bluuebunny/crossref_metadata_2025_split huggingface dataset:
Profiles Associated with Sarcopenia in Hepatoma Patients Underwent Transcatheter Arterial Chemoembolization: A Data‐Mining Analysis
Authors: Hirota Keisuke , Kawaguchi Takumi , Hashida Ryuki , Koya Shunji , Bekki Masafumi , Goshima Norihiro , Yoshiyama Teruhito , Otsuka Takashi , Nozoe Ryosuke , Nakano Dan , Shirono Tomotake , Shimose Shigeo , Iwamoto Hideki , Niizeki Takashi , Matsuse Hiroo , Koga Hironori , Shiba Naoto , Torimura Takuji 
Published: August 2018

AbstractAimsSarcopenia is a prognostic factor in patients with hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) may aggravate sarcopenia because of post‐embolization syndrome. The aims of this study are to investigate changes in skeletal muscle mass after TACE and its risk profiles in patients with HCC.Methods and resultsWe enrolled 104 HCC patients (age 73.5 [41.0–88.0] years, female/male 35/69, body mass index 22.4 [16.0–32.7]). Changes in skeletal muscle mass were evaluated by Δskeletal muscle index (SMI) using computed tomography before and after TACE. Factors correlated with ΔSMI were evaluated. Independent factors and profiles associated with a decrease in SMI were evaluated by multivariate analysis and decision‐tree analysis, respectively. SMI was significantly decreased after TACE in patients with HCC (32.8 vs. 30.6 cm2/m2; P=0.0001). However, there was no significant correlation between the ΔSMI and other variables including Δalbumin. In the logistic regression analysis, no factor was significantly associated with a decrease in SMI. In the decision‐tree analysis, sex was selected as the initial split and, in female, 74% of subjects showed a decrease in SMI. While, in male, an estimated glomerular filtration rate (eGFR) ≤81.7 ml/min/1.73 m2 was the second split; of these patients, 74% of subjects had a decreased SMI.ConclusionsWe demonstrated that skeletal muscle mass was decreased after TACE in patients with HCC. “female” and “male who had a lower eGFR” were profile for a decrease in skeletal muscle mass. Thus, such patients who have HCC treated with TACE may benefit from preventive treatment for sarcopenia.
Changing Trends in Hyperacute Stroke Treatment and Early Clinical Outcomes Reflecting Recent Improvement in Endovascular Thrombectomy Techniques
Authors: Davidson Travis William , Chakraborty Santanu 
Published: August 2018

Objective: Ischemic stroke is a major disease causing death and permanent neurological disability with the mainstay treatment being to re-established blood flow as quickly as possible. Recent changes in the efficiency of endovascular devices performing thrombectomies have led to it now being considered the gold standard. Nevertheless, successful endovascular thrombectomy (EVT) requires access to many resources and expertise which may impact its effectiveness. The objective of the current study is to describe the application and utility of EVT in the clinical treatment of ischemic stroke at a single tertiary care hospital.
Methods: This is a descriptive retrospective cohort study from a stroke database. A total of 548 patients diagnosed with an ischemic stroke affecting large cerebral arteries between January 2010 and June 2016 were included. National Institute of Health Stroke Scale (NIHSS) score was used to evaluate stroke severity upon admission. Modified Ranking Scale was used to determine the functional status of patients upon discharge. Successful reperfusion defined as a TICI score of 2B or 3, age, thrombolytic use and time- to-treatment were all considered for analysis.
Results: Thrombectomies became more frequent (p<0.001) with shorter time-to-treatment in recent years (p=0.001). A successful thrombectomy has significantly improved functional status at discharge (p<0.001), even when thrombolytics were not given (p=0.003) or when patients were over 80 years old (p=0.021).
Conclusion: The current work provides evidence that this single hospital has increased its frequency of application of EVT for ischemic stroke, leading to a better functional outcome at discharge independent of prior thrombolysis or age.
A Cry for Help: Suicide Attempts by an Iraqi Refugee and the Role of Community Service Learning
Authors: DCruz Jennifer T 
Published: August 2018

Community Service Learning (CSL) is a method of teaching where students learn through active participation in thoughtfully organized community service. CSL has emerged as a promising training method to address the changing needs of medical students and to improve their social accountability (1,2). Medical schools are beginning to incorporate community service learning into their curriculums as a way to introduce students to the complicated world of delivering care to vulnerable populations.
Mr. A, a refugee from Iraq, immigrated to Canada in June 2015 with his family. Five months later, during a CSL medical intake interview with two medical students and an Arabic interpreter, he revealed to have ongoing suicidal ideation and multiple suicide attempts. Due to significant cultural taboos and stigma around mental illness, Mr. A was initially very hesitant to seek medical help. However, with the help of the CSL program he was able to get much needed medical care.
Transplantation and Surgery: A Discussion on the Current and Future Direction of Renal Transplantation
Authors: Mookerji Nikhile , Malhi Gurpreet 
Published: August 2018

