bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone Graft Substitutes in Single- or Double-Level Anterior Cervical Discectomy and Fusion
Authors: Stark Jessica R. , Hsieh Joseph , Waller Dorothy 
Published: November 2018

Study Design.
Systematic review

Objective.
To undertake a systematic review of published literature to evaluate efficacy of bone graft substitutes on radiographic and clinical outcomes in single- or double-level anterior cervical discectomy and fusion (ACDF) for degenerative disease.

Summary of Background Data.
ACDF is one of the most common spinal surgeries completed in the United States. Today bone graft substitutes including ceramic-based synthetic bone grafts, allografts, bone morphogenetic proteins (BMPs), mesenchymal stem cells, and bone marrow aspirate are widely used to enhance fusions; even though the efficacy of these substitutes is poorly defined. Critical evaluation of these products is necessary to optimize radiographic and clinical outcomes for ACDF in degenerative disease.

Methods.
A systematic literature review of 22 published articles was conducted. All articles reported results on patients who underwent a single- or double-level ACDF performed using a bone graft substitute and reported results on radiographic fusion rates at least 6 months after surgery.

Results.
All studies using BMP showed 100% fusion rate despite length of the study or whether additional bone graft substitutes were used. Use of only ceramic-based synthetics had the lowest fusion rate, 80.5%. Use of only mesenchymal stem cells resulted in an average fusion rate of 87.7%. When used alone, allograft resulted in an average fusion rate of 87.3%. This was significantly influenced by one outlier, Kim et al, which when removed, increased the fusion rate to 93.5%. Clinical outcomes were improved postoperatively irrespective of the graft used, although dysphagia was significantly greater in studies using BMP (P < 0.001).

Conclusion.
Allograft alone has the lowest cost with similar fusion rates and clinical outcomes compared to other bone graft substitutes. Physicians should consider this when choosing to use bone graft substitutes for routine ACDFs.

Level of Evidence: 4
The Importance of the Pedicle Diameters at the Proximal Thoracic Vertebrae for the Correction of Proximal Thoracic Curve in Asian Patients With Idiopathic Scoliosis
Authors: Lee Choon Sung , Cho Jae Hwan , Hwang Chang Ju , Lee Dong-Ho , Park Jae-Woo , Park Kun-Bo 
Published: November 2018

Study Design.
A retrospective comparative radiographic study.

Objective.
The purpose of this study was to evaluate differences in the pedicle diameters of proximal thoracic vertebrae in relation to the severity of the proximal thoracic curve in Asian patients with idiopathic scoliosis.

Summary of Background Data.
A small pedicle diameter at the proximal thoracic vertebra has been reported in normal population, but the changes of pedicle diameter in patients with a proximal thoracic curve have not been properly evaluated.

Methods.
One hundred eighty-two patients with adolescent idiopathic scoliosis involving a greater than 10-degree proximal thoracic curve were analyzed. Sixty-nine and 113 patients had a structural and nonstructural proximal thoracic curve, respectively. The pedicle width was evaluated from T1 to T4 using a reconstructed computed tomography (CT) scan. The pedicle widths were compared between the convex and concave side, and between the structural and nonstructural proximal thoracic curve groups.

Results.
The pedicle widths at T3 (0.76 ± 0.92 mm) and T4 (0.50 ± 0.69 mm) on the concave side for the structural proximal thoracic curves were extremely narrow compared with those for the nonstructural proximal thoracic curves (T3,1.17 ± 0.84 mm; T4,0.82 ± 0.72 mm) (P = 0.002, 0.003, respectively). However, the T2 pedicle width was comparable on the concave side in both groups (2.44 ± 0.94 mm for the nonstructural and 2.32 ± 0.97 mm for the structural proximal thoracic curve, P = 0.430).

Conclusion.
A pedicle screw insertion at the T3 or T4 vertebra on the concave side is not always possible in cases of a structural proximal thoracic curve; however, the pedicle width of the T2 vertebra is very wide and safe for the standard pedicle screw insertion. These results should be considered when the surgeon decides the upper instrumented vertebra or the correction method for the structural proximal thoracic curve.

Level of Evidence: 3
The Changing Position of the Center of Mass of the Thorax During Growth in Relation to Pre-existent Vertebral Rotation
Authors: de Reuver Steven , Brink Rob C. , Homans Jelle F. , Kruyt Moyo C. , van Stralen Marijn , Schlösser Tom P.C. , Castelein René M. 
Published: November 2018

Study Design.
Cross-sectional.

