bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulse Pressure Variations and Plethysmographic Variability Index Measured at Ear Are Able to Predict Fluid Responsiveness in the Sitting Position for Neurosurgery
Authors: Bapteste Lionel , Carrillon Romain , Javelier Stéphanie , Guyotat Jacques , Desgranges François-P. , Lehot Jean-j. , Lukaszewicz Anne-c. 
Published: February 2019

Background:
Pulse pressure variation (PPV) and plethysmographic variability index (PVI), dynamic indicators of preload dependence based on heart-lung interactions, are used to predict fluid responsiveness in mechanically ventilated patients in the supine position. The sitting position for neurosurgery, by changing intrathoracic blood volume, could affect the capacity of PPV and PVI to predict fluid responsiveness. The aim of the study was to assess the ability of PPV and PVI to predict fluid responsiveness during general anesthesia in the sitting position.

Methods:
In total, 31 patients were included after settling in the sitting position but before surgery began. PPV, PVI with a finger sensor (PVI finger), and PVI with an ear sensor (PVI ear) were recorded before and after a fluid challenge of hydroxylethylstarch 250 mL over 10 minute. Esophageal Doppler was used to record stroke volume. Patients were defined as fluid responders if stroke volume increased by more than 10% after the fluid challenge.

Results:
In total, 13 (42%) patients were fluid responders. PPV and PVI ear were higher in responders than in nonresponders before the fluid challenge (12±5 vs. 7±3; P=0.0005 and 14±5 vs. 8±3; P=0.001, respectively). Areas under the receiver-operating curves to predict fluid responsiveness were 0.87 for PPV (P<0.0001), 0.87 for PVI ear (P<0.0001), and 0.64 for PVI finger (P=0.17). PPV ≥8% or PVI ear ≥11% predicted fluid responsiveness with sensitivities of 83% for both, and specificities of 83% and 91%, respectively. However PVI ear data were not available in 26% of patients.

Conclusions:
PPV can be used to predict fluid responsiveness in the sitting position for neurosurgery.
Prediction of infection risk in rheumatoid arthritis patients treated with biologics: are we any closer to risk stratification?
Authors: Jani Meghna , Barton Anne , Hyrich Kimme 
Published: February 2019

Purpose of review
There are currently several available biologics for rheumatoid arthritis (RA) with similar efficacy in most trials. A major consideration therefore in choosing a biologic, continues to be safety concerns such as infection. Considerable advances have been made in the understanding of biologic safety on a population level; however, how close are we to stratifying risk for individual patients? This review discusses evidence published in the last year, with reference to key previous literature.

Recent findings
Comparative safety of biologics has been studied in observational cohorts, with a possible increased risk of serious infection in tocilizumab-treated patients compared with etanercept. Rheumatoid arthritis patients on biologics are often on concomitant medications such as steroids and opioids, and the advances in relation to infection are summarized. Pharmacological biomarkers and optimizing existing risk prediction scores may allow better future risk stratification.

Summary
Improved quantification of personalized benefit:harms would allow better-informed decisions, reduction of infection-associated morbidity as well as direct/indirect costs associated with biologics. Although advances have been made to better understand and predict risk, future studies are likely to require a range of novel data sources and methodologies for the goal of precision medicine to be truly realized.
Does Hospital Volume Affect Outcomes in Spine Surgeries? A Systematic Review
Authors: Adkins Zachary B. , Malik Azeem T. , Jain Nikhil , Yu Elizabeth , Kim Jeffery , Khan Safdar N. 
Published: February 2019

Study Design:
Systematic review.

Objective:
To assess the impact of hospital volume on postoperative outcomes in spine surgery.

Summary of Background Data:
Several strategies have recently been proposed to optimize provider outcomes, such as regionalization to higher volume centers and setting volume benchmarks.

