bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supraspinal Mechanisms of Spinal Cord Stimulation for Modulation of Pain
Authors: Sivanesan Eellan , Maher Dermot P. , Raja Srinivasa N. , Linderoth Bengt , Guan Yun 
Published: July 2018

Abstract
The field of spinal cord stimulation is expanding rapidly, with new waveform paradigms asserting supraspinal sites of action. The scope of treatment applications is also broadening from chronic pain to include cerebral ischemia, dystonia, tremor, multiple sclerosis, Parkinson disease, neuropsychiatric disorders, memory, addiction, cognitive function, and other neurologic diseases. The role of neurostimulation as an alternative strategy to opioids for chronic pain treatment is under robust discussion in both scientific and public forums. An understanding of the supraspinal mechanisms underlying the beneficial effects of spinal cord stimulation will aid in the appropriate application and development of optimal stimulation strategies for modulating pain signaling pathways. In this review, the authors focus on clinical and preclinical studies that indicate the role of supraspinal mechanisms in spinal cord stimulation–induced pain inhibition, and explore directions for future investigations.
Impact of Adult Scoliosis on Roussouly Sagittal Shape Classification
Authors: Pizones Javier , Martin Montserrat Baldan , Perez-Grueso Francisco Javier Sánchez , Yilgor Caglar , Vila-Casademunt Alba , Serra-Burriel Miquel , Obeid Ibrahim , Alanay Ahmet , Acaroglu Emre R. , Pellisé Ferran 
Published: July 2018

Study Design.
A retrospective analysis of data collected prospectively in an adult spine deformity multicenter database.

Objective.
The aim of this study was to determine the impact of adult scoliosis (AS) on the type of Roussouly sagittal shape in terms of classification applicability, scoliosis modification of a patient theoretical sagittal shape, and coronal-sagittal deformity associations.

Summary of Background Data.
Roussouly described a four-type sagittal shape classification in healthy individuals, which has been also applied to patients with degenerative spinal disease. However, it remains uncertain if its principles can be applied to AS patients.

Methods.
AS patients recorded in a prospective multicenter database of adult spinal deformity were included. Preoperative sagittal radiographs were analyzed using the KEOPS software to measure pelvic parameters, global sagittal alignment, and the various criteria used for the Roussouly classification. The different sagittal shape types were compared using the Chi-square and McNemars tests, and analysis of variance with Bonferroni correction.

Results.
The classification was applicable to all of the 190 analyzed AS patients. In addition to Roussouly criteria, two parameters helped differentiate the different shapes: T10-L2 angle (24° ± 19 type-1; 14° ± 15 type-2; 3° ± 15 type-3; 0.4° ± 14 type-4; P < 0.001), and lordosis distribution index (90% ± 17 type-1; 83% ± 16 type-2; 73% ± 21 type-3; 63% ± 16 type-4; P < 0.001). AS changed the theoretical shape in 34% of the patients (P < 0.001). Curve etiology and curve pattern were not associated with any particular type of sagittal shape (P > 0.05). Type-1 was associated with older patients (P = 0.02), degenerative curves (P = 0.02), and greater PI-LL mismatch (P = 0.012). Types 3 to 4 were associated with younger age and idiopathic etiology (P < 0.001).

Conclusion.
Roussouly four-type sagittal shape classification could be applied to AS patients. AS modified the theoretical type in one of every three patients. No particular association was found between the sagittal types and specific coronal deformities. Sagittal shape recognition in patients with AS will help restore the appropriate theoretical shape through surgery, which can eventually lead to better surgical outcomes

Level of Evidence: 2
In-Hospital Outcomes of Patients With Advanced Chronic Kidney Disease, Dialysis, and Kidney Transplant Undergoing Spinal Fusion
Authors: Yoshihara Hiroyuki , Yoneoka Daisuke 
Published: July 2018

Study Design:
A retrospective analysis of population-based national hospital discharge data collected for the nationwide inpatient sample (NIS).

Objectives:
To examine the in-hospital outcomes of patients with advanced chronic kidney disease (CKD), dialysis, and kidney transplant undergoing spinal fusion on a national level.

