bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of a Bone-anchored Annular Closure Device Versus Conventional Lumbar Discectomy in Treating Lumbar Disc Herniations
Authors: Ament Jared , Thaci Bart , Yang Zhuo , Kulubya Edwin , Hsu Wellington , Bouma Gerrit , Kim Kee D. 
Published: June 2018

Study Design.
Cost-utility analysis of an annular closure device (ACD) based on data from a prospective, multicenter randomized controlled trial (RCT)

Objective.
The aim of this study was to determine the cost-effectiveness of a novel ACD in a patient population at high risk for recurrent herniation following discectomy.

Summary of Background Data.
Lumbar disc herniation patients with annular defect widths ≥6 mm are at high risk for recurrent herniation following limited discectomy. Recurrent herniation is associated with worse clinical outcomes and greater healthcare costs. A novel ACD may reduce the incidence of recurrent herniation and the associated burdens.

Methods.
A decision analytical modeling approach with a Markov method was used to evaluate the cost-effectiveness of the ACD versus conventional discectomy. Health states were created by projecting visual analogue scale (VAS) onto Oswestry Disability Index (ODI). Direct costs were calculated based on Humana and Medicare 2014 claims to represent private and public payer data, respectively. Indirect costs were calculated for lost work days using 2016 US average annual wages. The incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life year (QALY) was compared to willingness-to-pay thresholds. Sensitivity analyses were also conducted.

Results.
Patients with the ACD had less symptomatic reherniations, reoperations, and complications and gained 0.0328 QALYs within the first 2 years. Total direct medical costs for the ACD group were similar to control. When productivity loss was considered, using the ACD became $2076 cheaper, per patient, than conventional discectomy. Based on direct costs alone, the ICER comparing ACD to control equaled $6030 per QALY. When indirect costs are included, the ICER became negative, which indicates that superior quality of life was attained at less cost.

Conclusion.
For lumbar disc herniations patients with annular defects ≥6 mm, the ACD was, at 2 years, a highly cost-effective surgical modality compared to conventional lumbar discectomy.

Level of Evidence: 1
Preoperative Sagittal Spinal Profile of Adolescent Idiopathic Scoliosis Lenke Types and Non-Scoliotic Adolescents
Authors: Pasha Saba , Baldwin Keith 
Published: June 2018

Study Design.
Systematic review and meta-analysis.

Objective.
This study aims to determine the differences in sagittal spinopelvic parameters between adolescent idiopathic scoliosis (AIS) Lenke types and non-scoliotic controls through a systematic review and meta-analysis of the available literature.

Summary of Background Data.
AIS classification mainly focuses on frontal curve differences; however, the variations in the sagittal spinopelvic alignment in the current classification system is not fully established.

Methods.
Following preferred reporting items for systematic reviews and meta-analyses guidelines, searches were performed for sagittal spinal and pelvic parameters of Lenke types and non-scoliotic controls in PubMed, Scopus, EMBASE, and Cochrane databases. Selection criteria were: (1) age range 10 to 21 years; (2) Lenke types 1–6 (for AIS group) or non-scoliotic adolescents (for the control group); (3) preoperative data for T5–T12 thoracic kyphosis (TK), L1–S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA). (4) Written in English language. PI–LL mismatch was calculated from the weighted average of PI and LL. Publication bias between studies and within studies quality were assessed. A meta-regression compared each measured variable between groups. Thoracic (Lenke1 and 2) and thoracolumbar/lumbar (Lenke 5 and 6) scoliosis were combined and statistically compared with the control group.

Results.
Meta-analysis, including 81 AIS and 18 control studies, showed no significant differences in sagittal parameters between Lenke types and controls for LL, PI, PI–LL mismatch, SS, and SVA (P > 0.05). Publication bias was significant in Lenke 1 TK, Control LL, and Lenke 1, and 5 SVA. Stratification based on deformity region (thoracic vs. thoracolumbar/lumbar) showed no significant differences in sagittal spinopelvic parameters (P > 0.05).

Conclusion.
No definitive difference was found between non-scoliotic adolescents and Lenke types in sagittal spinal and pelvic parameters. Future studies on developing a sagittal classification specific to AIS patients with a goal to improve surgical planning and outcome prediction are highly encouraged.

