bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphometric Analysis of the Retroperitoneal Vessels With Respect to Lateral Access Surgery in Adult Scoliosis
Authors: Makanji Heeren S. , Le Hai , Wood Kirkham B. , Jenis Louis G. , Cha Thomas D. 
Published: March 2018

Study Design:
Cross-sectional study reviewing 62 magnetic resonance imaging or computed tomography scans from consecutive adult patients with scoliotic spinal deformity in the thoracolumbar spine.

Objective:
To investigate the variation in anatomic position of retroperitoneal vessels in relationship to curve direction, location, magnitude, and axial rotation of curves in adult scoliosis.

Summary of Background Data:
The minimally invasive lateral approach to the thoracolumbar spine avoids manipulation of abdominal and retroperitoneal structures and decreases risk of injury to paraspinal musculature. In adult patients with scoliosis, the varying anatomic relationship between retroperitoneal vessels and intervertebral disk spaces can increase the risk of vascular injury.

Materials and Methods:
Axial images were used to measure the anterior-posterior diameter of the inferior vertebral endplate with respect to the disk space perpendicular to the widest length of the disk. The overlap of the retroperitoneal vessels with the endplate were measured at the cephalad end vertebra, apex, and caudad end vertebra of each curve. Overlap and accessible disk space for individual disk spaces were also measured.

Results:
There was a significant difference in percentage overlap of the apex and cephalad vertebral endplate and inferior vena cava in right versus left-sided curves (P=0.002). Overlap between the inferior vertebral endplate and inferior vena cava at the cephalad, apex, and caudad end of the curve was significantly different between thoracolumbar and lumbar curves (P<0.05). Axial rotation significantly affected vessel overlap at multiple curve locations. There was a statistically significant difference in accessible disk space when approaching the curve from the concavity versus convexity.

Conclusions:
Overlap between retroperitoneal vessels and inferior vertebral endplates at the disk level in scoliotic spines varies significantly with direction of the curvature, level of the deformity, and degree of axial rotation. There is decreased accessible disk space and increased vessel overlap on the concavity of the curve. Surgeons, as usual, will take an individualized case by case approach to avoid approach-related vascular complications, but the general relationships reported in this study can guide side of approach.
Does Age Influence the Efficacy of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusions?
Authors: Ajiboye Remi M. , Eckardt Mark A. , Hamamoto Jason T. , Sharma Akshay , Khan Adam Z. , Wang Jeffrey C. 
Published: March 2018

Study Design:
Retrospective study.

Objective:
Evaluate the effect of age on the efficacy of allograft/demineralized bone matrix (DBM) enriched with concentrated bone marrow aspirate (BMA) in posterolateral lumbar fusions (PLFs).

Summary of Background Data:
Cell-based therapies such as concentrated BMA have been developed as a potential alternative to iliac crest bone graft (ICBG). BMA contains mesenchymal stem cells (MSCs) and growth factors that can confer osteogenic and osteoinductive potential to osteoconductive scaffolds such as DBM/allograft. To date, no studies have examined the role of age on fusion outcomes when BMA is utilized despite the well-established deleterious effects of advanced age on bone marrow and MSC potential.

Materials and Methods:
Fifty-one patients that underwent PLF were divided into 3 groups. Group A (n=14) composed of patients age 65 years and older who received BMA with DBM. Group B (n=17) consisted of patients younger than 65 years of age who received BMA with DBM. Group C (n=20) composed of patients age 65 years and older who received ICBG. Fusion rates and clinical outcomes were assessed.

Results:
Fusion was significantly lower in group A (35.7%) compared with both groups B (76.4%) and C (80%) (A vs. B, P=0.03; A vs. C, P=0.01). There were no differences in clinical outcomes among all groups except for pseudarthrosis which occurred in 28.6% of patients in group A compared with none and 5% of patients in groups B and C, respectively (A vs. B, P=0.03; A vs. C, P=0.13).