Summary of Background Data:
Patients with advanced CKD have been living longer with the support and improvement of medical treatment, dialysis, and organ transplant. Some of those patients undergo spinal fusion surgery. However, there is limited information regarding the outcomes of patients with advanced CKD, dialysis, and kidney transplant, undergoing spinal fusion.

Methods:
Clinical data were derived from the US Nationwide Inpatient Sample (NIS) between 2000 and 2009. Patients who underwent spinal fusion were identified and divided into 4 groups: those with advanced CKD, dialysis, and kidney transplant, and those without advanced CKD. Data regarding, patient-system and health care system–related characteristics, comorbidities, in-hospital complications, and mortality were retrieved and analyzed. In-hospital outcomes were compared between the groups and analyzed with the use of multivariate logistic regression.

Results:
Among the all groups, overall in-hospital complications rate was the highest (42.0%) for patients with advanced CKD and in-hospital mortality rate was the highest (5.2%) for those with dialysis, undergoing spinal fusion. Patients with dialysis had 8.7 and 9.5 times higher risk of in-hospital mortality compared with those with kidney transplant and those without advanced CKD.

Conclusions:
Patients with advanced CKD, dialysis, and kidney transplant had significant higher rates and risks of in-hospital morbidity or mortality than those without advanced CKD, undergoing spinal fusion. Particularly, patients with dialysis undergoing spinal fusion need to be informed with high mortality risk.
Bracing Following Transforaminal Lumbar Interbody Fusion is not Necessary for Patients With Degenerative Lumbar Spine Disease
Authors: Yao Yu-Cheng , Lin Hsi-Hsien , Chang Ming-Chau 
Published: July 2018

Study Design:
This is a prospective, randomized trial.

Objective:
This study aimed to evaluate the outcome of bracing following transforaminal lumbar interbody fusion (TLIF) in patients with degenerative lumbar spine diseases.

Summary of Background Data:
Bracing following spinal fusion for lumbar degenerative disease is common. However, the necessity of postoperative bracing is still controversial. A paucity of high-quality studies have assessed the efficacy of bracing.

Materials and Methods:
In total, 90 patients with degenerative lumbar disease receiving instrumented TLIF were randomly assigned to brace and no brace groups for postoperative care. Patients in the brace group were instructed to wear a rigid brace full-time for 12 weeks. Patients in the no brace group were instructed to wear a soft corset for 2 weeks, after which it was weaned off. In all patients, the Visual Analogue Scale and Oswestry Disability Index scores were evaluated preoperatively; postoperatively; and at 6 weeks, 3, 6, and 12 months of follow-up. The fusion rates, complications, and reoperation rates were recorded.

Results:
In total, 44 patients were assigned to the brace group (mean age, 69.2±10.7 y), and 46 were assigned to the no brace group (mean age, 68.8±11.9 y). All patients received at least 12 months of follow-up. There were no significant differences between the 2 groups with regard to patient demographic characteristics. The Visual Analogue Scale and Oswestry Disability Index scores at each follow-up were not significantly different between the 2 groups. The fusion rate and complications at the 12-month postoperative follow-up were not significantly different between the 2 groups.

Conclusions:
Our study showed that in patients with degenerative spinal disease who receive TLIF, wearing a rigid brace postoperatively is unnecessary. In addition, the fusion rate was not related to bracing, and there were no complications or reoperations whether a brace was worn.

Level of Evidence:
Level II—therapeutic.
Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock*
Authors: Woolum Jordan A. , Abner Erin L. , Kelly Andrew , Thompson Bastin Melissa L. , Morris Peter E. , Flannery Alexander H. 
Published: July 2018

Objectives:
Mounting evidence has shown that critically ill patients are commonly thiamine deficient. We sought to test the hypothesis that critically ill patients with septic shock exposed to thiamine would demonstrate improved lactate clearance and more favorable clinical outcomes compared with those not receiving thiamine.

Design:
Retrospective, single-center, matched cohort study.

Setting:
Tertiary care academic medical center.