Objective.
The aim of this study was to analyze the thoracic center of mass (COM) position of children at different ages and evaluate its relation with the previously reported pre-existent rotational pattern of the normal spine.

Summary of Background Data.
The normal, nonscoliotic thoracic spine is known to have a rotational pattern that changes direction during growth, a transition from left-sided toward right-sided rotation with increasing age. This matches the changing curve convexity seen when idiopathic scoliosis develops at different ages. Furthermore, the direction of pre-existent rotation was shown to be related to organ orientation; in situs inversus the rotation is opposite to situs solitus.

Methods.
Computed tomography (CT) scans of the thorax of infantile (0–4 years, n = 40), juvenile (4–10 years, n = 53), and adolescent (10–18 years, n = 62) children without spinal pathology were included from an existing database. The location of the COM inside the thorax was calculated based on Hounsfield-units, representing tissue mass. The COM offset was defined as the shortest distance to the midsagittal plane.

Results.
At the infantile age, the COM was 2.5 ± 2.1 mm on the right side, at juvenile age not significantly deviated, and at adolescent age 3.1 ± 2.3 mm on the left side of the midsagittal plane. The mean COM offset correlated linearly with age (r = 0.77, P < 0.001).

Conclusion.
The COM shifts from slightly on the right side of the thorax at the infantile age, to neutral at juvenile age, to the left at adolescent age. This corresponds to the earlier demonstrated change in direction of pre-existent rotation in the normal spine with age, as well as with the well-known changing direction, from left to right, of thoracic curve convexity in scoliosis at different ages.

Level of Evidence: N/ A
Minimum Clinically Important Difference and Patient Acceptable Symptom State of Japanese Orthopaedic Association Score in Degenerative Cervical Myelopathy Patients
Authors: Kato So , Oshima Yasushi , Matsubayashi Yoshitaka , Taniguchi Yuki , Tanaka Sakae , Takeshita Katsushi 
Published: November 2018

Study Design.
A retrospective analysis.

Objective.
The aim of this study was to elucidate the psychometric properties of the original Japanese Orthopaedic Association (JOA) score, including the minimum detectable change (MDC), minimum clinically important difference (MCID), and patient-accepted symptom state (PASS).

Summary of Background Data.
Despite the worldwide popularity of modified JOA score (mJOA), the original JOA score is still commonly used in East Asian countries, including Japan. However, unlike mJOA score, the psychometric properties of JOA score remain poorly understood.

Methods.
We retrospectively reviewed a consecutive series of laminoplasty for degenerative cervical myelopathy patients in a single academic institution. Pre- and postoperative JOA scores were collected, and the recovery rate was calculated. Anchor-based methods were used to determine the cut-off values by a receiver operating characteristic (ROC) curve analysis. The patients were also asked to answer an anchor question analyzing their postoperative health transition used for the MDC and another question assessing the patient satisfaction used for the MCID and PASS.

Results.
A total of 101 patients were included in the analysis. The mean preoperative JOA score was 10.3 [standard deviation (SD): 2.4), and the mean postoperative JOA score was 13.4 (SD: 2.5). The mean recovery rate was 44%. A total of 68% of the patients admitted that their health condition was at least “somewhat better” than their preoperative condition, and 66% were at least “somewhat satisfied” with the treatment results. On the basis of ROC curve analyses, the MDC and MCID for JOA score in degenerative cervical myelopathy patients were calculated to be 2.5. The PASS was estimated to be 14.5, and the MCID for JOA recovery rate was 52.8%.

Conclusion.
The MDC, MCID, and PASS for JOA score for degenerative cervical myelopathy patients were reported by anchor-based ROC curve analyses.

Level of Evidence: 4
Posterolateral Versus Transforaminal Interbody L4/5 Fusion
Authors: Gaffney Christian J. , Pinto Manuel R. , Buyuk Abdul F. , Garvey Timothy A. , Mueller Benjamin , Schwender James D. , Transfeldt Ensor E. , Tam Harrison K. , Dawson John M. 
Published: November 2018

Study Design:
This is a retrospective cohort study.

Objective:
To compare posterolateral versus transforaminal interbody fusion (PLF vs. PLF+TLIF) of the L4/5 segment regarding rates of subsequent surgery, clinical and radiographic parameters, and patient satisfaction.

