogenous lesion sized 4×4.5 cm within the right kidney were noted from the imaging study. Pathologic findings were consistent with cIFS and cCMN of the right kidney. In addition, both pathologic specimens contained the ETV6/NTRK3 fusion gene.

Conclusion:
Although cIFS and cCMN share similar histopathologic features and molecular genetic abnormality, simultaneous occurrence of these 2 types of tumor is exceedingly rare. To our knowledge, this is the first unusual case report of concurrent cIFS and cCMN.
Another Step Toward Clarifying the Benefits and Burdens of Selective Serotonin Reuptake Inhibitors
Authors: Wulsin Lawson R. 
Published: July 2019

ABSTRACT
Selective serotonin reuptake inhibitors (SSRIs) have substantial beneficial effects for the treatment of major depressive mood disorders and other conditions but can also result in unwanted clinical outcomes. One of the reported disadvantages of SSRIs, based on cross-sectional studies, is their adverse effects on glycemic control. However, in this issue of Psychosomatic Medicine, Tharmaraja et al. report a meta-analysis of 16 randomized controlled trials, demonstrating beneficial effects of SSRIs on changes in glycemia. In this editorial, the advantages of meta-analysis in biobehavioral medicine are highlighted as well as the importance of the study designs (observational studies versus randomized controlled trials) on which the meta-analyses are based. This article concludes with an outline for future research directions in the area of SSRIs and glycemic control.
Normal Lacrimal Gland Volumes by Magnetic Resonance Imaging and the Relationship of Lacrimal Gland Volume to Orbital Size
Authors: Tenzel Phillip A. , Moffa Diana , Decilveo Alexander P. , Reddy Harsha S. 
Published: July 2019

Purpose:
The aim of this study was to measure volumes of normal lacrimal glands (LGs) using magnetic resonance imaging in African-Americans (AAs) and whites and to evaluate relationships of LG volumes to demographic factors.

Methods:
A retrospective chart review was performed searching for “optic neuropathy” and “optic neuritis,” cross-referencing patients who had orbital MRI with and without contrast. Cases were excluded with known history of orbital trauma or surgery, previous diagnoses known to affect LG size, and poor image quality. LGs were outlined in consecutive axial and coronal slices, and volumes were generated using OsiriX software; cross-sectional area of the orbit was measured by outlining the bony orbit in largest axial section.

Results:
One hundred orbits from 50 patients were included (26 AAs, 24 whites). Mean LG volumes as measured in coronal and axial section were 0.714 and 0.671 cm3, respectively; mean orbital area was 10.42 cm2. Axial orbital size was found to be highly correlated (P < 0.01) with LG volume. No significant correlation was found with LG volume and age, sex, race, or laterality.

Conclusions:
This article presents normal values for LG volumes by MRI of AAs and whites. LG volumes were highly correlated with orbital size, a relationship which has not been explored in the recent literature.1–4 Such an assessment of LG size relative to patients’ orbital dimensions may be more clinically useful than comparison to population-based measures of normal LG volume alone. We found no statistically significant relationship between LG volume and race, sex, age, or laterality.
Incidence of Pneumothorax Experienced After Orthognathic Surgery
Authors: Liu Kai , Zhang Tianjia , Wang Shuze , Zhang Lei , Wang Xudong 
Published: July 2019

Abstract
The purpose of this study is to evaluate the frequency of pneumothorax following orthognathic surgery and describe its clinical presentation. A retrospective analysis of a hospital database was carried out on consecutive patients with normal presurgical clinical assessment, laboratory findings, and chest X-ray who underwent orthognathic surgery from January 2007 to September 2018 in the Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Two patients (0.038%), 1 male (age 20 years) and 1 female (age 32 years), complained of respiratory difficulty and chest pain and were clearly diagnosed with postoperative pneumothorax by radiographic chest X-rays from a sample of 5229 consecutive patients during the study period. Intercostal drainage under local anesthesia was performed immediately and the treatment effects for both patients were satisfactory. The present study findings indicate that although orthognathic surgeries can be safely performed in patients with craniofacial anomalies, some unexpected complications such as pneumothorax may occur. Therefore, accurate postoperative follow-up must be done in every patient to monitor possible clinical complications. Patients who experience respiratory difficulty and postoperative chest pain may have pneumothorax, and once it is diagnosed, treatment should be promptly carried out to eliminate further severe sequelae.
Use of Stock Titanium Mesh Plates in Cranioplasty
Authors: Madaree Anil , Moyeni Nondabula , Le Roux Petrus Andries Jacobus , Pillay Trishan 
Published: July 2019

Abstract
Craniofacial surgeons are often confronted with major defects of the calvarium. These most commonly are post-traumatic but could also be consequent upon neurosurgical procedures, infection, or tumor removal. There are several options available to reconstruct these defects including autogenous, heterogeneous, and alloplastic material. The goal is to have a method that is easy, cost-effective, with minimal complications, and long-lasting. In our unit we review 100 cases of the use of stock titanium mesh during a 5-year period. Complications occurred in 5 patients (5%) with 3 exposures, 1 late seroma and 1 case requiring repositioning of the plate following trauma. None of the patients required removal of the plate.