Materials and Methods:
We performed a systematic review examining the association between hospital volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior/posterior cervical fusions, anterior/posterior lumbar fusions, laminectomies, discectomies, spinal deformity surgeries, and surgery for spinal malignancies. We searched the Pubmed, OVID MEDLINE (1966–2018), Google Scholar, and Web of Science (1900–2018) databases in January 2018 using the search criteria (“Hospital volume” OR “volume” OR “volume-outcome” OR “volume outcome”) AND (“spine” OR “spine surgery” OR “lumbar” OR “cervical” OR “decompression” OR “deformity” OR “fusions”). There were no restrictions placed on study design, publication date, or language. The studies were evaluated with respect to the quality of methodology as outlined by the Grading of Recommendations Assessment, Development, and Evaluation system.

Results:
Twelve studies were included in the review. Studies were variable in defining hospital volume thresholds. Higher hospital volume was associated with statistically significant lower risks of postoperative complications, a shorter length of stay, lower cost of hospital stay, and a lower risk of readmissions and reoperations/revisions.

Conclusions:
Our findings suggest a trend toward better outcomes for higher volume hospitals; however, further study needs to be carried out to define objective volume thresholds for specific spine surgeries for hospitals to use as a marker of proficiency.
Cost-utility Analysis for Recurrent Lumbar Disc Herniation
Authors: Selva-Sevilla Carmen , Ferrara Paula , Gerónimo-Pardo Manuel 
Published: February 2019

Study Design:
This study was an ambispective long-term cost-utility analysis with retrospective chart review and included the prospective completion of health questionnaires by patients.

Objective:
This was a cost-utility analysis, comparing conservative treatment, discectomy, and discectomy with spinal fusion for patients with recurrent lumbar disc herniation after a previous discectomy.

Summary of Background Data:
Lumbar disc herniation is an important health problem, with recurrence rates ranging from 5% to 15%. Management of recurrences is controversial due to a lack of high-level evidence. Cost-effectiveness analyses are useful when making clinical decisions. There are economic assessments for first herniations, but not in the context of recurrent lumbar disc herniations.

Materials and Methods:
Fifty patients with disc herniation recurrence underwent conservative treatment (n=11), discectomy (n=20), or discectomy with fusion (n=19), and they completed the Short-Form 36, EuroQol-5D, and Oswestry Disability Index.
Baseline case quality-adjusted life year (QALY) values, cost-utility ratios, and incremental cost-utility ratios were calculated on the basis of the SF-36. Direct health costs were calculated by applying the health care system perspective. Both QALY and costs were discounted at a rate of 3%. One-way sensitivity analyses were conducted for uncertainty variables, such as other health surveys or 2-year follow-up.

Results:
Cost-utility analysis of conservative treatment versus discectomy showed that the former is dominant, mainly because it is significantly more economical (€904 vs. €6718, P<0.001), while health results were very similar (3.48 vs. 3.18, P=0.887). Cost-utility analysis of discectomy versus discectomy with fusion revealed that discectomy is dominant, showing a trend to be both more economical (€6718 vs. €9364, P=0.054) and more effective (3.18 vs. 1.92 QALY, P=0.061).

Conclusions:
This cost-utility analysis showed that conservative treatment is more cost-effective than discectomy in patients with lumbar disc herniation recurrence. In cases of recurrence in which conservative treatment is not feasible, and another surgery must be performed for the patient, discectomy is a more cost-effective surgical alternative than discectomy with fusion.

Level of Evidence:
Level II.
The Use of Bone Morphogenetic Protein in the Intervertebral Disk Space in Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: White Ian K. , Tuohy Megan , Archer Jacob , Schroeder Gregory D. , Vaccaro Alexander R. , Mobasser Jean-Pierre 
Published: February 2019

Study Design:
Retrospective Cohort.

Objective:
The objective of this study was to characterize one surgeon’s experience over a 10-year period using rhBMP-2 in the disk space for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:
MIS TLIF has been utilized as a technique for decreasing patients’ immediate postoperative pain, decreasing blood loss, and shortened hospital stays. Effectiveness and complications of rhBMP-2’s use in the disk space is limited because of its off-label status.

Methods:
Retrospective analysis of consecutive MIS TLIFs performed by senior author between 2004 and 2014. rhBMP-2 was used in the disk space in all cases. Patients were stratified based on the dose of rhBMP-2 utilized. Patients had 9 to 12 month computerized tomography scan to evaluate for bony fusion and continued follow-up for 18 months.

