bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Nano-Dose Protocol For Cobb Angle Assessment in Children With Scoliosis: Results of a Phantom-based and Clinically Validated Study
Authors: Pedersen Peter H. , Vergari Claudio , Tran Alexia , Xavier Fred , Jaeger Antoine , Laboudie Pierre , Housset Victor , Eiskjær Søren P. , Vialle Raphäel 
Published: June 2019

Study design:
This was a prospective validation study with technical notes.

Objective:
This study aimed to validate a new ultra–low-dose full-spine protocol for reproducible Cobb angle measurements—the “nano-dose” protocol.

Summary of Background Data:
Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced.

Methods:
An anthropomorphic child phantom was used to establish an ultra–low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction.

Results:
A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm2, corresponding to one sixth of the micro-dose protocol (30 mGy×cm2) and <1/40th of the standard-dose protocol (222 mGy×cm2). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals.

Conclusions:
We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.
Safety and Effectiveness of Antifibrinolytics in Posterior Scoliosis Surgery for Adolescent Idiopathic Scoliosis
Authors: Bovonratwet Patawut , Sheha Evan D. , Ondeck Nathaniel T. , Malpani Rohil , Smith Brian G. , Grauer Jonathan N. 
Published: June 2019

Study Design:
This was a retrospective study of prospectively collected data.

Objective:
To utilize a large national database with prospectively collected data [National Surgical Quality Improvement Program Pediatric (NSQIP-Pediatric)] to study the safety and effectiveness of antifibrinolytic use during multilevel posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Summary of Background Data:
There is currently a lack of consensus and evidence regarding the safety and effectiveness of antifibrinolytic use for pediatric patients undergoing corrective surgery for AIS.

Materials and Methods:
Patients who underwent multilevel PSF for AIS in the 2016 NSQIP-Pediatric database were identified. Preoperative and procedural characteristics were compared between patients who received antifibrinolytics versus those who did not. Multivariate regressions were used to compare perioperative transfusion rates and postoperative outcomes, such as rate of return to the operating room, 30-day readmission, and intensive care unit and hospital length of stay between the 2 treatment groups.

Results:
This study included 975 patients who received antifibrinolytics and 223 patients who did not. Patients who received these agents tended to have more levels fused, osteotomies performed, and longer operative times. After controlling for these variances, there were no statistical differences in rate and volume of transfusion, rate of return to the operating room, 30-day readmission, 30-day postoperative complications, or intensive care unit or hospital length of stay between the 2 treatment groups.

Conclusions:
This study did not demonstrate transfusion reduction in the group that received antifibrinolytics. This finding may be, in part, secondary to nonoptimized or nonstandardized protocols for antifibrinolytic use in pediatric deformity surgery or the inability to adequately control for selection bias, as those with greater surgical invasiveness may be more likely to receive antifibrinolytics. Nonetheless, using antifibrinolytics in this population appears safe and not associated with increased perioperative complications.

Level of Evidence:
Level III.
Differential Analysis of the Spinal Cord Shift After Laminoplasty With Upper Extension to the C2 Segment and Conventional Surgery of the C3–C7 Segments
Authors: Wang Yongfeng , Yuan Jie , Lu Xiangdong , Zhao Yibo , Wang Shaowei , Zhao Bin 
Published: June 2019

Study Design:
A retrospective controlled study.

Objective:
To clarify the differences of spinal cord shift between laminoplasty with extension to the C2 segment and conventional surgery of the C3–C7 segments.

Summary of Background Data:
For patients of spinal cord compression at C2/C3 or C2, it is difficult to achieve decompression involving only the C3–C7 segments. Therefore, a laminoplasty with upper extension to C2 is needed. Nevertheless, there is not yet a definitive conclusion regarding whether laminoplasty with extension to C2 can achieve a better spinal cord shift than an extension of the C3–C7 segments.

