bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Routine Postoperative Computer Tomography Scans Warranted for All Patients After Operative Fixation of Pelvic Ring Injuries?
Authors: Cronin Kevin J. , Hockensmith Lindsay , Hayes Christopher B. , Zuelzer David , Jacobs Cale A. , Moghadamian Eric S. 
Published: June 2019

Objective:
To evaluate the efficacy of routine postoperative computed topography (CT) scan after percutaneous fixation of unstable pelvic ring injuries.

Design:
Retrospective chart review.

Setting:
Level I Trauma Center.

Patients/Participants:
A total of 362 consecutive patients underwent operative fixation of unstable pelvic ring injuries during the study period.

Intervention:
Postoperative CT scan of the pelvis was obtained in 331 (91%) of the 362 patients treated operatively for unstable pelvic ring injuries.

Main Outcome Measurements:
Revision surgery based on routine postoperative CT scan.

Results:
Two patients (0.55%) returned to the operating room on the basis of postoperative CT scans due to malpositioned implants. There were no significant differences of age, sex, body mass index, Injury Severity Score, mechanism of injury, smoking status, or diabetes status between those who did and did not undergo revision surgery. A dysmorphic pelvis was identified in 154 (47%) patients. Both patients undergoing revision surgery were determined to have a dysmorphic pelvis while no patients with normal pelvic anatomy returned to the operating room based on postoperative CT (2/154, 1.3% vs. 0/177, 0%, P = 0.22).

Conclusions:
Although there remains a role for postoperative CT scans in the appropriately selected patient, in the hands of experienced orthopaedic traumatologists, patients with adequate intraoperative fluoroscopy and a nondysmorphic pelvis may not require routine postoperative three-dimensional imaging.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Natural History of Early-onset Scoliosis
Authors: Karol Lori A. 
Published: June 2019

Background:
Early-onset scoliosis (EOS) is defined as the diagnosis of a spinal deformity before the age of 5 years. It can be divided into idiopathic, neuromuscular/syndromic, and congenital etiologies.

Methods:
The literature on the natural history of EOS was summarized.

Results:
The natural history varies with the etiology of EOS. Idiopathic curves may benefit from early serial casting. The natural history of neuromuscular and syndromic scoliosis is highly dependent on the natural history of the underlying disorder. Congenital scoliosis has a variable prognosis depending on the location and extent of the congenital malformations.

Conclusions:
Treatment of children with EOS is customized to the particular disorder. While lack of treatment has been shown to lead to increased mortality, extensive early definitive fusion may lead to thoracic insufficiency. Delaying definitive surgery and the use of growing instrumentation may provide benefit in maintaining pulmonary health.

Clinical Relevance:
Potential disturbance of growth must be considered in the treatment of young children with scoliosis.
How Good is the Evidence Linking Acetabular Dysplasia to Osteoarthritis?
Authors: Cooperman Daniel R. 
Published: June 2019

Background:
A common claim in the orthopaedic literature is that acetabular dysplasia (AD) exists when the center-edge angle of Wiberg (CE angle) is <20 degrees and that AD leads to osteoarthritis (OA). Our purpose is to evaluate the validity of the linkage between AD and OA.

Methods:
We assess and discuss the theories and the empirical evidence relating AD to OA. Moreover, we test the rule that hips with a CE angle <20 degrees will develop OA by 65 years of age, by looking for exceptions to this rule.

Results:
Wiberg and Cooperman and colleagues present 30 ideal patients for assessing the relationship between AD and OA. Each was arthritis free, with stable AD, CE angle <20 degrees, without signs of subluxation. They were all followed and all developed OA. In the studies by Stulberg and colleagues, and Jacobsen and colleagues, every patient presented with OA, making it difficult to be certain about the appearance of the hip before the onset of OA. In the study by Murphy and colleagues, we have the same problem, as an unknown number of patients already had OA at first assessment. All of these studies used different schemes for diagnosing OA, making the studies difficult to compare. Most of the patients in the studies were of Northern European ancestry, making the results difficult to generalize to other populations. Four patients had CE angles <20 degrees and did not develop severe arthritis by 65 years of age.