Dr. Jeff Warren, MD, FRCPC, is an associate professor at the University of Ottawa within the Department of Surgery, Division of Urology. He has been a staff Urologist since 2009 and obtained his fellowship in multi-organ transplants, including kidneys and pancreases, from the University of Western Ontario. He received his MD from the University of Ottawa in 2002 and also completed his residency at the University of Ottawa in 2007. He is currently the head of surgical foundations for all surgical residency programs at the University of Ottawa. His clinical interests are in kidney transplantation surgery, minimally invasive surgery, and medical education.
Dr. Tom Skinner, MD, FRCPC, is a transplant fellow at the University of Ottawa within the Department of Surgery, Division of Urology. He received his MD from Dalhousie University in 2012 and completed his Urology residency at Queen’s University in 2017. He has a BSc. from the University of British Columbia and a MSc. from McGill University. His clinical interests are in minimally invasive surgery, renal transplantation, surgical education, and healthcare economics. During this interview, Dr. Skinner and Dr. Warren discuss the current state of transplant surgery, the biggest challenges to transplanting patients, and the future of the specialty. They also discuss robotic surgery and the Spanish model for organ donation.
O “direito à desindexação”: repercussões do caso González vs Google Espanha
Authors: Luz Pedro Henrique Machado da , Wachowicz Marcos 
Published: August 2018

O objetivo com este estudo foi investigar a decisão proferida no ano 2014, pelo Tribunal de Justiça da União Europeia, no que ficou conhecido como o caso González vs Google Espanha. Para tanto, fez-se uma análise sistematizada dos principais aspectos do caso, consistindo em uma introdução ao conflito entre as partes, alguns fatos relevantes, a história processual da lide, as questões jurídicas presentes somadas aos precedentes utilizados pela Corte decisória, a decisão adotada pelo Tribunal de Justiça da União Europeia, informações complementares sobretudo acerca do impacto desse caso e, finalmente, considerações críticas e inquietações sobre o surgimento do chamado direito à desindexação e sua potencial recepção no cenário brasileiro. Escolheu-se tal julgado como fonte de estudo. pois ele bem representa a tensão entre as novas tecnologias próprias da sociedade informacional e o direito, em sua missão de proteção de direitos fundamentais, especialmente, para o caso, os direitos de personalidade, na modalidade de resguardo aos dados pessoais.
Free Vascularized Medial Femoral Condyle Bone Graft After Failed Scaphoid Nonunion Surgery
Authors: Pulos Nicholas , Kollitz Kathleen M. , Bishop Allen T. , Shin Alexander Y. 
Published: August 2018

Background:
Outcomes following revision surgery for scaphoid nonunions with osteonecrosis are guarded. We hypothesized that use of free vascularized medial femoral condyle (MFC) bone grafts can lead to healing of the nonunion, increase vascularity of the proximal pole, and restore scaphoid architecture, resulting in acceptable functional outcomes.

Methods:
We performed a retrospective review of 49 patients who were treated with an MFC bone graft, between May 2005 and September 2016, after prior failure of operative treatment for scaphoid nonunion. The mean time from the injury to the revision surgery with the MFC bone graft was 24 months, and the mean time from the prior, failed surgery was 15 months. Thirty-six of the 49 patients had had a prior bone graft procedure and 6 patients had had 2 previous surgical procedures for the nonunion. The initial internal fixation of the scaphoid fracture was with a scaphoid screw in 43 patients. All patients had documented osteonecrosis of the proximal pole at the time of our surgery. Carpal indices, time to union, pain scores, functional outcomes, and complications were recorded.

Results:
Forty-one (84%) of the 49 previously operated on scaphoid nonunions healed at a mean of 16 weeks (range, 9 to 31 weeks) after the MFC bone-grafting as confirmed on computed tomography (CT). Radiographs demonstrated significant improvement in carpal alignment following the surgery with the MFC bone graft. Comparison between preoperative and postoperative values showed a trend toward improved grip strength and no important change in total wrist range of motion. Subsequent procedures were performed in 29 patients, 21 of whom had planned Kirschner wire removal. All 24 patients in whom scaphoid union had been achieved and who were available for follow-up were able to work or attend school full-time, and 88% were satisfied or very satisfied with their wrist function. Age, smoking status, body mass index, time to surgery, and preoperative radiographic findings were not found to be significant predictors of failure.