Summary of Background Data:
Surgical treatment of lumbar stenosis, decompression with or without fusion, is an efficacious treatment in select patients. Reoperation is thought to be a problem after lumbar fusion. Despite multiple studies, the fusion method that minimizes the need for subsequent surgery has yet to be determined.

Materials and Methods:
A retrospective cohort study was conducted on 89 patients who had an isolated L4/5 decompression and fusion, from January 2006 to 2012. All patients had stenosis and degenerative spondylolisthesis at the L4/5 level. All surgeries were performed at a single center, using either PLF (31 patients) or PLF+TLIF (58 patients) techniques. Preoperative and postoperative patient-reported outcome measures (Oswestry disability index, visual analog scale back pain, visual analog scale leg pain) and radiographic parameters (L4/5 lordosis and overall lumbar lordosis) were measured. Patient satisfaction was acquired via a questionnaire. Chart reviews and patient questionnaires were used to determine the incidence of subsequent lumbar surgery over a minimum follow-up of 5 years.

Results:
At an average of 8.7 years follow-up, 2 of 31 patients in the PLF group had subsequent lumbar surgery, compared with 16 of 58 patients in the PLF+TLIF group (6% vs. 28%; P=0.02). There were no significant differences between groups with respect to sex, age, body mass index, tobacco, perioperative measures, patient-reported outcomes, or radiographic parameters (P>0.05).

Conclusions:
Both PLF and PLF+TLIF are effective fusion methods for L4/5 stenosis and spondylolisthesis. In this study, patients treated with PLF were less likely to undergo a subsequent lumbar surgery. More research is needed to determine which factors influence whether PLF or PLF+TLIF should be used in these patients.

Level of Evidence:
Level III.
Percutaneous Vertebroplasty Does Not Increase the Incidence of New Fractures in Adjacent and Nonadjacent Vertebral Bodies
Authors: Yang Wencheng , Yang Jianyi , Liang Ming 
Published: November 2018

Study Design:
This was a clinical retrospective study.

Objectives:
This retrospective study aimed to investigate the incidence of new vertebral compression fractures (NVCFs) and analyze the risk factors that influence the secondary fractures in adjacent and nonadjacent levels after percutaneous vertebroplasty (PVP) and conservative treatment (CT).

Summary of Background Data:
PVP is an effective procedure to alleviate the pain caused by osteoporotic vertebral compression fractures. NVCFs have been noted as a potential late sequela of the procedure. However, it remains unclear whether NVCFs are due to this augmentation or simply are the result of the natural progression of osteoporosis.

Methods:
A total of 290 patients who had undergone PVP and 270 patients who had undergone CT during the last 4 years were examined. They were followed-up on a monthly basis by telephone for >2 years. They were divided into 2 groups: NVCFs and non-NVCFs. The groups were statistically compared in terms of age, sex, body mass index, initial fracture levels, bone mineral density (BMD) score of the spine, original fracture levels, and new fracture levels.

Results:
After a mean follow-up of at least 24 months (range, 24−78 mo), 42 NVCFs occurred in 37 of 290 patients after PVP and 33 NVCFs in 30 of 270 patients after CT. Only BMD was significantly different between the groups. Lower BMD was a significant predictive factor for NVCFs.

Conclusions:
PVP did not increase the incidence of NVCFs, especially those adjacent to the treated vertebrae, following augmentation with PVP compared with CT. The most important risk factor for NVCFs was osteoporosis.
Effects of Fluid Bolus Therapy on Renal Perfusion, Oxygenation, and Function in Early Experimental Septic Kidney Injury
Authors: Lankadeva Yugeesh R. , Kosaka Junko , Iguchi Naoya , Evans Roger G. , Booth Lindsea C. , Bellomo Rinaldo , May Clive N 
Published: November 2018

Objectives:
To examine the effects of fluid bolus therapy on systemic hemodynamics, renal blood flow, intrarenal perfusion and oxygenation, Po
2, renal function, and fluid balance in experimental early septic acute kidney injury.

Design:
Interventional study.

Setting:
Research institute.

Subjects:
Adult Merino ewes.

Interventions:
Implantation of flow probes on the pulmonary and renal arteries and laser Doppler oxygen-sensing probes in the renal cortex, medulla, and within a bladder catheter in sheep. Infusion of Escherichia coli to induce septic acute kidney injury (n = 8). After 24, 25, and 26 hours of sepsis, fluid bolus therapy (500 mL of Hartmann’s solution over 15 min) was administered.

