bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-Dimensional–Printed Uterine Model for Surgical Planning of a Cesarean Delivery Complicated by Multiple Myomas
Authors: Mackey Amy , Ng Joshua I. , Core Jason , Nguyen Linh , Cross Devon , Lim Philip , Woodfield Courtney , Pugliese Robert , Ku Bon 
Published: March 2019

BACKGROUND:
Uterine myomas encountered at cesarean delivery increase the complexity and risk of the procedure. Preoperative planning of such deliveries may help optimize patient outcomes. The application of three-dimensional printing technology is rapidly expanding in many surgical specialties. We created a three-dimensional–printed model from the magnetic resonance images (MRIs) of a gravid uterus with multiple myomas for surgical planning of cesarean delivery.

INSTRUMENT:
A three-dimensional–printed uterine model from MRIs of a pregnant patient with multiple uterine myomas as a tool for planning cesarean delivery.

EXPERIENCE:
A 33-year-old woman with a myomectomy history presented to our institution for prenatal care. Initial ultrasound imaging revealed multiple uterine myomas. A three-dimensional–printed uterine model, based on subsequent MRI, was created for presentation at an obstetric multidisciplinary meeting. The model accurately represented the number, size, and locations of uterine myomas, aiding surgical planning, including skin and uterine incisions. At the time of cesarean delivery, the model was directly correlated with patient anatomy to further determine the optimal placement of uterine incision. Maternal and fetal outcomes were excellent.

CONCLUSION:
Three-dimensional–printed models, through improved surgical planning, could optimize outcomes for patients with uterine myomas undergoing cesarean delivery.
Etonogestrel Subdermal Implant–Associated Regression of Endometrial Intraepithelial Neoplasia
Authors: Wong Sunnie , Naresh Amber 
Published: March 2019

BACKGROUND:
Endometrial intraepithelial neoplasia is a precursor lesion to endometrial adenocarcinoma. Total hysterectomy is the preferred management, but systemic or locally acting progestin therapies are acceptable alternatives. The use of the etonogestrel subdermal implant for treatment of endometrial intraepithelial neoplasia has not been studied.

CASE:
A 36-year-old woman, G2P2002, with obesity presented with abnormal uterine bleeding. Her endometrial specimen demonstrated endometrial intraepithelial neoplasia. She declined both hysterectomy and conventional medical management. The etonogestrel implant was offered as an alternative to no treatment. After etonogestrel implant insertion, serial biopsies showed regression of endometrial intraepithelial neoplasia. Sixteen months after implant insertion, biopsy showed inactive and atrophic endometrium.

CONCLUSION:
The etonogestrel subdermal implant should be considered for further study for the treatment of endometrial intraepithelial neoplasia in women who decline surgical management.
Importance of Estimated Blood Loss in Resource Utilization and Complications of Hysterectomy for Benign Indications
Authors: English Emily M. , Bell Sarah , Kamdar Neil S. , Swenson Carolyn W. , Wiese Hallie , Morgan Daniel M. 
Published: March 2019

OBJECTIVE:
To identify the variation in estimated blood loss at the time of hysterectomy for benign indications and to analyze how blood loss is associated with measures of resource utilization and complications.

METHODS:
We conducted a retrospective cohort study and analyzed hysterectomy for benign indications at hospitals in the Michigan Surgical Quality Collaborative between January 1, 2013, and May 30, 2015. A sensitivity analysis was performed to identify how estimated blood loss was associated with measures of utilization (transfusion, readmission, reoperation, and length of stay) and postoperative complications. A hierarchical logistic regression model was used to identify patient level factors independently associated with estimated blood loss greater than 400 mL and to calculate a risk- and reliability-adjusted rate for each hospital.