Conclusions:
Elderly patients undergoing PLF using DBM enriched with BMA achieved lower radiographic fusion success compared with their nonelderly counterparts and compared with elderly patients that had fusion with ICBG. This may be partly due to the effect of advanced age on MSC potential.
The Effect of Hospital Ownership on Health Care Utilization in Orthopedic Surgery
Authors: Schroeder Gregory D. , Kurd Mark F. , Kepler Christopher K. , Radcliff Kris E. , Maltenfort Mitchell G. , Murphy Hamadi , Rihn Jeffery A. , Anderson D. Greg , Hilibrand Alan S. , Vaccaro Alexander R. 
Published: March 2018

Purpose:
To determine if ownership of a specialty hospital or ambulatory surgery centers (ASC) affects surgical volume.

Materials and Methods:
All surgeries performed by 75 orthopedic surgeons at a single practice between January 1, 2010 and March 1, 2015 were identified. During this time, the practice purchased an ownership stake in 1 hospital and 3 ASC. The total surgical volume by partnership status and location was collected and analyzed.

Results:
A total of 104,661 surgical surgeries were performed by 75 surgeons. Over the 62 months, there was an average increase in the number of surgical cases performed per surgeon per year of 2.82±0.48 cases; however, the average increase in cases per year was lower for equity partners by 1.51 cases per year (P<0.0001). In the 2 years before purchasing the specialty hospital, the increase in the number of surgical cases per surgeon per month was 0.093±0.087 cases. In the 2 years after investing in the physician-owned specialty hospital, there was a decrease in the number of cases performed per surgeon per month by 0.027±0.110 (P=0.92).

Conclusions:
In a well-established large orthopedic practice, surgeon ownership of a hospital or ASC does not lead to an increase in surgical volume.

Level of Evidence:
Level 4.
Prognostic Role of Rib Hump in Overlying Thoracic Curve Correction Above Selective Fusion for Lenke 5 Idiopathic Adolescent Scoliosis
Authors: Solla Federico , Gallo Massimiliano , Doria Carlo , Caci Hervé , Voury Audrey , Rosello Olivier , Clément Jean-Luc , Rampal Virginie 
Published: March 2018

Study design:
Prospective study.

Objective:
To assess whether rib hump is a prognostic factor of final thoracic Cobb angle.

Summary of Background Data:
Correction of thoracolumbar/lumbar curve, preoperative thoracic curves angle, thoracic curves angle on bending, the thoracolumbar-lumbar angle/thoracic curves angle ratio, thoracic kyphosis, and growth stage influences spontaneous correction of uninstrumented thoracic curves angle above selective fusion for Lenke 5 Adolescent Idiopathic Scoliosis. Indeed, preoperative rib hump has never been expressly evaluated as a prognostic factor of final thoracic curves angle.

Methods:
In total, 50 patients with Lenke 5 Adolescent Idiopathic Scoliosis, selectively instrumented with posterior construct were included. Two patients were lost to follow-up and 48 had follow-up ≥2 years. Demographic data, preoperative thoracic rib hump (measured in millimeter in trunk anteflexion), and radiologic spinal parameters were recorded preoperatively and at last consultation. T test was used to compare mean values, linear and logistic regressions to assess predictability of final thoracic curve angle.

Results:
Main thoracolumbar-lumbar curve angle decreased from 47 degrees (range, 36–72 degrees) to 12 degrees at the final consultation (range, 1–28 degrees). Thoracic curves angle decreased from 26 degrees (range, 2–40 degrees) preoperatively to 16 degrees (range, 2–41 degrees) at the final consultation (P=0.001) (correction=37%). Preoperative rib hump was present in 10 patients. Final thoracic Cobb angle was 27 degrees (8–41 degrees) in patients with rib hump and 14 degrees (0–32 degrees) in patients without rib hump (P<0.001).
Multiregression highlighted thoracic curves angle on bending (P=0.001), preoperative thoracic curves angle (P=0.011) and rib hump (P=0.012) as prognostic factors of higher final thoracic curves angle.

Conclusion:
Rib hump significantly influenced final thoracic curves angle.

Level of Evidence:
Level III—prospective study.
Cervical Artificial Disc Replacement With Discover Prosthesis Does Not Reduce the Midterm Risk of Heterotopic Ossification
Authors: Miao Jinhao , Shen Ye , Li Chao , Fang Lei , Zhang Lei , Zhang Xiangyi , Li Yiman , Kuang Yong 
Published: March 2018

Study Design:
A prospective cohort study with 79 patients.