Conclusions:
Our conclusions apply directly to patients of Northern European ancestry. A few patients with stable, mild AD (CE angle 15 to 19 degrees) will be arthritis free at 65 years of age. Almost all patients with stable AD develop OA by 65 years of age. Unstable AD (CE angle <20 degrees, with subluxation) always leads to OA by 65 years of age. It is probably reasonable to extend these conclusions to other populations, but the reader must be prepared to re-evaluate them, as more data accumulates.
Utility of Patient-reported Symptoms and Health Conditions for Predicting Surgical Candidacy and Utilization of Surgery via an Outpatient Spine Clinic Nomogram
Authors: Pennington Zach , Lubelski Daniel , Tanenbaum Joseph , Ahmed A. Karim , Rosato Marissa , Passias Peter , Sciubba Daniel M. 
Published: June 2019

Study Design:
Retrospective cohort.

Objective:
Identify the nonradiographic predictors of a patient’s decision to undergo elective spine surgery.

Summary of Background Data:
Up to 132 million people seek elective evaluation by spine surgeons annually, though 55%–82% of specialty referrals may be inappropriate. We sought to determine which clinical and psychosocial factors are associated with surgical utilization by patients seeking surgical evaluation for degenerative spine pathologies.

Materials and Methods:
Consecutive elective outpatient visits seen in a single clinic between May 2016 and April 2017 for degenerative spine pathologies were reviewed. Data were collected on presenting symptoms, baseline medical illness, demographics, and previous spine care. Multivariable logistic regressions were performed to determine which factors were associated with surgical candidacy and surgical utilization.

Results:
A total of 353 patients were seen during the period reviewed, of which 144 had complete medical records. Our cohort included 90 nonsurgical candidates, 25 surgical candidates who declined surgery, and 29 patients who underwent surgery. In multivariable analysis, factors negatively associated with surgical candidacy were age, a history of smoking, and osteoporosis, where those positively associated with surgical candidacy were reports of spine-specific pain, higher Charlson Comorbidity Index, pain medication use, number of neurological symptoms, and being myelopathic. Factors positively associated with surgical utilization included proportion of all complaints that were neurological in nature, being myelopathic, higher Charlson Comorbidity Index, and report of pain as chronic, whereas being osteoporotic was negatively associated with surgical use. A receiver operating curve constructed for these models produced c-statistics of 0.75 and 0.80, respectively.

Conclusions:
Our results suggest that the results of standard clinic intake questions, such as review of systems, medical history, and chief complaints, may be predictive of surgical candidacy before evaluation by a surgeon. The present pilot study suggests a preliminary algorithm that can be further validated and expanded upon to help decide on optimal patient referrals to spine surgery specialists.
Interprofessional Shared Decision-Making in the ICU: A Systematic Review and Recommendations From an Expert Panel*
Authors: Michalsen Andrej , Long Ann C. , DeKeyser Ganz Freda , White Douglas B. , Jensen Hanne I. , Metaxa Victoria , Hartog Christiane S. , Latour Jos M. , Truog Robert D. , Kesecioglu Jozef , Mahn Anna R. , Curtis J. Randall 
Published: June 2019

Objectives:
There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision-making. The aim of this project is to use systematic review and normative analysis by experts to examine existing evidence regarding interprofessional shared decision-making, describe its principles and provide ICU clinicians with recommendations regarding its implementation.

Data Sources:
We conducted a systematic review using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases and used normative analyses to formulate recommendations regarding interprofessional shared decision-making.

Study Selection:
Three authors screened titles and abstracts in duplicate.

Data Synthesis:
Four papers assessing the effect of interprofessional shared decision-making on quality of care were identified, suggesting that interprofessional shared decision-making is associated with improved processes and outcomes. Five recommendations, largely based on expert opinion, were developed: 1) interprofessional shared decision-making is a collaborative process among clinicians that allows for shared decisions regarding important treatment questions; 2) clinicians should consider engaging in interprofessional shared decision-making to promote the most appropriate and balanced decisions; 3) clinicians and hospitals should implement strategies to foster an ICU climate oriented toward interprofessional shared decision-making; 4) clinicians implementing interprofessional shared decision-making should consider incorporating a structured approach; and 5) further studies are needed to evaluate and improve the quality of interprofessional shared decision-making in ICUs.