RESULTS:
There were 18,033 hysterectomies for benign indications from 61 hospitals included for analysis. The median estimated blood loss was 100 mL, and the 90th percentile estimated blood loss was 400 mL. A sensitivity analysis demonstrated increased risks of transfusion, readmission, reoperation, length of stay, and major postoperative complications with estimated blood loss greater than 400 mL. The proportion of hysterectomies at hospitals in the collaborative with estimated blood loss greater than 400 mL ranged from 3.5% to 16.9% after risk and reliability adjustments. The risk factors with the highest adjusted odds for estimated blood loss greater than 400 mL included abdominal surgery compared with laparoscopic hysterectomy (adjusted odds ratio [aOR] 2.8, CI 2.3–3.5), surgical time longer than 3 hours (aOR 3.9, CI 3.3–4.5), and specimen weight greater than 250 g compared with less than 100 g (aOR 4.8, CI 3.9–5.8). Adhesive disease, low surgeon volume, being younger than 40 years of age, having a body mass index greater than 35, and the need for a preoperative transfusion were also statistically significantly associated with estimated blood loss greater than 400 mL.

CONCLUSION:
There is fivefold variation in the hospital rate of hysterectomies with an estimated blood loss greater than 400 mL (90th percentile)—a threshold associated with significantly higher rates of health care utilization and complications. Avoidance of abdominal hysterectomy when possible may reduce intraoperative blood loss and associated sequelae.
Wound Complication Rates After Vulvar Excisions for Premalignant Lesions
Authors: Mullen Mary M. , Merfeld Emily C. , Palisoul Marguerite L. , Massad L. Stewart , Woolfolk Candice , Powell Matthew A. , Mutch David G. , Thaker Premal H. , Hagemann Andrea R. , Kuroki Lindsay M. 
Published: March 2019

OBJECTIVE:
To assess the rate of wound complications and evaluate the effectiveness of antibiotic prophylaxis in vulvar wide local excision procedures.

METHODS:
We performed a single-institution, retrospective cohort study of women undergoing vulvar surgery for premalignant lesions between January 2007 and January 2017. The primary outcome was a composite wound complication rate that included breakdown or infection within 8 weeks postoperatively. Data were analyzed using Fisher exact or χ2 test, Student t-test, and Poisson regression.

RESULTS:
Wound complications occurred in 154 (28.7%) of the 537 patients. Mean age was 52 years; most patients were white (83.1%), cigarette smokers (65.2%), had no prior vulvar treatment (54.4%), and had a preoperative diagnosis of high-grade squamous intraepithelial lesion (vulvar HSIL) (70.0%). The presence of other predisposing factors was similar between groups. In multivariate analysis, smoking (odds ratio [OR] 1.64, 95% CI 1.14–2.38) and primary rather than repeat vulvar surgery (OR 1.99, 95% CI 1.31–3.01) were associated with increased risk for wound complications. There was no significant difference in wound complications between women who received preoperative antibiotics and those who did not (30.4% vs 27.4%, P=.45), although the mean length of wound separation in the antibiotic group was shorter (1 vs 2 cm, P=.03).

CONCLUSION:
Wound complications are common among women undergoing surgery for vulvar HSIL, and interventional trials are warranted to evaluate the role of smoking cessation and prophylactic antibiotics to reduce postoperative morbidity.
Quantification of Risk Factors for Cervical Ossification of the Posterior Longitudinal Ligament in Korean Populations
Authors: Shin Jaeyong , Choi Ja Young , Kim Yong Wook , Chang Jee Suk , Yoon Seo Yeon 
Published: March 2019

Study Design.
Case-control study.

Objective.
To quantify risk factors for cervical ossification of the posterior longitudinal ligament (OPLL) using a large nationwide cohort in Korea, a country with a high prevalence of OPLL.

Summary of Background Data.
OPLL is a pathological calcification of the posterior longitudinal ligament of the spine. OPLL progression can cause spinal cord injury that results in disability. Considering neurologic deficits and disability caused by OPLL, identifying OPLL risk factors for early prediction have important health benefits.

Methods.
The nationwide population-based matched cohort study was conducted using the Korean National Health Insurance Service cohort data. We selected patients with a primary diagnosis of OPLL involving cervical lesion (International Classification of Diseases-10 code: M48.82, M48.83). A matched cohort without cervical OPLL was enrolled by randomly matching patients by sex, age, year of diagnosis, and residential area to the OPLL group with a ratio of 1:9. Logistic regression analyses were performed to identify risk associated with OPLL development using odds ratios (OR) and 95% confidence intervals (CI).