Objective:
To analyze the midterm incidence of heterotopic ossification (HO) after cervical artificial disc replacement with Discover prosthesis in treatment of cervical degenerative disc disease.

Materials and Methods:
A cohort of 79 patients with 102 Discover prostheses (56 monosegment and 23 bisegments) was evaluated. Clinical and radiographic follow-up was performed. The performance of HO of the operative segments was assessed annually after the operation for 4 years.

Results:
Early follow-up at 2 years postsurgical treatment showed satisfactory clinical outcomes. No significant changes on the mean Japanese Orthopaedic Association and Visual Analog Scale scores were detected at 3 and 4 years postoperation. The occurrence rate of HO was 5.9% in 1-year follow-up and 17.6% in 2-year follow-up, and then the percentages increased to 49.2% in 3-year follow-up and 65.6% in 4-year follow-up, respectively. No association between the HO grades and the type of the surgical segment was detected by the Fisher exact test (P-value=0.56). No prosthesis subsidence or excursion was identified during the whole follow-up period.

Conclusions:
The use of Discover prosthesis resulted in satisfactory clinical outcomes after operation. However, the new prosthesis did not reduce the midterm risk of HO, despite the fact that the observed incidence was relatively low in the early follow-up.
The Effect of Ketorolac on Thoracolumbar Posterolateral Fusion
Authors: Li Jesse , Ajiboye Remi M. , Orden Michael H. , Sharma Akshay , Drysch Austin , Pourtaheri Sina 
Published: March 2018

Study Design:Systematic review and meta-analysis.Objective:The purpose of this study was to evaluate the effect of postoperative ketorolac administration (ie, dosage and duration of use) on pseudarthrosis following thoracolumbar posterolateral spinal fusions.Summary of Background Data:Ketorolac is a nonsteroidal anti-inflammatory drug often administered for pain control after spine surgery. The main concern with ketorolac is the risk of pseudarthrosis following fusion.Materials and Methods:A systematic search of multiple medical reference databases was conducted for studies detailing postoperative ketorolac use in lumbar fusion and scoliosis surgery in adult and pediatric patients, respectively. Meta-analysis was performed using the random-effects model for heterogeneity as this study analyzes heterogenous patient populations undergoing variable approaches to fusion and variable numbers of levels with variable means of detection of pseudarthrosis. Outcome measure was pseudarthrosis.Results:Overall, 6 studies totaling 1558 patients were reviewed. Pseudarthrosis was observed in 119 (7.6%) patients. Pseudarthrosis were observed in adults with ketorolac administered for >2 days [odds ratio (OR), 3.44, 95% confidence interval (95% CI), 1.87–6.36;P<0.001], adults with doses of ≥120 mg/d (OR, 2.93, 95% CI, 1.06–8.12;P=0.039), and adults with ketorolac administered for >2 days and at doses ≥120 mg/d (OR, 4.75, 95% CI, 2.34–9.62;P<0.001). Ketorolac use in smokers was associated with pseudarthrosis (OR, 8.71, 95% CI, 2.23–34.0;P=0.002).Conclusion:Ketorolac, when administered for >2 days and/or at a dose of ≥120 mg/d, is associated with pseudarthrosis in adults after posterolateral lumbar fusion. Ketorolac use in smokers is also associated with pseudarthrosis.
Patient Perceptions of Minimally Invasive Versus Open Spine Surgery
Authors: Narain Ankur S. , Hijji Fady Y. , Duhancioglu Gabriel , Haws Brittany E. , Khechen Benjamin , Manning Blaine T. , Colman Matthew W. , Singh Kern 
Published: March 2018

Study Design:
Prospective questionnaire.

Objective:
To describe patient perceptions of minimally invasive spine (MIS) versus open surgery, and to determine which factors are most heavily considered by the patient when choosing between approaches.

Summary of Background Data:
MIS surgery has increased in popularity due to proposed advantages in the perioperative and immediate postoperative periods. However, patient preferences and understanding with regard to the differences between MIS and open surgery have not been elucidated.

Materials and Methods:
An anonymous questionnaire consisting of 30 questions was administered to patients scheduled to see either an MIS surgeon or an open spine surgeon for a clinical evaluation from 2016 to 2017. Six questions asked about patient demographics and medical history. Nine questions asked respondents to rate the importance of several criteria when deciding between MIS and open surgery. In total, 15 multiple choice and free response questions asked respondents about their perceptions of MIS versus open surgery with regard to surgical and physician characteristics.