Conclusions:
Clinicians should consider an interprofessional shared decision-making model that allows for the exchange of information, deliberation, and joint attainment of important treatment decisions.
Complex Reconstruction of a Pelvic Marjolin’s Ulcer Arising from Hidradenitis Suppurativa
Authors: Buchanan Lauren E. , Campbell Chris A. 
Published: June 2019

Summary:
The chronic inflammation of hidradenitis suppurativa can cause painful nodules, draining abscesses, sinus tracts, and fibrous scars. This long-term cutaneous inflammation in rare circumstances can lead to malignant transformation producing an aggressive cutaneous malignancy referred to as a Marjolin’s ulcer. Particularly when a Marjolin’s ulcer involves the sacral region, resection and reconstruction can be challenging. We present the case of a patient with a recurrent Marjolin’s ulcer originating from a hidradenitis wound bed overlying and involving the sacrum. Previous radiation, large defect size, and sacral and perianal involvement necessitated the use of a multiflap approach. An extended transpelvic vertical rectus abdominis myocutaneous flap, bilateral gluteal advancement flaps, and a delayed transverse back flap were used to reconstruct the defect after abdominoperineal resection and nerve-sparing partial sacrectomy. Flap choice was derived by dividing the defect into anatomic subunits and considering intrapelvic defect volume, creating a systematic approach that led to successful reconstruction and functional restoration.
Culturing Discarded Peripheral Human Corneal Endothelial Cells From the Tissues Deemed for Preloaded DMEK Transplants
Authors: Parekh Mohit , Romano Vito , Ruzza Alessandro , Kaye Stephen B. , Ponzin Diego , Ahmad Sajjad , Ferrari Stefano 
Published: June 2019

Purpose:
To investigate if the peripheral corneal endothelium that is discarded after the preparation of preloaded Descemet membrane endothelial keratoplasty (DMEK) grafts for transplantation could be successfully used for corneal endothelial cell culture.

Methods:
Complete Descemet membrane–endothelial complex (11.00 mm) was peeled from research-grade tissues (n = 15). The periphery (2.75 mm) of clinical-grade tissues (n = 15) deemed for preloaded DMEK transplants was gently peeled and preserved for 48 hours in tissue culture media, followed by centrifugation at 1000 rpm for 5 minutes. After enzymatic digestion, the cells from each group were plated in 2 different wells of an 8-well chamber slide. Media were refreshed and the confluence rate was monitored every alternate day. Live/dead staining and the expression of ZO-1, Tag1A3, Tag2A12, and Ki-67 markers were used to assess the viability, morphology, tight-junctions, cell area, and number of proliferative cells. The Wilcoxon and Student's t test were applied, where P < 0.05 was deemed statistically significant.

Results:
Average endothelial cell density at confluence was 2,352 cells/mm2 from complete endothelium and 2,510 cells/mm2 from peripheral endothelium (P = 0.0351). The confluence rate (%), hexagonality (%), polymorphism (%), cell area (μm2), and Ki-67 positivity (%) did not differ between both groups (P > 0.05). All the antibodies were expressed in both groups at confluence.

Conclusions:
The discarded peripheral endothelial cells obtained after preparing a preloaded DMEK graft for clinical application has a huge reservoir of healthy endothelial cells having proliferative potential. Using these discarded tissue pieces from donor tissues will significantly increase the primary source of healthy donor endothelial cells for regenerative treatments, which are otherwise difficult to obtain.
Six-Month Outcomes After High Hyperopia Correction Using Laser-Assisted In Situ Keratomileusis With a Large Ablation Zone
Authors: Gauthier-Fournet Laurent , Penin Franck , Arba Mosquera Samuel 
Published: June 2019

Purpose:
To evaluate refractive and visual outcomes of laser-assisted in situ keratomileusis (LASIK) to treat high hyperopia using an aberration-neutral profile and large ablation zone.

Methods:
This was a retrospective, consecutive observational case series at Helios Ophtalmologie, St. Jean-de-Luz, France. One hundred forty-six consecutive eyes of 77 patients who underwent LASIK with mechanical microkeratome to correct hyperopia with correction in the maximum hyperopic meridian strictly higher than +5 D (mean + 6.6 ± 1.0 D) were included. Procedures were performed with an Amaris 750S excimer laser (Schwind eye-tech-solutions GmbH, Kleinostheim, Germany) using an aberration-neutral profile, a 6.7 ± 0.1 mm optical zone, and a 9.2 ± 0.1 mm total ablation zone. Refractive results, predictability, safety, and efficacy were evaluated at 6 months postoperatively.