Materials and Methods:
Preoperative and final follow-up Japanese Orthopedic Association scores were recorded. MRI T2 patient images before and after surgery were used for data collection. The anterior subarachnoid spaces, spinal cord diameters, posterior subarachnoid spaces, and dural sac diameters were measured. The distance of spinal cord shift in a single plane was represented by the differences in the sum of the anterior subarachnoid spaces and the spinal cord diameters before and after surgery. The overall distances and distances of each segment backward were compared between the C2–C7 group and the C3–C7 group. All planes were also classified as segments with compression or noncompression, and the differences in backward shift were compared.

Results:
There were no significant differences in Japanese Orthopedic Association score between the C2–C7 and C3–C7 groups at final follow-up and no significant differences in the overall backward shift between the 2 groups. The spinal cord shift of C1, C2, and C2/C3 segments and the segment of the largest shift distance were significantly different between the 2 groups; the spinal cord shift of the segments under compression was larger than that of noncompression.

Conclusions:
Surgery with upper extension to the C2 segment did not increase the overall spinal cord shift; instead, a better effect was achieved by the effective decompression of local compressed segments, thus obtaining an effective expansion and shift of the spinal cord.

Levels of Evidence:
Level II.
Sex Differences on Postoperative Pain and Disability Following Minimally Invasive Lumbar Discectomy
Authors: Patel Dil V. , Yoo Joon S. , Karmarkar Sailee S. , Lamoutte Eric H. , Singh Kern 
Published: June 2019

Study Design:
Retrospective cohort.

Objective:
To determine if sex is associated with differences in postoperative pain scores, narcotic consumption, and long-term improvements in pain and disability following minimally invasive lumbar discectomy (MIS LD).

Summary of Background Data:
There exists a question as to what extent sex influences surgical and clinical outcomes following MIS LD.

Methods:
Patients undergoing primary, single-level MIS LD were retrospectively reviewed and stratified on the basis of sex. Immediate postoperative Visual Analog Scale (VAS) pain scores and narcotic consumption were collected. Patient-reported outcomes, including Oswestry Disability Index (ODI), 12-Item Short-Form- (SF-12) Physical Component Score, and VAS back and leg pain, were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month follow-up. Sex differences were tested for an association between immediate postoperative pain, narcotics utilization, and long-term improvements in patient-reported outcomes using linear regression.

Results:
A total of 188 patients were included and 62.8% were male individuals. At the time of surgery, female individuals were older than male individuals (P=0.045). There were no observed differences in other demographic or perioperative characteristics between cohorts. Female individuals had similar inpatient VAS pain scores and narcotic consumption compared with male individuals. Female individuals had a higher ODI score than male individuals preoperatively, however, both cohorts had similar improvements in ODI at all postoperative time points. Both sexes had similar VAS back and leg pain and SF-12 PCS scores preoperatively and at all postoperative time points.

Conclusions:
Our study demonstrated that sex does not affect immediate postoperative pain, narcotic consumption, and long-term recovery following MIS LD. Female individuals demonstrated similar preoperative back and pain scores compared with male individuals but reported greater disability before surgery. However, both sexes experienced similar improvements in pain and disability at all follow-up time points through 12 months. The results of this study may enable providers to better counsel patients regarding the expected improvement in pain and disability.
Circulating Histones Are Major Mediators of Multiple Organ Dysfunction Syndrome in Acute Critical Illnesses
Authors: Cheng Zhenxing , Abrams Simon T. , Alhamdi Yasir , Toh Julien , Yu Weiping , Wang Guozheng , Toh Cheng-Hock 
Published: June 2019

Objectives:
Multiple organ dysfunction syndrome is characterized by simultaneous multiple organ failure, which is the leading cause of death in acute critically ill patients. However, what mediates multiple organ dysfunction syndrome is not fully understood. The discovery of toxic effects by extracellular histones on different individual organs strongly suggests their involvement in multiple organ dysfunction syndrome. In this study, we investigate whether circulating histones are major mediators of multiple organ dysfunction syndrome in acute critical illnesses.