Results:
A total of 688 patients underwent a MIS TLIF. A medium kit of rhBMP-2 was utilized in 97 patients, and small kit was used in 591 patients. Fusion rate was 97.9% and this was not different between the 2 groups with 96/97 patients fusing in the medium kit group and 577/591 patients fusing in the small kit group. Five patients taken back to the operating room for symptomatic pseudoarthrosis, 4 reoperated for bony hyperostosis, and 10 radiographic pseudoarthroses that did not require reoperation. A statistically significant difference in the rate of foraminal hyperostosis was found when using a medium sized kit of rhBMP-2 was 4.12% (4/97 patients), compared with a small kit (0/591 patients, P=0.0004).

Conclusions:
Utilization of rhBMP-2 in an MIS TLIF leads to high fusion rate (97.9%), with an acceptable complication profile. The development of foraminal hyperostosis is a rare complication that only affected 0.6% of patients, and seems to be a dose related complication, as this complication was eliminated when a lower dose of rhBMP-2 was utilized.

Level of Evidence:
Level IV.
Safety Profile of Lumbosacropelvic Fixation in Patients Aged 60 Years or Older
Authors: Ishida Wataru , Ramhmdani Seba , Casaos Joshua , Perdomo-Pantoja Alexander , Elder Benjamin D. , Theodore Nicholas , Gokaslan Ziya L. , Wolinsky Jean-Paul , Sciubba Daniel M. , Bydon Ali , Witham Timothy F. , Lo Sheng-Fu L. 
Published: February 2019

Study Design:
This is a retrospective study.

Objective:
To report the safety profile of S2-alar-iliac (S2AI) in patients over 60, comparing S2AI screws with iliac screws (ISs).

Summary of Background Data:
The surgical management involving the lumbosacropelvic spine remains a challenge due to high mechanical demand and risk of pseudarthrosis. Previous articles showed lower rates of complications in patients receiving S2AI screws than ISs; however, none of them have focused on patients aged over 60 who may harbor significant comorbidities and thus require more meticulous perioperative management, given these invasive and lengthy procedures.

Materials and Methods:
Retrospective review of clinical records from 2010 to 2015 identified 60 patients undergoing lumbosacropelvic fixation (17 patients with ISs and 43 patients with S2AI screws) who satisfied the following criteria: (1) patients aged over 60 years old and (2) patients with >1-year follow-up periods. Rates of complications such as unplanned reoperation and cardiorespiratory complications were collected and statistically analyzed.

Results:
Baseline characteristics such as age, sex, and comorbidities were similar in both groups. The S2AI group had lower rates of reoperation (18.6% vs. 47.4%; P=0.02), surgical site infection (2.3% vs. 29.4%; P=0.006), wound dehiscence (2.3% vs. 29.4%; P=0.006), and postoperative anemia (7.0% vs. 29.4%; P=0.03) and had lower total volume of estimated blood loss (EBL) (mL) (1846.4 vs. 2721.2; P=0.02) and transfused red blood cell units (7.2 vs. 4.7; P=0.04) than the IS group, while rates of L5–S1 pseudarthrosis and other cardiorespiratory complications were similar in both groups. In multivariate analysis, operative time, body mass index, and use of S2AI screws over ISs were independent predictors of EBL.

Conclusions:
Use of S2AI screws over ISs in patients aged over 60 was associated with lower rates of reoperation, surgical site infection, wound dehiscence, and lower volume of EBL and red blood cell transfusion and is a viable surgical option.
Navigation Versus Fluoroscopy in Multilevel MIS Pedicle Screw Insertion
Authors: Konieczny Markus R. , Krauspe Rüdiger 
Published: February 2019

Study Design:
This study was a retrospective radiographic analysis of consecutive patients.

Objectives:
To analyze exposure to radiation of the surgeon and—separately—of patients in minimally invasive surgery (MIS) of multilevel posterior stabilization by percutaneous pedicle screw insertion guided by navigation (PIN) versus percutaneous pedicle screw insertion guided by fluoroscopy (PIF).