Results:
At 6 months postsurgery, the mean manifest refraction spherical equivalent was −0.06 ± 0.83 D and the mean cylinder was 0.42 ± 0.35 D. Sixty-six percent of eyes were within ±0.50 D of the attempted spherical equivalent correction. Six months postoperatively, 60% of eyes achieved an uncorrected distance visual acuity of 20/20 or better. Ten percent of eyes lost 1 line of corrected distance visual acuity and 4% gained a line. No eyes lost more than 2 Snellen lines of corrected distance visual acuity at any follow-up.

Conclusions:
High hyperopia correction with LASIK using an aberration-neutral profile and large ablation zone provides good efficacy, safety, predictability, and visual outcomes.
Five-Year Trends in Reported National Football League Injuries
Authors: Bedard Gillian , Wyndham Lawrence David 
Published: June 2019

Objective:
To determine the incidence of all-cause injury and concussion in the National Football League (NFL) over a 5-season time span (2012-2016).

Design:
Prospective descriptive epidemiological study.

Setting:
National Football League Injury Report data from 2012 to 2016.

Participants:
National Football League players.

Interventions:
None (descriptive study).

Main Outcome Measures:
Injury report data were collected prospectively for all NFL injuries from 5 seasons (2012-2016). The incidences of reported concussions, knee injuries, and all-cause injury were compared across the 5 seasons using the Kruskal–Wallis rank-sum test.

Results:
A total of 10 927 injuries were identified across the 5 seasons, including 752 (6.9%) concussions. The top 3 most injured areas included the knee (17.2%), ankle (13.6%), and shoulder (8.8%). Defensive backs consistently had the highest number of all-cause injuries per season. When comparing across years, there was a significant decrease in all-cause injury in 2016 compared with 2015, a significant decrease in knee injuries in 2016 compared with 2015, and a significant increase in concussion in 2015 compared with 2014 (P < 0.05).

Conclusions:
Reported all-cause injury incidence and knee injury incidence is currently on the decline. However, reported concussion incidence has recently increased, perhaps due to increased awareness and rule changes implemented to aid in the detection and treatment of concussion. Strategies to reduce injury and improve injury awareness should continue to be explored.
Recent Advances in Cognitive Behavioral Therapy For Digestive Disorders and the Role of Applied Positive Psychology Across the Spectrum of GI Care
Authors: Feingold Jordyn , Murray Helen B. , Keefer Laurie 
Published: June 2019

Background:
Although cognitive behavior therapies (CBTs) have shown great promise in the reduction of symptom burden from as well as anxiety around various gastrointestinal (GI) disorders, there are substantial issues involving the scalable delivery of such interventions within the clinical setting of a gastroenterology practice, leaving most patients without access to psychological care.

Goals:
This paper discusses the application of positive psychology principles and techniques for adoption by various GI providers to initiate early, effective psychological care for patients with GI disorders, saving CBTs for more complex cases.

Study/Results:
Authors provide a comprehensive framework of patient well-being known as REVAMP, which is consistent with CBT principles, and elaborate on research and interventions that can be adopted within the gastroenterology practice setting. Building positive resources can bolster patients with GI disorders against comorbid psychological and psychiatric distress.

Conclusions:
Positive psychology interventions can be implemented within gastroenterology practice. Research is necessary to evaluate the efficacy and acceptability of positive psychology interventions among patients with different digestive disorders and baseline psychological characteristics, as well as the feasibility of administration by different clinicians in the gastroenterology practice setting.
A Comprehensive Analysis of Liver Transplantation Outcomes Among Ethnic Minorities in the United States
Authors: Kaswala Dharmesh H. , Zhang Julia , Liu Andy , Sundaram Vinay , Liu Benny , Bhuket Taft , Wong Robert J. 
Published: June 2019

Goals:
The aim of this study was to perform a comprehensive assessment of liver transplant (LT) outcomes among US adults with a specific focus on understanding race/ethnicity-specific disparities.

Background:
Despite improvements in the liver allocation and LT-related care, disparities in LT outcomes persist.