Level of Evidence: 4
Hypertonic Lactate to Improve Cerebral Perfusion and Glucose Availability After Acute Brain Injury*
Authors: Carteron Laurent , Solari Daria , Patet Camille , Quintard Hervé , Miroz John-Paul , Bloch Jocelyne , Daniel Roy T. , Hirt Lorenz , Eckert Philippe , Magistretti Pierre J. , Oddo Mauro 
Published: June 2018

Objectives:
Lactate promotes cerebral blood flow and is an efficient substrate for the brain, particularly at times of glucose shortage. Hypertonic lactate is neuroprotective after experimental brain injury; however, human data are limited.

Design:
Prospective study (clinicaltrials.gov NCT01573507).

Setting:
Academic ICU.

Patients:
Twenty-three brain-injured subjects (13 traumatic brain injury/10 subarachnoid hemorrhage; median age, 59 yr [41–65 yr]; median Glasgow Coma Scale, 6 [3–7]).

Interventions:
Three-hour IV infusion of hypertonic lactate (sodium lactate, 1,000 mmol/L; concentration, 30 µmol/kg/min) administered 39 hours (26–49 hr) from injury.

Measurements and Main Results:
We examined the effect of hypertonic lactate on cerebral perfusion (using transcranial Doppler) and brain energy metabolism (using cerebral microdialysis). The majority of subjects (13/23 = 57%) had reduced brain glucose availability (baseline pretreatment cerebral microdialysis glucose, < 1 mmol/L) despite normal baseline intracranial pressure (10 [7–15] mm Hg). Hypertonic lactate was associated with increased cerebral microdialysis lactate (+55% [31–80%]) that was paralleled by an increase in middle cerebral artery mean cerebral blood flow velocities (+36% [21–66%]) and a decrease in pulsatility index (–21% [13–26%]; all p < 0.001). Cerebral microdialysis glucose increased above normal range during hypertonic lactate (+42% [30–78%]; p < 0.05); reduced brain glucose availability correlated with a greater improvement of cerebral microdialysis glucose (Spearman r = –0.53; p = 0.009). No significant changes in cerebral perfusion pressure, mean arterial pressure, systemic carbon dioxide, and blood glucose were observed during hypertonic lactate (all p > 0.1).

Conclusions:
This is the first clinical demonstration that hypertonic lactate resuscitation improves both cerebral perfusion and brain glucose availability after brain injury. These cerebral vascular and metabolic effects appeared related to brain lactate supplementation rather than to systemic effects.
Comparative Pharmacokinetic and Electrocardiographic Effects of Intratracheal and Intravenous Administration of Flecainide in Anesthetized Pigs
Authors: Stocco Fernando G. , Evaristo Ederson , Silva Anderson C. , de Antonio Victor Zandona , Pfeiffer Juergen , Rangachari Narasimhan , Belardinelli Luiz , Verrier Richard L. 
Published: June 2018

Abstract:
We compared the pharmacokinetic (PK) profile and electrocardiographic (ECG) changes in response to intratracheal instillation of flecainide acetate into the left atrium and ventricle with intravenous (IV) flecainide acetate administration. In 12 closed-chest anesthetized Yorkshire pigs, we monitored the QRS complex and PR, JTc, and QTc intervals during sinus rhythm and correlated changes with venous plasma drug concentrations before and at 2, 5, 10, 15, and 30 minutes after drug administration. Intratracheal instillation of flecainide (0.75 and 1.5 mg/kg, rapid bolus) caused dose/concentration-dependent increases in the QRS complex duration of 10% and 19%, respectively, at 2 minutes, coinciding with peak venous plasma levels (1688 ± 177 and 2808 ± 217 ng/mL, respectively). IV infusion of flecainide (2 mg/kg) over 2 or 10 minutes similarly prolonged QRS complexes and PR intervals (both, P < 0.001). Intratracheal flecainide instillation increased PR interval briefly at 5 minutes. Neither intratracheal nor IV flecainide affected JTc or QTc intervals. Thus, the PK pattern of intratracheal instillation of flecainide is comparable to IV administration, although the absolute plasma concentrations were higher with IV infusion. Both modes of delivery elicited ECG changes that were consistent with the expected pharmacological activity of flecainide.
Fat Grafting Can Induce Browning of White Adipose Tissue
Authors: Hoppela Erika , Grönroos Tove J. , Saarikko Anne M. , Tervala Tomi V. , Kauhanen Susanna , Nuutila Pirjo , Kivinen Katri , Hartiala Pauliina 
Published: June 2018