Summary of Background Data:
Spine surgeons are exposed to a 12-fold higher dose of radiation than other nonspinal musculoskeletal surgeons and PIF in MIS leads to a 2-fold higher dose of radiation than in open surgery. PIN might reduce the dose of radiation for the surgeon and the patient, especially in multilevel MIS surgery. To the best of our knowledge, there are only rare data of short-segment fusions that do not focus on exposure to radiation of surgeons.

Methods:
After power analysis, we included 205 consecutive screws (22 patients). We monitored dose of radiation (recorded separately for patient and surgeon), accuracy of screw placement, time of operation, and approach-related complications.

Results:
In PIN, only 58.7% of dose area product (cGy×cm2) per screw of PIF was determined for patients (P<0.01). The surgeon was only exposed to 19.9% of radiation per screw in PIN compared with dosage in PIF (P<0.01). Four of 205 screws (2.0%) were classified as being incorrectly positioned: 2 of 87 screws (2.3%) in PIF and 2 of 118 screws (1.7%) in PIN (P>0.05). We did not observe any wound infections.

Conclusions:
PIN in MIS is a safe procedure and does, compared with PIF, lead to significant reduction of radiation dose for patients and—even more—for spine surgeons.
Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study
Authors: Kushimoto Shigeki , Abe Toshikazu , Ogura Hiroshi , Shiraishi Atsushi , Saitoh Daizoh , Fujishima Seitaro , Mayumi Toshihiko , Hifumi Toru , Shiino Yasukazu , Nakada Taka-aki , Tarui Takehiko , Otomo Yasuhiro , Okamoto Kohji , Umemura Yutaka , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiraishi Shin-ichiro , Takuma Kiyotsugu , Tsuruta Ryosuke , Hagiwara Akiyoshi , Yamakawa Kazuma , Masuno Tomohiko , Takeyama Naoshi , Yamashita Norio , Ikeda Hiroto , Ueyama Masashi , Fujimi Satoshi , Gando Satoshi 
Published: February 2019

Objectives:
To investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients.

Design:
Retrospective sub-analysis.

Setting:
Fifty-nine ICUs in Japan, from January 2016 to March 2017.

Patients:
Adult patients with severe sepsis based on Sepsis-2 were enrolled and divided into three categories (body temperature < 36°C, 36–38°C, > 38°C), using the core body temperature at ICU admission.

Interventions:
None.

Measurements and Main Results:
Compliance with the bundles proposed in the Surviving Sepsis Campaign Guidelines 2012, in-hospital mortality, disposition after discharge, and the number of ICU and ventilator-free days were evaluated. Of 1,143 enrolled patients, 127, 565, and 451 were categorized as having body temperature less than 36°C, 36–38°C, and greater than 38°C, respectively. Hypothermia—body temperature less than 36°C—was observed in 11.1% of patients. Patients with hypothermia were significantly older than those with a body temperature of 36–38°C or greater than 38°C and had a lower body mass index and higher prevalence of septic shock than those with body temperature greater than 38°C. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on the day of enrollment were also significantly higher in hypothermia patients. Implementation rates of the entire 3-hour bundle and administration of broad-spectrum antibiotics significantly differed across categories; implementation rates were significantly lower in patients with body temperature less than 36°C than in those with body temperature greater than 38°C. Implementation rate of the entire 3-hour resuscitation bundle + vasopressor use + remeasured lactate significantly differed across categories, as did the in-hospital and 28-day mortality. The odds ratio for in-hospital mortality relative to the reference range of body temperature greater than 38°C was 1.760 (95% CI, 1.134–2.732) in the group with hypothermia. The proportions of ICU-free and ventilator-free days also significantly differed between categories and were significantly smaller in patients with hypothermia.

Conclusions:
Hypothermia was associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles.
Renal Replacement Therapy in the ICU
Authors: Rachoin Jean-Sebastien , Weisberg Lawrence S. 
Published: February 2019

Objectives:
The incidence of acute kidney injury in critically ill patients is increasing steeply. Acute kidney injury in this setting is associated with high morbidity and mortality. There is no doubt that renal replacement therapy for the most severe forms of acute kidney injury can be life saving, but there are a number of uncertainties about the optimal application of renal replacement therapy for patients with acute kidney injury. The objective of this synthetic review is to present current evidence supporting best practices in renal replacement therapy for critically ill patients with acute kidney injury.