Patients:
Adult patients admitted with an International Classification of Diseases, 9th Edition, or International Classification of Diseases, 10th Edition, diagnosis code of septic shock to either the medicine or surgery ICU.

Interventions:
None.

Measurements and Main Results:
Patients who received IV thiamine supplementation within 24 hours of hospital admission were identified and compared with a matched cohort of patients not receiving thiamine. The primary objective was to determine if thiamine administration was associated with a reduced time to lactate clearance in septic shock. Secondary outcomes included 28-day mortality, acute kidney injury, and need for renal replacement therapy, and vasopressor and mechanical ventilation-free days. Two-thousand two-hundred seventy-two patients were screened, of whom 1,049 were eligible. The study consisted of 123 thiamine-treated patients matched with 246 patients who did not receive thiamine. Based on the Fine-Gray survival model, treatment with thiamine was associated with an improved likelihood of lactate clearance (subdistribution hazard ratio, 1.307; 95% CI, 1.002–1.704). Thiamine administration was also associated with a reduction in 28-day mortality (hazard ratio, 0.666; 95% CI, 0.490–0.905). There were no differences in any secondary outcomes.

Conclusions:
Thiamine administration within 24 hours of admission in patients presenting with septic shock was associated with improved lactate clearance and a reduction in 28-day mortality compared with matched controls.
Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock*
Authors: Hatfield Kelly M. , Dantes Raymund B. , Baggs James , Sapiano Mathew R. P. , Fiore Anthony E. , Jernigan John A. , Epstein Lauren 
Published: July 2018

Objectives:
To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013–2014.

Design:
A retrospective cohort design.

Setting:
Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medicare and Medicaid Services inpatient prospective payment system in 2013 and 2014.

Patients:
Medicare fee-for-service beneficiaries greater than or equal to 65 years old who had an inpatient hospitalization coded with present at admission severe sepsis or septic shock.

Interventions:
None.

Measurements and Main Results:
Individual level mortality was assessed as death at or within 7 days of hospital discharge and aggregated to calculate hospital-level mortality rates. We used a logistic hierarchal linear model to calculate mortality risk-adjusted for patient characteristics. We quantified variability among hospitals using the median odds ratio and calculated risk-standardized mortality rates for each hospital. The overall crude mortality rate was 34.7%. We found significant variability in mortality by hospital (p < 0.001). The middle 50% of hospitals had similar risk-standardized mortality rates (32.7–36.9%), whereas the decile of hospitals with the highest risk-standardized mortality rates had a median mortality rate of 40.7%, compared with a median of 29.2% for hospitals in the decile with the lowest risk-standardized mortality rates. The median odds ratio (1.29) was lower than the adjusted odds ratios for several measures of patient comorbidities and severity of illness, including present at admission organ dysfunction, no identified source of infection, and age.

Conclusions:
In a large study of present at admission sepsis among Medicare beneficiaries, we showed that mortality was most strongly associated with underlying comorbidities and measures of illness on arrival. However, after adjusting for patient characteristics, mortality also modestly depended on where a patient with sepsis received care, suggesting that efforts to improve sepsis outcomes in lower performing hospitals could impact sepsis survival.
New insights into breast implant-associated anaplastic large cell lymphoma
Authors: Laurent Camille , Haioun Corinne , Brousset Pierre , Gaulard Philippe 
Published: July 2018

Purpose of review
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare form of lymphoma arising adjacent to a breast implant. We aim to review the pathogenesis and clinico-biological features of BI-ALCL.

Recent findings
BI-ALCL is a new provisional entity in the 2017 updated WHO classification. Among several hypotheses, BI-ALCL development seems to be determined by the interaction of immune response related to implant products and additional genetic events.