Background:
Fat grafting is commonly used when treating soft-tissue defects. However, much of the basic biology behind fat transfer is still uncovered. Adipocytes can be divided into energy storing white and energy burning brown adipose cells. It is now well known, that also adult humans have metabolically active brown adipose tissue (BAT) within white adipose tissue (WAT). Previously our group showed that transfer of metabolically inactive WAT into a new environment increased the metabolic activity of the fat grafts to resemble the activity in the recipient site and that different WAT depots have variation in the metabolic activity. This led us to speculate, whether the metabolic increase of the graft is a result of “browning” of the transferred WAT toward beige adipose tissue.

Methods:
We investigated the metabolic and histological characteristics and BAT marker Ucp1 gene expression in different types of WAT grafts placed either in subcutaneous or muscle tissue in mice. Metabolic activity of the grafts was investigated by FDG-PET/CT at 4- and 12-week time-points.

Results:
The glucose uptake of all transferred fat types was increased when compared with respective control WAT regardless of transfer location. Ucp1 gene and protein expression was increased in 4 of 15 intramuscularly placed fat graft samples and showed histological resemblance to BAT with multilocular cells.

Conclusions:
Grafting of metabolically inactive fat intramuscularly may induce browning of fat grafts toward more active beige adipose tissue. This opens up new research areas in exploiting fat grafting in metabolic diseases.
Efficacy of Cultured Epithelial Autograft after Curettage for Giant Melanocytic Nevus of the Head
Authors: Maeda Tamami , Morimoto Naoki , Kakudo Natsuko , Kusumoto Kenji 
Published: June 2018

Summary:
Cultured epithelial autograft (CEA) is an epithelial sheet prepared from a patient’s own skin using cell culture. In Japan, CEA (JACE; Japan Tissue Engineering Co., Ltd., Gamagori, Japan) was approved and covered by public health care insurance for use in the treatment of giant congenital melanocytic nevus (GCMN) in 2016. There are several treatment options for GCMN; however, the complete removal of a GCMN is usually difficult due to the lack of skin. In this report, we describe a case of GCMN in the occipital region that was treated using CEA after curettage. A 2-month-old boy had a GCMN of 13 × 21 cm in his occipital region. We used full-thickness skin taken from the back of the right auricle to prepare CEA under general anesthesia at 4 months of age. Three weeks after preparing CEA, we performed curettage of the right half of the GCMN, and CEA was grafted onto the wound afterward. CEA took completely, and epithelization was observed at 10 days after surgery. We then performed curettage with subsequent grafting of CEA on the left half of the GCMN at 7 months of age. CEA took completely, and epithelization was observed in this procedure as well with no hair loss at 8 months of age. Whether or not curettage can reduce the risk of malignant transformation into malignant melanoma of GCMN is unclear; however, the application of CEA after curettage may be a promising option for obtaining early epithelization.
Composite Grafts for Pediatric Fingertip Amputations: A Retrospective Case Series of 100 Patients
Authors: Borrelli Mimi R. , Dupré Sophie , Mediratta Saniya , Bisquera Alessandra , Greig Aina 
Published: June 2018

Background:
Fingertip amputations are common. This study reports on the outcomes of composite grafts used for fingertip amputations in children, measuring graft take, predictors of graft take, complications, and patient-reported outcomes.

Methods:
A retrospective case series of consecutive patients (≤ 16 years) undergoing composite grafts for fingertip amputations in a tertiary pediatric hospital, January 06 to December 16, was performed. Information was collected on amputations, graft take, and complications. Logistic regression was used to analyze factors predicting graft take (partial/complete or failure) including age; amputation level; mechanism and time delay to surgery. Patients were contacted via post or telephone to ask about functional and cosmetic outcomes and their perception of graft take.