Measurements and Main Results:
In conscious sheep, infusion of Escherichia coli decreased creatinine clearance and increased plasma creatinine, renal blood flow (+46% ± 6%) and cortical perfusion (+25% ± 4%), but medullary perfusion (–48% ± 5%), medullary Po
2 (–56% ± 4%), and urinary Po
2 (–54% ± 3%) decreased (p < 0.01). The first fluid bolus therapy increased blood pressure (+6% ± 1%), central venous pressure (+245% ± 65%), cardiac output (+11% ± 2%), medullary Po
2 (+280% ± 90%), urinary Po
2 (+164% ± 80%), and creatinine clearance (+120% ± 65%) at 30 minutes. The following two boluses had no beneficial effects on creatinine clearance. The improvement in medullary oxygenation dissipated following the third fluid bolus therapy. Study animals retained 69% of the total volume and 80% of sodium infused. Throughout the study, urinary Po
2 correlated significantly with medullary Po
2.

Conclusions:
In early experimental septic acute kidney injury, fluid bolus therapy transiently improved renal function and medullary Po
2, as also reflected by increased urinary Po
2. These initial effects of fluid bolus therapy dissipated within 4 hours, despite two additional fluid boluses, and resulted in significant volume retention.
The Effect of Propofol and Dexmedetomidine Sedation on Norepinephrine Requirements in Septic Shock Patients: A Crossover Trial
Authors: Morelli Andrea , Sanfilippo Filippo , Arnemann Philip , Hessler Michael , Kampmeier Tim G. , D’Egidio Annalia , Orecchioni Alessandra , Santonocito Cristina , Frati Giacomo , Greco Ernesto , Westphal Martin , Rehberg Sebastian W. , Ertmer Christian 
Published: November 2018

Objectives:
Propofol-based sedation may increase hemodynamic instability by decreasing vascular tone and venous return. Incremental exogenous catecholamines doses may be required to counteract such effects, aggravating the deleterious effects of sympathetic overstimulation. α-2 adrenergic agonists have been reported to decrease norepinephrine requirements in experimental septic shock. The aim of the present study is to test the hypothesis that switching from sedation with propofol to the α-2 agonist dexmedetomidine may decrease norepinephrine doses in septic shock.

Design:
Prospective open-label crossover study.

Settings:
University hospital, ICU.

Patients:
Thirty-eight septic shock patients requiring norepinephrine to maintain adequate mean arterial pressure and needing deep sedation with propofol and remifentanil to maintain a Richmond Agitation-Sedation Scale score between –3 and –4.

Interventions:
An initial set of measurements including hemodynamics, norepinephrine doses, and depth of sedation were obtained during sedation with propofol. Propofol was then replaced by dexmedetomidine and a second set of data was obtained after 4 hours of dexmedetomidine infusion. Sedation was switched back to propofol, and a final set of measurements was obtained after 8 hours. A Richmond Agitation-Sedation Scale score between –3 and –4 was maintained during the study period.

Measurements and Main Results:
Norepinephrine requirements decreased from 0.69 ± 0.72 μg/kg/min before dexmedetomidine to 0.30 ± 0.25 μg/kg/min 4 hours after dexmedetomidine infusion, increasing again to 0.42 ± 0.36 μg/kg/min while on propofol 8 hours after stopping dexmedetomidine (p < 0.005). Dexmedetomidine dosage was 0.7 ± 0.2 μg/kg/hr. Before and after dexmedetomidine infusion, sedative doses remained unchanged (propofol 2.6 ± 1.2 vs 2.6 ± 1.2 mg/kg/hr; p = 0.23 and remifentanil 1.27 ± 0.17 vs 1.27 ± 0.16 μg/kg/hr; p = 0.52, respectively). Richmond Agitation-Sedation Scale was –4 (–4 to –3) before, –4 (–4 to –3) during, and –4 (–4 to –4) after dexmedetomidine (p = 0.07).