Results:
In total, 326 patients completed the survey. The 3 most important criteria for patients when choosing between open and MIS surgery were: long-term outcomes, surgeon’s recommendation, and complication risk. When compared with MIS surgery, the majority of patients perceived open surgery to be more painful (83.8%), have increased complication risk (78.5%), have increased recovery time (89.3%), have increased costs (68.1%), and require heavier sedation (62.6%). If required to have spine surgery in the future, the majority of both patient groups would prefer a minimally invasive approach (80.0%).

Conclusions:
Long-term outcomes, surgeon’s recommendation, and complication risk were the most important criteria identified by patients when choosing between open and MIS surgery. Patients also perceived MIS surgery to have advantages over open surgery with regard to postoperative pain, complication risk, recovery time, cost, and anesthesia requirement. Most patients seem to prefer a minimally invasive approach to their treatment.
Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis
Authors: Allia Jérémy , Clément Jean-Luc , Rampal Virginie , Leloutre Béatrice , Rosello Olivier , Solla Federico 
Published: March 2018

Study Design:
Monocentric study comparing results of simultaneous translation on 2 rods (ST2R) with derotation connectors (prospective series) or without derotation connectors (retrospective series) in Adolescent Idiopathic Scoliosis (AIS) surgery.

Objective:
The objective of this study was to assess if derotation connectors influence axial, coronal, and sagittal results in AIS surgery.

Summary of Background Data:
Conventional reduction techniques remain limited in their ability to reduce axial torsion. Direct vertebral derotation technique accomplishes partial axial derotation but decreases thoracic kyphosis.

Methods:
Monocentric study including AIS surgeries performed using ST2R technique with derotation connectors (group D+, n=44) or without derotation connectors (group D−, n=24). The axial intervertebral rotation was measured between apical and neutral vertebra on pre and postoperative computed tomography scan. T test was used to compare mean values. ANCOVA analyzed the influence of connectors and covariates on the primary outcome, which was the difference between preoperative and postoperative intervertebral rotation.

Results:
The mean axial torsion gain in the D+ group was 23% (+3.84 degrees, 95% confidence interval, +1.95/+5.73). In the D− group, mean axial torsion increase of 4% (−0.42 degrees, 95% confidence interval, −1.19/+2.03). The result was significantly different between the 2 groups (P=0.005). The coronal correction of the main curve angle was 80% in the D+ group and 64% in the D− group (P=0.004). Kyphosis correction was similar between the 2 groups (P=0.3) with significant increase of thoracic kyphosis in the whole series (P=0.02) and no patients with postoperative hypokyphosis <10 degrees. Multivariate analysis confirmed the influence of derotation connectors on both axial and coronal correction (P<0.05).

Conclusions:
The use of derotation connectors in the surgical treatment of AIS significantly improved axial and coronal correction compared to nonuse of connectors without compromising the sagittal plane.
Chapter 7. The Contributions of the ESPGHAN Committees on Nutrition to Paediatric Nutrition
Authors: Hernell Olle , Aggett Peter , Fewtrell Mary , Koletzko Berthold , Rey Jean 
Published: March 2018