Results:
One hundred patients [57 (57%) males; mean age, 4.41 ± 3.98 years], presenting with 100 fingertip amputations, met the inclusion criteria. Amputation mechanism was crush in 75 (75%), avulsion in 13 (13%), and laceration in 12 (13%). Thirteen (13%) composite grafts survived completely, 46 (46%) partially, and 41 (41%) failed. Graft survival was higher in children under 4 years (P = 0.016). Seventeen (17%) grafts became infected, 9 (9%) required a reoperation, 9 (9%) had wound healing complications, and 4 (4%) patients developed psychological complications. Patient-reported survival was 33% higher than medical-reported survival. Cosmetic issues were the commonest complication reported by patients. Patients rated fingertips looking 3.5/5 normal, and that they were 4/5 satisfied with the appearance. Most patients were using their fingers normally by 2–6 months.

Conclusions:
Composite grafts for fingertip amputations mostly only partially survive, but morbidity is low, patient satisfaction is high, and acceptable cosmetic and functional outcomes are achieved.
Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial
Authors: Hou Wei , Norton Thomas T. , Hyman Leslie , Gwiazda Jane ,   the COMET Group
Published: June 2018

Objectives:
Describe axial elongation using 14-year longitudinal data in a large, ethnically diverse group of myopic children, estimate age and axial length (AL) at stabilization, and evaluate associations between the progression and stabilization of AL and myopia.

Methods:
Axial length was measured by A-scan ultrasonography annually. Axial length data were fit with individual polynomial functions and curve-based parameters (AL at stabilization and age at stabilization when annual rate of axial elongation ≤0.06 mm) were estimated. For myopia progression, noncycloplegic spherical equivalent refractions were fit with Gompertz functions.

Results:
Four hundred thirty-one participants, with AL and myopia data fit successfully, were classified into four cohorts: Younger (n=30); Older (n=334); AL Stabilized at Baseline (n=19); and AL Not Stabilized (n=48). At AL stabilization, for participants in the Younger and Older Cohorts, mean (SD) age and AL were 16.3 (2.4) years and 25.2 (0.9) mm, respectively. No associations were found between age at AL stabilization and ethnicity, sex, or number of myopic parents. At stabilization, sex and number of myopic parents (both P<0.003), but not ethnicity, were significantly associated with AL. Axial length and myopia progression curves were highly correlated overall (all r>0.77, P<0.0001). However, unlike AL, the amount of myopia did not differ significantly between males and females.

Conclusions:
In most of the participants, AL increased rapidly at younger ages and then slowed and stabilized. The close association between growth and stabilization of AL and myopia is consistent with the suggestion that axial elongation is the primary ocular component in myopia progression and stabilization.
Revision Surgery for Undercorrected Blepharoptosis After Frontalis Sling Operation Using Autogenous Fascia Lata
Authors: Lee Ju-Hyang , Woo Kyung In , Kim Yoon-Duck 
Published: June 2018

Purpose:
Undercorrected blepharoptosis can be encountered after frontalis sling operation. Revision surgery for undercorrection has commonly involved introducing a new sling material. We describe and evaluate a simple surgical technique to correct undercorrection by adjusting preexisting fascia.

Methods:
This is a retrospective interventional case series of patients undergoing sling revision between February 2010 and February 2017. Skin incision was made on the previous incision line. Careful dissection was performed superiorly to identify a preexisting fascia, and the dissected fascia was reattached to the tarsal plate using nonabsorbable sutures with adjustments for eyelid height and contour. The success of the procedure was defined as less than 1 mm of difference in the marginal reflex distance 1 of both eyes without any contour deformity.

Results:
Twenty-one eyelids in 18 patients were included with a mean follow-up of 17.5 months (range 6–48) and a mean age of 14.7 years (range 5–57). All patients had undergone frontalis sling with autogenous fascia lata for congenital ptosis. Undercorrection due to recurrent ptosis was found in 12 eyelids, and contour deformity such as temporal ptosis was found in 9 eyelids. The mean time interval between previous frontalis sling operation and sling revision was 6.8 years. Nineteen patients (90.5%) achieved surgical success and a cosmetically acceptable appearance.