Study:
Using data from the 2005 to 2016 United Networks for Organ Sharing LT registry, we evaluated waitlist survival, probability of receiving LT, and post-LT survival among US adults stratified by race/ethnicity and liver disease etiology. Kaplan-Meier methods evaluated unadjusted waitlist and post-LT outcomes, and multivariate regression models evaluated adjusted waitlist and post-LT outcomes.

Results:
Among 88,542 listed for LT patients (41.3% hepatitis C virus, 25.3% alcoholic liver disease, 22.3% nonalcoholic steatohepatitis, 11.1% hepatitis C virus/alcoholic liver disease), significant race/ethnicity-specific disparities were observed. Compared with non-Hispanic whites, Hispanics had a significantly lower risk of waitlist death [hazard ratio (HR)=0.84, 95% confidence interval (CI): 0.79-0.90, P<0.001]. Compared with non-Hispanic whites, significantly lower likelihood of receiving LT was observed in African Americans (HR=0.94, 95% CI: 0.91-0.98, P<0.001), Hispanics (HR=0.70, 95% CI: 0.68-0.73, P<0.001) and Asians (HR=0.74, 95% CI: 0.69-0.80, P<0.001). Compared with non-Hispanic whites, African Americans had a significantly higher risk of 5-year post-LT death (HR=1.31, 95% CI: 1.23-1.39, P<0.001).

Conclusion:
Among US adults awaiting LT, significant race/ethnicity-specific disparities in LT outcomes were observed. Despite evaluating an era after implementation of the Model for End-Stage Liver Disease, ethnic minorities continue to demonstrate a lower probability of receiving LT, and significantly higher risk of death post-LT in African Americans.
Comparison of hand-sewn versus mechanical esophagogastric anastomosis in esophageal cancer
Authors: Wang Yang , Zhang Xiangwei , Jiang Yuanzhu , Ma Guoyuan , Wang Zhaoyang , Xue Xianbiao , Sang Shaowei , Zhang Lin 
Published: June 2019

Abstract

Background:
Many studies have been conducted to compare the hand-sewn and mechanical staples in esophageal cancer (EC) patients who received esophagogastric anastomosis. However, the results remain controversial. Hence, the purpose of the meta-analysis is to evaluate the impact of different anastomosis methods on the early and long-term outcomes.

Methods:
We will perform a systematic electronic search of the PubMed, Embase, Cochrane Library, Web of Science for relevant articles published in English language. Pooled odds ratios will be calculated for the effect on discrete variables including anastomotic leakage, anastomotic strictures, 30-day mortality, quality of life, cardiac and pulmonary complications. The weighted mean difference was calculated for the effect size on continuous variables such as operative time and bleeding amount. We will use the software Review Manager 5.3 and STATA 14.0 to perform the meta-analysis to calculate the data synthesis.

Results:
The review will provide a high-quality synthesis of current evidence of the impact of different anastomosis methods on postoperative course in ECs after esophagectomy. The results will be published in a peer-reviewed journal.

Conclusion:
This systematic review and meta-analysis will compare the different anastomosis methods in EC patients. The results will better offer some specific suggestions for esophagogastric anastomosis.

PROSPERO registration number:
This systematic review protocol has been registered in the PROSPERO network (No. CRD 42019109523).
Radiofrequency ablation for lung squamous cell carcinoma in a single-lung patient
Authors: Song Guo-qiang , Li Guan-gnan , Chen Fei , Chen Dun-shun , Qian Hui-juan , Deng Xiao-e , Lu Huo-quan , Lin Bin 
Published: June 2019

Abstract

Rationale:
High morbidity and high mortality are the main features of non-small cell lung cancer (NSCLC). Radiofrequency ablation, which produces a large amount of heat to kill tumor cells, is one effective way to treat this disease.

Patient concerns:
We report the case of a 74-year-old man who presented with a 1-month history of right chest pain. His left lung was removed 12 years prior. Chest computed tomography (CT) revealed a mass in the right lower lobe.

Diagnoses:
An excision biopsy of the mass showed lung squamous cell carcinoma.

Interventions:
We performed radiofrequency ablation.

Outcomes:
The patient underwent 3.5 and 10 months of follow-up, with a partial response and complete remission, respectively.

Lessons:
CT-guided radiofrequency ablation is a safe and an effective minimally invasive treatment option. Radiofrequency appears to be a valuable alternative to surgery for inoperable patients presenting with a single-lung NSCLC.