ABSTRACTThe first Committee on Nutrition (CoN) was founded in 1974. Two years later nutrition (N) was added to the society's name, which then became ESPGAN. The Committee systematised compositional and quality criteria for breast milk substitutes and food for special medical purposes, the first of many examples on how recommendations and comments published by the Committees on Nutrition (CsoN) were adopted by the European Economic Community, later the European Union and also influenced the World Health Organization/Food and Agriculture Organization of the United Nations Codex standards. A second CoN focusing on preterm infants was established in 1979 and its recommendations on nutrition of these infants were widely implemented. The third and standing CoN, established 1986, started to organise high‐quality symposia at the annual meetings appreciating the need to enhance the expertise in nutritional research. From 1991 the CoN has organised Summer Schools in paediatric nutrition for young colleagues further emphasising its educational interest and more recently an annual, more specialised Nutrition Masterclass. Successively the interest of the CoN has expanded to other areas, such as highlighting dilemmas and uncertainties in the field of nutrition including the design, choice of outcomes and statistical analysis of trials in infant nutrition. The work of the CsoN have had great impact on paediatric nutrition and the committee will continue its important role by writing commentaries and systematic reviews and revising guidelines when required to inform and stimulate discussion among colleagues as well as stimulate training in paediatric nutrition by organising workshops and scientific meetings, training courses, and other approaches, and by interaction with other expert groups.
Sex Differences in Subclinical Coronary Atherosclerotic Plaque Among Individuals With HIV on Antiretroviral Therapy
Authors: Foldyna Borek , Fourman Lindsay T. , Lu Michael T. , Mueller Martin E. , Szilveszter Balint , Neilan Tomas G. , Ho Jennifer E. , Burdo Tricia H. , Lau Emily S. , Stone Lauren A. , Toribio Mabel , Srinivasa Suman , Looby Sara E. , Lo Janet , Fitch Kathleen V. , Zanni Markella V. 
Published: March 2018

Background:
In high-resource settings, the HIV-attributable risk of myocardial infarction (MI) is higher among women than among men. The extent to which unique mechanisms contribute to MI risk among women vs. men with HIV remains unclear.

Methods:
Subclinical coronary atherosclerotic plaque characteristics—including high-risk morphology plaque features—were compared among 48 HIV-infected women [48 (41, 54) years] and 97 HIV-infected men [48 (42, 52) years] on stable antiretroviral therapy (ART) without known cardiovascular disease. These individuals had previously completed coronary computed tomography angiography and metabolic/immune phenotyping as part of a prospective study.

Results:
Extending previous analyses, now focusing exclusively on ART-treated participants, we found that HIV-infected women had a lower prevalence of any subclinical coronary atherosclerotic plaque (35% vs. 62%, P = 0.003) and a lower number of segments with plaque (P = 0.01), compared with HIV-infected men. We also report for the first time that ART-treated HIV-infected women had a lower prevalence of high-risk positively remodeled plaque (25% vs. 51%, P = 0.003) and a lower number of positively remodeled plaque segments (P = 0.002). In models adjusting for cardiovascular risk factors, we further showed that male sex remained associated with any coronary plaque [odds ratio 3.8, 95% confidence interval: (1.4 to 11.4)] and with positively remodeled plaque [odds ratio 3.7, 95% confidence interval: (1.4, 10.9)].

Conclusions:
ART-treated HIV-infected women (vs. HIV-infected men) had a lower prevalence and burden of subclinical coronary plaque and high-risk morphology plaque. Thus, unique sex-specific mechanisms beyond subclinical plaque may drive the higher HIV-attributable risk of MI among women vs. men.
The Utility of Failure Modes and Effects Analysis of Consultations in a Tertiary, Academic, Medical Center
Authors: Niv Yaron , Itskoviz David , Cohen Michal , Hendel Hagit , Bar-Giora Yonit , Berkov Evgeny , Weisbord Irit , Leviron Yifat , Isasschar Assaf , Ganor Arian 
Published: March 2018

Background:
Failure modes and effects analysis (FMEA) is a tool used to identify potential risks in health care processes. We used the FMEA tool for improving the process of consultation in an academic medical center.

Methods:
A team of 10 staff members—5 physicians, 2 quality experts, 2 organizational consultants, and 1 nurse—was established. The consultation process steps, from ordering to delivering, were computed. Failure modes were assessed for likelihood of occurrence, detection, and severity. A risk priority number (RPN) was calculated. An interventional plan was designed according to the highest RPNs. Thereafter, we compared the percentage of completed computer-based documented consultations before and after the intervention.

Results:
The team identified 3 main categories of failure modes that reached the highest RPNs: initiation of consultation by a junior staff physician without senior approval, failure to document the consultation in the computerized patient registry, and asking for consultation on the telephone. An interventional plan was designed, including meetings to update knowledge of the consultation request process, stressing the importance of approval by a senior physician, training sessions for closing requests in the patient file, and reporting of telephone requests. The number of electronically documented consultation results and recommendations significantly increased (75%) after intervention.

Conclusion:
FMEA is an important and efficient tool for improving the consultation process in an academic medical center.