Design:
Combination of retrospective clinical studies and animal models with intervention.

Setting:
ICU in a tertiary hospital and research laboratories.

Patients:
Four hundred and twenty ICU patients, including sepsis (140), severe trauma (63), severe pancreatitis (89), and other admission diagnoses (128).

Laboratory Investigation:
Cells from major organs are treated with calf thymus histones or histone-containing sera. Animal models for sepsis, trauma, and acute pancreatitis are treated with antihistone reagents.

Intervention:
Antihistone reagents in in vitro, ex vivo, and animal models.

Measurement and Main Results:
Retrospective analysis of a prospectively recruited ICU cohort demonstrated a strong correlation between circulating histones and organ injury markers and Sequential Organ Failure Assessment scores. Ex vivo experiments showed that patient sera containing high histone levels were toxic to cultured cells from different origins, suggesting their universal toxicity to multiple organs. Animal models of sepsis, trauma, and pancreatitis further demonstrated a temporal correlation between histone levels and disease severity and multiple organ injury. Importantly, antihistone reagents, that is, antihistone single-chain variable fragment and nonanticoagulant heparin, could dramatically reduce multiple organ injury, particularly of the heart and lungs, and improve survival in mouse models.

Conclusions:
High levels of circulating histones are major mediators of multiple organ dysfunction syndrome. Our results indicate that monitoring upon ICU admission could inform on disease severity and developing antihistone therapy holds great potential of reducing multiple organ dysfunction syndrome and improving survival of critically ill patients.
A Progressive Early Mobilization Program Is Significantly Associated With Clinical and Economic Improvement: A Single-Center Quality Comparison Study
Authors: Liu Keibun , Ogura Takayuki , Takahashi Kunihiko , Nakamura Mitsunobu , Ohtake Hiroaki , Fujiduka Kenji , Abe Emi , Oosaki Hitoshi , Miyazaki Dai , Suzuki Hiroyuki , Nishikimi Mitsuaki , Komatsu Mamoru , Lefor Alan Kawarai , Mato Takashi 
Published: June 2019

Objectives:
To determine whether a progressive early mobilization protocol improves patient outcomes, including in-hospital mortality and total hospital costs.

Design:
Retrospective preintervention and postintervention quality comparison study.

Settings:
Single tertiary community hospital with a 12-bed closed-mixed ICU.

Patients:
All consecutive patients 18 years old or older were eligible. Patients who met exclusion criteria or were discharged from the ICU within 48 hours were excluded. Patients from January 2014 to May 2015 were defined as the preintervention group (group A) and from June 2015 to December 2016 was the postintervention group (group B).

Intervention:
Maebashi early mobilization protocol.

Measurements and Main Results:
Group A included 204 patients and group B included 187 patients. Baseline characteristics evaluated include age, severity, mechanical ventilation, and extracorporeal membrane oxygenation, and in group B additional comorbidities and use of steroids. Hospital mortality was reduced in group B (adjusted hazard ratio, 0.25; 95% CI, 0.13–0.49; p < 0.01). This early mobilization protocol is significantly associated with decreased mortality, even after adjusting for baseline characteristics such as sedation. Total hospital costs decreased from $29,220 to $22,706. The decrease occurred soon after initiating the intervention and this effect was sustained. The estimated effect was $–5,167 per patient, a 27% reduction. Reductions in ICU and hospital lengths of stay, time on mechanical ventilation, and improvement in physical function at hospital discharge were also seen. The change in Sequential Organ Failure Assessment score and Sequential Organ Failure Assessment score at ICU discharge were significantly reduced after the intervention, despite a similar Sequential Organ Failure Assessment score at admission and at maximum.