Results.
Comorbidities, such as hypertension (OR = 1.283, 95% CI 1.071–1.538), ischemic stroke (OR = 1.386, 95% CI 1.017–1.889), diabetes mellitus (OR = 1.331, 95% CI 1.098–1.615), hypothyroidism (OR = 1.562, 95% CI 1.165–2.094), and osteoporosis (OR = 1.456, 95% CI 1.151–1.842), were significantly associated with the prospective development of OPLL, with low predictive value.

Conclusion.
OPLL was significantly associated with comorbidities such as hypertension, ischemic stroke diabetes mellitus, hypothyroidism, and osteoporosis. Our findings can provide helpful information for OPLL prediction and offer important health benefits.

Level of Evidence: 3
Development of Deployable Predictive Models for Minimal Clinically Important Difference Achievement Across the Commonly Used Health-related Quality of Life Instruments in Adult Spinal Deformity Surgery
Authors: Ames Christopher P. , Smith Justin S. , Pellisé Ferran , Kelly Michael P. , Gum Jeffrey L. , Alanay Ahmet , Acaroğlu Emre , Pérez-Grueso Francisco Javier Sánchez , Kleinstück Frank S. , Obeid Ibrahim , Vila-Casademunt Alba , Burton Douglas C. , Lafage Virginie , Schwab Frank J. , Shaffrey Christopher I. , Bess Shay , Serra-Burriel Miquel 
Published: March 2019

Study Design.
Retrospective analysis of prospectively-collected, multicenter adult spinal deformity (ASD) databases.

Objective.
To predict the likelihood of reaching minimum clinically important differences in patient-reported outcomes after ASD surgery.

Summary of Background Data.
ASD surgeries are costly procedures that do not always provide the desired benefit. In some series only 50% of patients achieve minimum clinically important differences in patient-reported outcomes (PROs). Predictive modeling may be useful in shared-decision making and surgical planning processes. The goal of this study was to model the probability of achieving minimum clinically important differences change in PROs at 1 and 2 years after surgery.

Methods.
Two prospective observational ASD cohorts were queried. Patients with Scoliosis Research Society-22, Oswestry Disability Index , and Short Form-36 data at preoperative baseline and at 1 and 2 years after surgery were included. Seventy-five variables were used in the training of the models including demographics, baseline PROs, and modifiable surgical parameters. Eight predictive algorithms were trained at four-time horizons: preoperative or postoperative baseline to 1 year and preoperative or postoperative baseline to 2 years. External validation was accomplished via an 80%/20% random split. Five-fold cross validation within the training sample was performed. Precision was measured as the mean average error (MAE) and R2 values.

Results.
Five hundred seventy patients were included in the analysis. Models with the lowest MAE were selected; R2 values ranged from 20% to 45% and MAE ranged from 8% to 15% depending upon the predicted outcome. Patients with worse preoperative baseline PROs achieved the greatest mean improvements. Surgeon and site were not important components of the models, explaining little variance in the predicted 1- and 2-year PROs.

Conclusion.
We present an accurate and consistent way of predicting the probability for achieving clinically relevant improvement after ASD surgery in the largest-to-date prospective operative multicenter cohort with 2-year follow-up. This study has significant clinical implications for shared decision making, surgical planning, and postoperative counseling.

Level of Evidence: 4
The Relationship Between Endplate Pathology and Patient-reported Symptoms for Chronic Low Back Pain Depends on Lumbar Paraspinal Muscle Quality
Authors: Bailey Jeannie F. , Fields Aaron J. , Ballatori Alex , Cohen Danielle , Jain Deeptee , Coughlin Dezba , O’Neill Conor , McCormick Zachary , Han Misung , Krug Roland , Demir-Deviren Sibel , Lotz Jeffrey C. 
Published: March 2019

Study Design.
Cross-sectional cohort study of chronic low back pain (CLBP) patients and matched controls.

Objective.
To explore the interplay between vertebral endplate damage and adjacent paraspinal muscle (PSM) quality, and to test their association in a cohort of patients with CLBP and matched controls.

Summary of Background Data.
Nonspecific CLBP is challenging to diagnose, in part, due to uncertainty regarding the source of pain. Delineating interactions among potential CLBP mechanisms may enhance diagnosis and treatment customization.