Data Sources:
We reviewed literature regarding timing of initiation of renal replacement therapy, optimal vascular access for renal replacement therapy in acute kidney injury, modality selection and dose or intensity of renal replacement therapy, and anticoagulation during renal replacement therapy, using the following databases: MEDLINE and PubMed. We also reviewed bibliographic citations of retrieved articles.

Study Selection:
We reviewed only English language articles.

Conclusions:
Current evidence sheds light on many areas of controversy regarding renal replacement therapy in acute kidney injury, providing a foundation for best practices. Nonetheless, important questions remain to be answered by ongoing and future investigation.
Integrating poly(ADP-ribose) polymerase (PARP) inhibitors in the treatment of early breast cancer
Authors: Garber Haven R. , Litton Jennifer K. 
Published: February 2019

Purpose of review
Poly(ADP-ribose) polymerase (PARP) inhibitors were recently approved for the treatment of patients with BRCA1 or BRCA2 germline pathogenic variants and metastatic breast cancer. PARP inhibitors have also demonstrated activity in early stage breast cancer, and this review discusses completed and ongoing trials of PARP inhibitors in the neoadjuvant and adjuvant setting.

Recent findings
A recent phase II trial of neoadjuvant talazoparib monotherapy in patients with BRCA1 or BRCA2 germline pathogenic variants and early stage breast cancer demonstrated a pathological complete response in 10/19 (53%) patients. Previous trials of PARP inhibition in early stage breast cancer included the I-SPY-2 and BrighTNess trials, which ultimately failed to show a benefit for adding the PARP inhibitor veliparib to standard neoadjuvant chemotherapy in patients with triple-negative breast cancer. Investigators are building on these results by designing novel clinical trials for patients with BRCA1/2-deficient tumors and/or triple-negative breast cancer.

Summary
The OlympiAD and EMBRACA trials that led to the recent approval of PARP inhibitors for metastatic breast cancer patients with BRCA1/2 germline pathogenic variants are practice changing. Investigators are now working to translate this success into the early breast cancer setting where ongoing trials incorporate new dosing schedules, PARP inhibitor monotherapy, and novel PARP combinations.
Incidence of Neonatal Neutropenia and Leukopenia After In Utero Exposure to Chemotherapy for Maternal Cancer
Authors: La Nasa Maria , Gaughan John , Cardonick Elyce 
Published: February 2019

Objective:
The main purpose of this article was to report the incidence of neonatal neutropenia or leukopenia after chemotherapy exposure during pregnancy according to the time elapsed between treatment during pregnancy and birth.

Background:
A single study reports 33% of infants exposed to chemotherapy within the last month of pregnancy are born with neutropenia, which can place the newborn at risk for nosocomial infections. On the basis of this report, chemotherapy is typically stopped by 34 weeks of pregnancy to avoid maternal or neonatal myelosuppression at delivery. Such a pause in treatment may affect maternal health. Determining the true incidence of neutropenia after chemotherapy in relation to the time of this lapse in treatment is important to support this practice.

Materials and Methods:
Complete blood counts are collected for newborn whose mothers were treated for cancer during pregnancy and enrolled in the Cancer and Pregnancy Registry. Neutropenia was defined as absolute neutrophil count<1000 mm3 and leukopenia was defined as white blood cells <5000 cells/μL. Incidence of neutropenia was calculated according to the time elapsed from last chemotherapy treatment until birth. Fisher’s exact test is used to determine if neutropenia or leukopenia is related to the time elapsed between chemotherapy during pregnancy and newborn birth. A Bayesian analysis evaluated the occurrence of neutropenia and leukopenia according to the number of days between the initiation of chemotherapy and birth.

Results:
A total of 135 infants exposed to chemotherapy in utero with a complete blood count collected at birth were identified from the database. Only 7.3% and 2.9% of infants were born with neutropenia or leukopenia, respectively. The highest incidence of newborn neutropenia occurred in infants delivered 22 to 28 days after chemotherapy.

Conclusions:
The incidence of neutropenia peaks when chemotherapy is given 22 to 28 days before birth, while leukopenia is highest if delivery is <7 days from chemotherapy.