Conclusions:
In-hospital mortality and total hospital costs are reduced after the introduction of a progressive early mobilization program, which is significantly associated with decreased mortality. Cost savings were realized early after the intervention and sustained. Further prospective studies to investigate causality are warranted.
Increasing Incidence of Pelvic Sepsis Following Ileal Pouch-Anal Anastomosis for Ulcerative Colitis in Denmark: A Nationwide Cohort Study
Authors: Mark-Christensen Anders , Kjær Mie D. , Ganesalingam Subathra , Qvist Niels , Thorlacius-Ussing Ole , Rosenberg Jacob , Hillingsø Jens G. , Preisler Louise , Laurberg Søren 
Published: June 2019

BACKGROUND:
The risk of pelvic sepsis following IPAA for ulcerative colitis may have changed with changes in medical and surgical treatment, but data are scarce.

OBJECTIVES:
This study aims to examine temporal changes in the risk of pelvic sepsis following IPAA for ulcerative colitis and to ascertain risk factors associated with pelvic sepsis.

DESIGN:
This is a nationwide cohort study.

SETTING:
This study was conducted in Denmark from 1996 to 2013.

PATIENTS:
Patients were operated on with an IPAA for ulcerative colitis.

MAIN OUTCOME MEASURES:
Pelvic sepsis was defined and validated as the occurrence of anastomotic leakage, pelvic abscesses or fistulas, or an operation for these conditions, recorded in a nationwide registry. Cumulative risks were calculated by using death as a competing risk. Multivariate Cox regression was used to examine the effects of calendar periods (1996–1999, 2000–2004, 2005–2009, and 2010–2013) on hazards ratios for pelvic sepsis, adjusting for age, sex, comorbidity, annual hospital volume, pelvic sepsis in the 12 months preceding surgery, operative stage (1-, 2-, modified 2-, or 3-stage), laparoscopy, and preoperative treatment with biological medicine within 12 weeks before surgery.

RESULTS:
Of 1456 patients, 244 (16.8%) experienced pelvic sepsis. The 1-year risk increased by calendar period (1996–1999: 2.5%, 2000–2004: 4.5%, 2005–2009: 7.4%, and 2010–2013: 9.6%). The adjusted hazard ratio for pelvic sepsis increased by an average 4.4% (95% CI, 1.3–7.6) per year in the study period. In general, patients were older and had more comorbidities at IPAA in recent years than in earlier years, and more had experienced pelvic sepsis in the 12 months preceding the operation.

LIMITATIONS:
This study was register based. There were no data on important clinical variables to determine the causes of an increased risk over calendar periods.

CONCLUSION:
In this nationwide cohort study, the 1-year risk of pelvic sepsis following primary IPAA for ulcerative colitis increased 4-fold from 1996 to 2013. See Video Abstract at http://links.lww.com/DCR/A956.
Anatomic Distribution of Colorectal Adenocarcinoma in Young Patients
Authors: Lu Pamela , Fields Adam C. , Vise Allison S. , Shabat Galyna , Irani Jennifer L. , Bleday Ronald , Goldberg Joel E. , Melnitchouk Nelya 
Published: June 2019

BACKGROUND:
The incidence of colorectal cancer has increased in the younger population. Studies show an increased prevalence of left-sided tumors in younger patients; however, exact anatomic distribution is not known.

OBJECTIVE:
We sought to determine the anatomic distribution of colorectal cancer in young patients and to calculate the proportion of tumors that would be within reach of a flexible sigmoidoscopy.

DESIGN:
The National Cancer Database (2004–2015) was used to identify patients with colorectal cancer.

SETTINGS:
This was a multicenter study using national data.

PATIENTS:
The study included 117,686 patients under the age of 50 years diagnosed with colorectal cancer and 1,331,048 patients over the age of 50 years diagnosed with colorectal cancer.

MAIN OUTCOME MEASURES:
The primary outcome was the proportion of left-sided tumors in patients under the age of 50 years.