Methods.
We collected advanced MRI imaging on 52 adult subjects, including 38 CLBP patients and 14 age- and sex-matched asymptomatic control subjects. Mean multifidus and erector spinae fat fraction (FF) was measured throughout the spine using an IDEAL MRI sequence. Presence of cartilage endplate (CEP) defects was determined at each disc level using UTE MRI. Logistic regression was used to test association of PSM FF, CEP defects, modic changes (MC), disc degeneration, and their interplay.

Results.
We observed that CEP defects were the strongest predictor of nonspecific CLBP (OR: 14.1, P < 0.01) even after adjusting for MC and disc degeneration (OR: 26.1, P = 0.04). PSM quality did not independently distinguish patient and control groups, except for patients with high self-reported disability.
At specifically L4L5, CEP damage was most prevalent and CEP damage was significantly associated with CLBP (OR: 3.7, 95% CI: 1.2–21.5, P = 0.03). CEP damage at L4L5 was predictive of CLBP when adjacent to PSMs with greater FF (MF, OR 14.7, P = 0.04; ES, OR: 17.3, P = 0.03), but not when PSM FF was lower and comparable to values in control, asymptomatic subjects.

Conclusion.
These results demonstrate the clinically important reciprocity between passive and dynamic spinal stabilizers, and support the notion that therapies targeting the PSMs may provide clinical benefit even in the presence of other spinal pathologies.

Level of Evidence: 4
Counting Efficiencies Determined by Monte Carlo Methods for In Vivo Measurement of 131I Activity in Thyroid
Authors: Park MinSeok , Kwon Tae-Eun , Ha Wi-Ho , Kim Chan Hyeong , Park Sunhoo , Jin Young Woo 
Published: March 2019

Abstract
The counting efficiencies obtained using a physical neck phantom are typically used in the measurement of 131I activity in the thyroid. It is well known, however, that the geometrical discrepancies between the physical neck phantom and the anatomy of the subject can significantly influence the counting efficiencies. Thus, it is necessary to consider the anatomical characteristics of individuals if we need to accurately determine the activity of 131I in the thyroid. This study aims to produce individualized counting efficiencies for thyroid measurement, considering the age, sex, and overlying tissue thickness of the subject being measured by Monte Carlo simulation. Simulations were performed using a series of computational human phantoms of different ages and sexes. The difference in counting efficiencies, depending on the age and sex of the phantom, were found to range from −26 to 3% for the phantoms and monitoring systems considered in the present study. The overlying tissue thickness of the computational phantoms was also modified to find the relationship between the counting ratio of the 80.2 and 364 keV gammas from 131I and the overlying tissue thickness. The equations for estimating the overlying tissue thickness of a subject were then derived from the relationships between counting ratios and overlying tissue thickness. Finally, in the present study, a set of equations representing the variation in counting efficiencies for the 364 keV peak as a function of the overlying tissue thickness were derived, which can be used to determine individualized counting efficiencies for the subject being measured. These individualized counting efficiencies considering the overlying tissue thickness given a subject’s age and sex can provide accurate estimates of 131I activity for internal dosimetry.
Does the Application of a Lycra Arm Sleeve Change Shoulder Biomechanics in Young Healthy People? A Mechanistic Study
Authors: Kumar Praveen , Desai Ashni , Elliot Lottie 
Published: March 2019

ABSTRACT

Introduction
Glenohumeral subluxation (GHS) is commonly reported in people with stroke. Lycra sleeves provide a compressive and supportive effect, influencing the neuromuscular activity in the affected body segment. A recent study reported reduction in GHS (acromion-greater tuberosity [AGT] distance) after application of Lycra arm sleeve; however, its mechanism on the shoulder region as a whole is unclear. The aim of this study was to investigate if application of a Lycra sleeve changes the AGT distance, muscle activity around the shoulder region, and scapular position.

Methods
Healthy participants aged older than 18 years were recruited. Measurements were taken before and immediately after application of the sleeve. Portable diagnostic ultrasound, surface electromyography, and a tape measure were used to measure AGT distance, muscle activity (biceps, triceps, deltoid, and supraspinatus), and position of the scapula, respectively.

Results
Thirty-one participants (11 men, 20 women) with mean age 25 ± 10 years participated. Paired test showed significant mean reduction of 0.12 cm (95% confidence interval [CI], 0.07–0.16 cm) in AGT distance measurements (t = 5.112, df = 30, P = 0.003) and scapula measurements (0.3 cm; 95% CI, 0.04–0.4 cm; t = 2.501; df = 30, P < 0.01) when compared without and with sleeve application.