Summary
BI-ALCL is an uncommon T-cell lymphoma which is increasingly diagnosed since its first description in 1997 with 500 estimated cases worldwide. Two BI-ALCL subtypes correlating with clinical presentation have been described. Although most BI-ALCL patients with tumor cell proliferation restricted to the periprosthetic effusion and capsule have excellent outcomes, other patients presenting with a tumor mass, may have a more aggressive disease. The pathogenesis of BI-ALCL remains elusive. It is postulated that local chronic inflammation elicitated by bacterial infection or implant products may promote the activation and proliferation of T cells. Additional genetic events resulting in the activation JAK/STAT pathway are also incriminated. Further investigations are needed to better characterize the pathogenesis of this disease in order to determine the potential risk to develop BI-ALCL after surgical implants.
Injectable Platelet-, Leukocyte-, and Fibrin-Rich Plasma (iL-PRF) in the Management of Androgenetic Alopecia
Authors: Schiavone Giovanni , Paradisi Andrea , Ricci Francesco , Abeni Damiano 
Published: July 2018

BACKGROUNDThe role of enriched autologous plasmas in androgenetic alopecia (AGA) management is emerging in recent literature.OBJECTIVEIn this prospective study, the authors aimed to confirm that the induction of a minor local trauma immediately followed by injections of an enriched plasma made of a strongly concentrated platelet fraction, a robust white cell presence, concentrated fibrinogen, and other plasma proteins (injectable leukocyte platelet-rich fibrin [iL-PRF]) could be able to produce positive clinical results in patients with AGA.MATERIALS AND METHODSA 2-injection regimen was instituted, with a 3-month interval between the 2 interventions. A treatment group (TG) and a control group (CG) were instituted. Macrophotographs were taken at baseline and after 6 months, and rated by 5-people expert panel (blinded to this assignment) using the 15-point scale proposed by Jaeschke to evaluate the clinical change.RESULTSOverall, TG showed better scores compared with the CG in all 5 classes of global physician assessment at baseline, all age groups, and in both sexes, and such differences always reached statistical significance. A greater severity at baseline showed a larger improvement after treatment in the TG.CONCLUSIONThis study provides preliminary evidence that the biological composition of the iL-PRF is of crucial importance in ensuring a good degree of clinical efficacy in patients with AGA.
BILATERAL SIMULTANEOUS RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Singh Niharika , Jain Mukesh , Jaisankar Durgasri , Sharma Tarun , Raman Rajiv ,   for the Sankara Nethralaya Vitreoretinal Study Group (SNVR-Study Group)
Published: July 2018

Purpose:
To elucidate the clinical characteristics and surgical outcome of consecutive patients with bilateral simultaneous retinal detachment who reported to a tertiary eye care institution over a period of 10 years.

Methods:
Retrospective interventional consecutive study of 168 eyes of 84 patients with bilateral simultaneous retinal detachment, observed by indirect ophthalmoscopy at the initial examination was performed. Demographic and clinical characteristics were collected before and after surgery. Patients with attached retina at final follow-up were considered to have anatomical success and those with two or more lines improvement in visual acuity were considered to have functional success.

Results:
Most cases (90% in the better eye and 82.1% in the worse eye) were managed by scleral buckling procedure. With scleral buckle, anatomical success was seen in 99% and functional success was seen in 87% of the cases. Pars plana vitrectomy was performed in remaining cases with anatomical success in 83% and functional success in 78% of cases. Eyes with partial retinal detachment, without macular involvement, and eyes in which additional surgeries were not performed had significantly better anatomical and functional results.

Conclusion:
Early sequential surgery gives good anatomical and functional outcomes. Surgical outcomes were better with scleral buckling than pars plana vitrectomy.
TYPICAL POLYPOIDAL CHOROIDAL VASCULOPATHY AND POLYPOIDAL CHOROIDAL NEOVASCULARIZATION
Authors: Jang Jun Won , Kim Jong Min , Kang Se Woong , Kim Sang Jin , Bae Kunho , Kim Kyung Tae 
Published: July 2018

Purpose:
To compare typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV), which can be defined as two subtypes of PCV, and to elucidate the significance of the classification.

Methods:
Seventy-seven patients diagnosed with PCV and followed up for more than 12 months were reviewed. The PCV cases were divided into a T-PCV group (n = 36) and a P-CNV group (n = 41) according to the presence of features of pachychoroid or age-related macular degeneration. Angiographic and tomographic characteristics and changes in vision during the follow-up period were compared between the two groups.