RESULTS:
A total of 74.4% of patients under age 50 years and 56.1% of patients over age 50 years had left-sided colorectal cancer.

LIMITATIONS:
The study is a retrospective review and does not exclude young patients who developed colorectal cancer with familial syndromes with a colorectal cancer disposition.

CONCLUSIONS:
A total of 74.4% of colorectal cancers diagnosed before age 50 years are left sided. In light of recent changes to screening recommendations, distribution of disease in young patients is important to both provider and patient education and decision-making. See Video Abstract at http://links.lww.com/DCR/A966.
Efonidipine-Induced Exanthematic Drug Eruption and Literature Review
Authors: Davis Suresh , Raju Anu R. , Thomas Eapen , Cherian Jerin J. 
Published: June 2019

Abstract:
We report the case of an elderly woman who developed exanthematic drug eruption after administration of efonidipine. An 84-year-old woman presented to emergency department with complaints of generalized itching and erythema since 4 days. She was on human-soluble insulin since 11 years. In view of her hypertension and left anterior descending artery stenosis, she was initiated on aspirin, clopidogrel, atorvastatin, pantoprazole, nebivolol, aldactone, and efonidipine a week ago. Her presenting complaints were initially managed with parenteral pheniramine maleate and hydrocortisone. She was admitted, and all her medications except antiplatelets and insulin were discontinued. She was prescribed topical beclomethasone and oral antihistamines for better control of her symptoms. To confirm the drug precipitating the reaction, she was rechallenged with efonidipine, 20 mg once daily on the third day of admission. She developed itching 8 hours after administering the medication, and efonidipine was stopped and nebivolol 5 mg once daily was restarted for hypertension. She did not develop any adverse event when the remaining medications were reinitiated. World Health Organization–Uppsala Monitoring Centre causality assessment criteria indicated a “certain” association. To the best of the knowledge of the authors, this is one among the first reported cases of efonidipine-induced exanthematic drug eruption.
A Review of Diagnostic and Therapeutic Dacryoendoscopy
Authors: Singh Swati , Ali Mohammad Javed 
Published: June 2019

Dacryoendoscopy examinations are increasingly playing a significant role in the diagnosis and therapies of lacrimal drainage disorders.

Purpose:
To provide a systematic review of the literature on diagnostic and therapeutic indications, techniques, utility, and complications of dacryoendoscopy (DEN).

Methods:
The authors performed a PubMed search of articles published in English/German/Japanese/Chinese on DEN. Data captured include evolution and techniques, diagnostic utility, therapeutic interventions, outcomes, and limitations. Specific emphasis was laid on addressing the current practice patterns and existing lacunae.

Results:
Diagnostic DEN has enabled the exact localization and differentiation of mucosal edema, stenosis, strictures, and obstructions throughout the lacrimal drainage system (LDS). Guided expansion of the stenosis, laser dacryoplasty (LDP) for strictures and microdrill removal of dacryoliths (microdrill dacryoplasty [MDP]) are some of the therapeutic uses of DEN. Successful outcomes of up to 60%–70% were achieved with stenosis anywhere along the LDS with a restenosis rate of 20%. Longer segment of stenosis (>2 mm), presence of enlarged lacrimal sac, history of dacryocystitis, postsaccal stenosis, and complete obstruction were associated with poorer outcomes. Microendoscopic procedures like LDP or MDP achieve canalicular and NLD recanalization with optimal results. DEN guided-probing demonstrated high success rates in cases with an earlier failed probing. Available dacryoendoscopes allow high-quality image capture (15,000 pixels) with multiple ports for additional instrumentation and irrigation.

Conclusions:
Dacryoendoscopic examination of canaliculus and nasolacrimal duct plays a significant role in the diagnosis and management of lacrimal disorders. Further improvements in microendoscopic techniques and instrumentation will expand its clinical usage and give impetus to minimally invasive lacrimal surgeries.