Conclusions
Future research should investigate the effects of the Lycra sleeve on people with GHS in the different phases of rehabilitation.
The Accuracy of a Home‐performed Faecal Calprotectin Test in Paediatric Patients With Inflammatory Bowel Disease
Authors: Lerchova Tereza , Hradsky Ondrej , Copova Ivana , Potuznikova Kristyna , Gonsorcikova Lucie , Bronsky Jiri 
Published: March 2019

ABSTRACTObjectives:Owing to the invasiveness of endoscopy, the use of biomarkers, especially faecal calprotectin (FC), has become standard for remission assessment. This study aimed to compare the accuracy for detection of endoscopic activity using recently developed FC home test using smartphone application (FC‐IBDoc) against standard enzyme‐linked immunosorbent assay (ELISA).Methods:In all, 102 consecutive observations (89 participants) were included in prospective observational study. FC‐IBDoc was performed parallelly with FC‐ELISA in paediatric patients with inflammatory bowel disease indicated for endoscopy. Both tests were performed by trained staff. Mucosal healing was defined using Simple Endoscopic Score for Crohn disease (CD) ⩽2 in patients with CD (n = 44), ulcerative colitis (UC) Endoscopic Index of Severity ⩽4 in patients with UC (n = 27) and Rutgeerts score i0 and i1 without colon involvement in patients with CD after ileocaecal resection (n = 19).Results:Out of 102 endoscopic findings 23 were assessed as mucosal healing. We found an association of the mucosal healing scores of the entire group both with FC‐ELISA (P = 0.002) and FC‐IBDoc (P = 0.001). The area under the receiver operating characteristic curve for FC‐ELISA was 0.883 (95% confidence interval 0.807–0.960), with optimal cut‐off at 136.5 μg/g. The area under the receiver operating characteristic curve for FC‐IBDoc was 0.792 (95% confidence interval 0.688–0.895) with optimal cut‐off at 48 μg/g. The FC‐ELISA was more accurate than FC‐IBDoc when tested by a Delong test (P = 0.023).Conclusions:Standard FC‐ELISA for FC evaluation is more reliable predictor of mucosal healing than the FC‐IBDoc in paediatric patients with inflammatory bowel disease. The cut‐off values for both tests were incongruous.
Resting Energy Expenditure of Children With End‐stage Chronic Liver Disease Before and After Liver Transplantation
Authors: Kyrana Eirini , Williams Jane E. , Wells Jonathan C. , Dhawan Anil 
Published: March 2019

ABSTRACTObjectives:Our objective was to test the hypothesis that children with end‐stage chronic liver disease (ESCLD) are hypermetabolic when compared to healthy children, and that this hypermetabolism persists for at least 6 months after liver transplant.Methods:Seventeen patients with end‐stage chronic liver disease and 14 healthy controls had their resting energy expenditure measured (mREE) by indirect calorimetry. Weight, height, and body mass index were converted to standard deviation (SD) scores. Children older than 5 years had air displacement plethysmography and patients older than 5 years also had whole body dual‐energy X‐ray absorptiometry with characterization of fat mass (FM), fat‐free mass (FFM), and bone‐free fat free (lean) mass.Results:When compared to the prediction equation 44% of the patients and 50% of the healthy controls were hypermetabolic. The younger patients (0–5 years) had a lower mREE than the healthy controls but were significantly lighter and shorter than their healthy counterparts. mREE correlated strongly for all children with age, weight, height, and FFM. There was a strong negative correlation between age and mREE/kg in both patients (rs = −0.94, P < 0.01) and controls (rs = −0.91, P < 0.01). Almost 84% of the variance in mREE was explained by age (P < 0.001). There were no significant differences between resting energy expenditure (REE)/FFM between the 2 groups. mREE/kg before liver transplant correlated with mREE/kg after transplant (Pearson r = 0.83, P < 0.01).Conclusions:REE mostly reflected the size of the child. The patients were not hypermetabolic when compared to the healthy children. The main determinant of REE/kg after transplant was REE/kg before transplant.