Results:
Logarithm of the minimum angle of resolution visual acuity of T-PCV and P-CNV was 0.27 ± 0.31 and 0.62 ± 0.47 at baseline (P < 0.001) and 0.28 ± 0.41 and 0.54 ± 0.52 at the final visit (P = 0.006), respectively. A marginally higher rate of complete response to anti–vascular endothelial growth factor treatment was noted in the T-PCV group (47.2%) compared with the P-CNV group (26.8%) (P = 0.05). At the final visit, subfoveal fibrosis was noted in 11.1% of the T-PCV group and 39.0% of the P-CNV group (P = 0.009).

Conclusion:
The two subtypes of PCV, P-CNV and T-PCV, behave differently in terms of angiographic and tomographic manifestations and visual outcomes. Classifying PCVs would be helpful not only for pathogenic implications, but also for prognostic significance.
Differentiation Between Intralabyrinthine Schwannoma and Contrast-enhancing Labyrinthitis on MRI: Quantitative Analysis of Signal Intensity Characteristics
Authors: Bae Yun Jung , Song Jae-Jin , Choi Byung Se , Kang Young , Kim Jae Hyoung , Koo Ja-Won 
Published: July 2018

Objective:
Distinguishing intralabyrinthine schwannoma (ILS) from labyrinthitis is crucial in deciding patient management between surgery and medication; however, the clinical and radiological differentiation between ILS and labyrinthitis is difficult, especially when labyrinthitis shows contrast-enhancement mimicking ILS on magnetic resonance imaging (MRI). This study aimed to evaluate the quantitative characteristics of signal intensity on 3T MRI for differentiating ILS from contrast-enhancing labyrinthitis (CEL).

Study Design:
Retrospective study.

Setting:
Tertiary referral center.

Patients:
Between July 2003 and June 2017, 9 subjects diagnosed with ILS (16 MRI cases) and 9 subjects diagnosed with CEL (9 MRI cases) were enrolled in the study.

Main Outcome Measures:
Normalized signal intensity on contrast-enhanced T1-weighted image (nCE-T1), normalized signal intensity on T2-weighted image (nT2), and normalized signal intensity on contrast-enhanced fluid-attenuated inversion recovery image (nFLAIR) were measured and compared between ILS and CEL. The diagnostic performance of these values was assessed using receiver operating characteristic (ROC) analysis.

Results:
In ILS, the nCE-T1 and the nT2 were significantly higher and lower, respectively, than in CEL (all, p < 0.05); and the nFLAIR did not significantly differ (p > 0.05). The maximal nCE-T1 achieved the highest area under the curve (AUC) in differentiating ILS and CEL, followed by the mean nCE-T1, the mean nT2, and the maximal nT2. Combination of the nCE-T1 and the nT2 showed higher AUC than the nCE-T1 alone, but without statistical significance (p = 0.340).

Conclusions:
Quantitative measurement of the signal intensity on MRI can be a viable imaging tool for differentiating ILS from CEL.
Facilitating cells: role in inducing transplantation tolerance
Authors: Chhabra Anita Yogendra , Ildstad Suzanne T. 
Published: July 2018

Purpose of review
This review discusses the role and mechanisms by which facilitating cells promote stem cell engraftment and induce tolerance in HLA-disparate kidney transplant recipients.

Recent finding
Facilitating cells in both mice and human are heterogeneous, consisting of several subpopulations. They have been shown to enhance stem cell engraftment in allogeneic recipients. They also increase hematopoietic stem cells (HSC) clonogenicity, enhance migration and homing of stem cells via secretion of cytokines/chemokines/growth factors, prevent apoptosis of stem cells and induce regulatory cells. This review summarizes the findings that led to the development of chimerism-based induction of tolerance using FCRx (a mobilized blood product enriched in stem cells and facilitating cells) in allogenic kidney transplant patients.

Summary
A phase-2 clinical trial based on FCRx therapy has been successful in inducing tolerance to living donor kidney allografts, leading to withdrawal of immunosuppression in over 70% of patients transplanted. The ultimate goal of establishing tolerance in the absence of immunosuppresive drugs can be achieved using FCRx therapy.