Conclusions:
MFC grafts increase vascularity and restore scaphoid architecture, promoting union in most patients with the combination of proximal pole osteonecrosis, carpal collapse, and failed prior scaphoid nonunion surgery.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Type of Anticoagulant Used After Total Knee Arthroplasty Affects the Rate of Knee Manipulation for Postoperative Stiffness
Authors: Kahlenberg Cynthia A. , Richardson Shawn S. , Schairer William W. , Sculco Peter K. 
Published: August 2018

Background:
The aim of this study was to perform a population-level analysis on the effect of different types of anticoagulation on postoperative stiffness after total knee replacement, requiring manipulation under anesthesia. We hypothesized that patients receiving warfarin would have a higher rate of manipulation under anesthesia compared with patients receiving low-molecular-weight heparin. We also hypothesized that aspirin, direct factor Xa inhibitors, and fondaparinux would have no effect on the rate of manipulation under anesthesia.

Methods:
Using the PearlDiver patient database, we analyzed 32,320 patients who underwent a primary unilateral total knee replacement from 2007 to 2015. Patients were included if they filled a prescription for anticoagulation medication within 2 days of their discharge and were excluded if they were taking a prescription anticoagulation medication (except for aspirin) in the 3 months before total knee replacement. The primary outcome was manipulation under anesthesia performed within 6 months after a primary total knee replacement.

Results:
The most commonly prescribed postoperative anticoagulation was warfarin (38.0%), followed by low-molecular-weight heparin (33.8%). There were 1,178 patients (3.64%) who underwent manipulation under anesthesia within 6 months of total knee replacement. In multivariable analysis using low-molecular-weight heparin as a comparison group and accounting for age, sex, comorbidities, and length of stay, there was a significant increase in the risk of manipulation under anesthesia for patients who received warfarin (hazard ratio [HR], 1.17 [95% confidence interval (CI), 1.01 to 1.36]; p = 0.032), direct factor Xa inhibitors (HR, 1.42 [95% CI, 1.20 to 1.66]; p < 0.001), or fondaparinux (HR, 1.33 [95% CI, 1.01 to 1.72]; p = 0.038). Although patients who received aspirin had the same risk estimate as patients who received warfarin, there was not a significantly increased risk of manipulation under anesthesia in patients who received aspirin compared with low-molecular-weight heparin (HR, 1.17 [95% CI, 0.72 to 1.80]; p = 0.493).

Conclusions:
We found an increased rate of manipulation under anesthesia after total knee replacement in patients who received oral anticoagulants including warfarin, direct factor Xa inhibitors, and fondaparinux, in comparison with patients who received aspirin or low-molecular-weight heparin. We recommend that patients receiving oral anticoagulants after total knee replacement should be counseled about associated stiffness. Furthermore, surgeons should take these data into account when selecting thromboprophylaxis for patients after total knee replacement.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Medical Costs of Delayed Hip Fracture Surgery
Authors: Pincus Daniel , Wasserstein David , Ravi Bheeshma , Huang Anjie , Paterson J. Michael , Jenkinson Richard J. , Kreder Hans J. , Nathens Avery B. , Wodchis Walter P. 
Published: August 2018

Background:
Waiting for hip fracture surgery is associated with complications. The objective of this study was to determine whether waiting for hip fracture surgery is associated with health-care costs.

Methods:
We conducted a population-based, propensity-matched cohort study of patients treated between 2009 and 2014 in Ontario, Canada. The primary exposure was early hip fracture surgery, performed within 24 hours after arrival at the emergency department. The primary outcome was direct medical costs, estimated for each patient in 2013 Canadian dollars, from the payer perspective. The costs in the early and delayed groups were then compared using a difference-in-differences approach: the baseline cost in the year prior to the hip fracture that had been accrued by patients with early surgery was subtracted from the cost in the first year following the surgery (first difference), and the difference was then compared with the same difference among propensity-score-matched patients who had received delayed surgery (second difference). The secondary outcome was the postoperative length of stay (in days).

Results:
The study included 42,230 patients who received hip fracture surgery from a total of 522 different surgeons at 72 hospitals. The mean cost (and standard deviation) attributed to the hip fracture was $39,497 ± $46,645 per person. The matched patients who underwent surgery after 24 hours had direct 1-year medical costs that were an average of $2,638 higher (95% confidence interval [CI] = $1,595 to $3,680, p < 0.0001) and a postoperative length of stay that was an average of 0.610 day longer (95% CI = 0.1749 to 1.0331 days, p = 0.0058) compared with those who underwent surgery within 24 hours.

Conclusions:
Waiting >24 hours for hip fracture surgery was associated with increased medical costs and length of stay. Costs incurred by waiting may provide a financial incentive to mitigate delays in hip fracture surgery.

Level of Evidence:
Economic Level III. Please see Instructions for Authors for a complete description of levels of evidence.
Effects of Upper-Extremity Surgery on Manual Performance of Children and Adolescents with Cerebral Palsy
Authors: Louwers Annoek , Warnink-Kavelaars Jessica , Obdeijn Miryam , Kreulen Mick , Nollet Frans , Beelen Anita 
Published: August 2018

Background:
Little is known about the effects of upper-extremity surgery on the manual performance of children and adolescents with cerebral palsy (CP). This clinical cohort study describes our experience with patient selection based on multidisciplinary assessment and shared decision-making and the effects of upper-extremity surgery on manual performance and patient-relevant outcomes.