Conclusions:
For a comparable level of sedation, switching from propofol to dexmedetomidine resulted in a reduction of catecholamine requirements in septic shock patients.
The Fragility and Reliability of Conclusions of Anesthesia and Critical Care Randomized Trials With Statistically Significant Findings: A Systematic Review*
Authors: Grolleau François , Collins Gary S. , Smarandache Andrei , Pirracchio Romain , Gakuba Clément , Boutron Isabelle , Busse Jason W. , Devereaux P. J. , Le Manach Yannick 
Published: November 2018

Objectives:
The Fragility Index, which represents the number of patients responsible for a statistically significant finding, has been suggested as an aid for interpreting the robustness of results from clinical trials. A small Fragility Index indicates that the statistical significance of a trial depends on only a few events. Our objectives were to calculate the Fragility Index of statistically significant results from randomized controlled trials of anesthesia and critical care interventions and to determine the frequency of distorted presentation of results or “spin”.

Data Sources:
We systematically searched MEDLINE from January 01, 2007, to February 22, 2017, to identify randomized controlled trials exploring the effect of critical care medicine or anesthesia interventions.

Study Selection:
Studies were included if they randomized patients 1:1 into two parallel arms and reported at least one statistically significant (p < 0.05) binary outcome (primary or secondary).

Data Extraction:
Two reviewers independently assessed eligibility and extracted data. The Fragility Index was determined for the chosen outcome. We assessed the level of spin in negative trials and the presence of recommendations for clinical practice in positive trials.

Data Synthesis:
We identified 166 eligible randomized controlled trials with a median sample size of 207 patients (interquartile range, 109–497). The median Fragility Index was 3 (interquartile range, 1–7), which means that adding three events to one of the trials treatment arms eliminated its statistical significance. High spin was identified in 42% (n = 30) of negative randomized controlled trials, whereas 21% (n = 20) of positive randomized controlled trials provided recommendations. Lower levels of spin and recommendations were associated with publication in journals with high impact factors (p < 0.001 for both).

Conclusions:
Statistically significant results in anesthesia and critical care randomized controlled trials are often fragile, and study conclusions are frequently affected by spin. Routine calculation of the Fragility Index in medical literature may allow for better understanding of trials and therefore enhance the quality of reporting.
Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database*
Authors: Lindell Robert B. , Nishisaki Akira , Weiss Scott L. , Balamuth Fran , Traynor Danielle M. , Chilutti Marianne R. , Grundmeier Robert W. , Fitzgerald Julie C. 
Published: November 2018

Objectives:
To compare the performance of three methods of identifying children with severe sepsis and septic shock from the Virtual Pediatric Systems database to prospective screening using consensus criteria.

Design:
Observational cohort study.

Setting:
Single-center PICU.

Patients:
Children admitted to the PICU in the period between March 1, 2012, and March 31, 2014.

Interventions:
None.

Measurements and Main Results:
During the study period, all PICU patients were prospectively screened daily for sepsis, and those meeting consensus criteria for severe sepsis or septic shock on manual chart review were entered into the sepsis registry. Of 7,459 patients admitted to the PICU during the study period, 401 met consensus criteria for severe sepsis or septic shock (reference standard cohort). Within Virtual Pediatric Systems, patients identified using “Martin” (n = 970; κ = 0.43; positive predictive value = 34%; F1 = 0.48) and “Angus” International Classification of Diseases, 9th Edition, Clinical Modification codes (n = 1387; κ = 0.28; positive predictive value = 22%; F1 = 0.34) showed limited agreement with the reference standard cohort. By comparison, explicit International Classification of Diseases, 9th Edition, Clinical Modification codes for severe sepsis (995.92) and septic shock (785.52) identified a smaller, more accurate cohort of children (n = 515; κ = 0.61; positive predictive value = 57%; F1 = 0.64). PICU mortality was 8% in the reference standard cohort and the cohort identified by explicit codes; age, illness severity scores, and resource utilization did not differ between groups. Analysis of discrepancies between the reference standard and Virtual Pediatric Systems explicit codes revealed that prospective screening missed 66 patients with severe sepsis or septic shock. After including these patients in the reference standard cohort as an exploratory analysis, agreement between the cohort of patients identified by Virtual Pediatric Systems explicit codes and the reference standard cohort improved (κ = 0.73; positive predictive value = 70%; F1 = 0.75).

Conclusions:
Children with severe sepsis and septic shock are best identified in the Virtual Pediatric Systems database using explicit diagnosis codes for severe sepsis and septic shock. The accuracy of these codes and level of clinical detail available in the Virtual Pediatric Systems database allow for sophisticated epidemiologic studies of pediatric severe sepsis and septic shock in this large, multicenter database.