Methods:
All patients (up to 20 years of age) with CP referred to our multidisciplinary team for evaluation for upper-extremity surgery between July 2011 and May 2017 were included. Suitability for upper-extremity surgery was assessed with comprehensive, multidisciplinary screening, and the decision to proceed with surgery was made together with the patient. Individual patient-relevant goals were identified with the Canadian Occupational Performance Measure (COPM); perceived independence in performing bimanual activities at home was assessed with the ABILHAND-Kids tool, and perceived quality of use of the affected hand during daily activities was assessed with a visual analog scale (VAS). The quality of use of the affected hand during bimanual performance was measured with the Assisting Hand Assessment (AHA), and gross manual dexterity was evaluated with the Box and Block Test (BBT). All baseline assessments were repeated at an average of 9 months after the surgery.

Results:
Of 66 patients assessed by the multidisciplinary upper-extremity-surgery team, 44 were considered eligible for upper-extremity surgery. Of these patients, 39 (mean age and standard deviation [SD], 14.9 ± 2.10 years, 87% with unilateral CP, and 72% at Manual Ability Classification System [MACS] level II) underwent upper-extremity surgery and were evaluated in the pre-post study. All outcomes improved significantly after upper-extremity surgery, with average improvements of 3.1 ± 1.6 points in the COPM-Performance (COPM-P) score (p < 0.001), 3.3 ± 2.1 points in the COPM-Satisfaction (COPM-S) score (p < 0.001), 1.5 ± 1.2 logits in the ABILHAND score (p < 0.001), 2.4 ± 1.9 cm in the VAS score (p < 0.001), 6.7 ± 4.2 units in the AHA score (p < 0.001), and 2.2 ± 5.0 blocks/minute on the BBT (p = 0.021). The improvement in the COPM-P, COPM-S, ABILHAND, VAS, AHA, and BBT scores was clinically meaningful in 80%, 77%, 55%, 62%, 71%, and 31% of the patients, respectively.

Conclusions:
Careful assessment of eligibility for upper-extremity surgery, based on multidisciplinary screening and shared decision-making, resulted in a clinically relevant improvement in patient-specific functional and/or cosmetic goals and manual performance after upper-extremity surgery in most patients with CP.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
Authors: Joelson Anders , Danielson Barbro I. , Hedlund Rune , Wretenberg Per , Frennered Karin 
Published: August 2018

Background:
This case series of consecutive patients evaluated sagittal balance and health-related quality of life (HRQoL) 3 decades after in situ arthrodesis for high-grade isthmic spondylolisthesis.

Methods:
Global sagittal balance, pelvic parameters, and compensatory mechanisms were evaluated on standing lateral radiographs of the spine and pelvis for 28 of 39 consecutive patients, 28 to 41 years after in situ arthrodesis for high-grade L5 to S1 spondylolisthesis. The mean age at surgery was 14 years (range, 9 to 24 years), and the mean age at the time of follow-up was 48 years (range, 39 to 59 years). A subset of the radiographic parameters was compared with the corresponding data from an 8-year follow-up examination of the same patients. HRQoL was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire.

Results:
We found that 3 of the 28 patients had a global sagittal imbalance (T1 spinopelvic inclination of >0°). Signs of compensatory mechanisms, such as reduced thoracic kyphosis and pelvic retroversion, were frequent. There was a significant decrease in sacral slope compared with 8-year follow-up data (p = 0.01). The median SRS-22r subscore was on the same level as Swedish normative data. We found no association between radiographic parameters and SRS-22r outcome.

Conclusions:
Three decades after in situ arthrodesis for high-grade spondylolisthesis, radiographic signs of noncompensated sagittal imbalance were observed in only a few individuals. The patients had normal SRS-22r scores. There was no association between any radiographic parameter and SRS-22r outcome. The findings are relevant in the controversial discussion on whether to perform a reduction procedure to treat high-grade spondylolisthesis.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Enthesis Repair
Authors: Derwin Kathleen A. , Galatz Leesa M. , Ratcliffe Anthony , Thomopoulos Stavros 
Published: August 2018

Abstract:
On May 22, 2017, the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) hosted a roundtable on “Innovative Treatments for Enthesis Repair.” A summary of the roundtable discussion, as well as a list of the extramural participants, can be found at https://www.niams.nih.gov/about/meetings-events/roundtables/roundtable-innovative-treatments-enthesis-repair. This paper reviews the challenges and opportunities for developing effective treatment strategies for enthesis repair that were identified at the roundtable discussion.