Conclusion:
Sling revision is a simple and effective method with low perioperative morbidity for cases of undercorrection or contour deformity following frontalis sling operation using autogenous fascia lata, even long after the primary procedure.
Evaluation of the symptom of itch ambulatory office-based care in the United States
Authors: Fleischer Alan B. 
Published: June 2018

Introduction:
This study was designed to assess the characteristics of visits for itch from a cross-sectional study of office-based ambulatory care in the United States.

Methods:
To characterize itch as a symptom, ambulatory visits from the 1993 to 2015 National Ambulatory Medical Care Survey were analyzed when they included “itching” as a symptom or itch as a diagnosis code (ICD-9-CM 692.X).

Results:
This study finds 129 million itch visits occurred, averaging 5.6 million visits per year. There is seasonality to itch visits, with the largest numbers occurring in summer and fewest in winter. Vulvovaginal conditions including candidiasis and vaginitis and vulvovaginitis are commonly associated with itching, yet under-represented in the dermatology literature.

Discussion:
These data provide insights for further investigation into the burden of itch-related diseases.
Over the Scope Clips for Treatment of Acute Nonvariceal Gastrointestinal Bleeding in Children Are Safe and Effective
Authors: Tran Paul , Carroll Joshua , Barth Bradley A. , Channabasappa Nandini , Troendle David M. 
Published: June 2018

ABSTRACTObjective:There is little published experience with the use of over‐the‐scope clips (OTSCs) in pediatric patients. The aim of this study is to present our single‐center experience utilizing OTSCs for nonvariceal gastrointestinal (GI) bleeding.Methods:This is a retrospective case series of pediatric patients who underwent endoscopic management of GI bleeding during which OTSCs were used.Results:Eleven cases of OTSC utilization for hemostasis were identified in 10 unique patients between November 2014 and May 2016. The median age at intervention was 14.7 years (range 3.9–16.8 years) and median weight was 39 kg (range 17.4–85.8 kg). Technical success and hemostasis were achieved in all cases and there were no complications. Median follow‐up was 32.9 months (range 21.2–39.4 months). All nonanastomotic ulcers (4), polypectomy bleeding (2), and sphincterotomy bleeding (1) had no evidence of recurrent GI bleeding at last follow‐up. Two patients with anastomotic ulcerations required additional medical interventions.Conclusions:Our series demonstrates the safety and effectiveness of the OTSCs in the pediatric population for acute GI bleeding throughout the GI tract. In our experience, it is effective for nonanastomotic ulcers, postpolypectomy bleeding, and postsphincterotomy bleeding even when other hemostatic techniques have failed. OTSCs may be less effective in the setting of anastomotic ulcerations, reaffirming the refractory nature of these lesions.
Multiple Micronutrient Plasma Level Changes Are Related to Oxidative Stress Intensity in Critically Ill Children*
Authors: Valla Frédéric V. , Bost Muriel , Roche Sylvain , Pitance Marion , Cuerq Charlotte , Ridout Jenna , Ecochard René , Ginhoux Tiphanie , Bellon Amandine , Ford-Chessel Carole , Portefaix Aurélie , Javouhey Etienne , Blond Emilie 
Published: June 2018

Objectives:
Micronutrient supplementation in critically ill adults remains controversial. In the pediatric setting, the impact of oxidative stress on the overall micronutrient status has been poorly explored, due to the limited number of studies and to confounding factors (i.e., malnutrition or extra losses). In order to better understand this phenomenon, we aim to describe micronutrient status, focusing on seven micronutrients, in well-nourished critically ill children presenting with severe oxidative stress.

Design:
Prospective, transversal, observational, single-center study.

Setting:
PICU, and anesthesiology department, Lyon, France.

Patients:
Three groups of patients were clinically defined: severe oxidative stress PICU group (at least two organ dysfunctions), moderate oxidative stress PICU group (single organ dysfunction), and healthy control group (prior to elective surgery); oxidative stress intensity was controlled by measuring plasma levels of glutathione peroxidase and glutathione. Children presenting any former condition leading to micronutrient deficiency were excluded (malnutrition, external losses).

Interventions:
Plasma levels of selenium, zinc, copper, vitamin A, vitamin E, vitamin C, and β-carotene were measured in PICU oxidative stress conditions and compared with those of healthy children.

Measurements and Main Results:
Two hundred one patients were enrolled (51, 48, and 102 in severe, moderate, and healthy control groups, respectively). Median age was 7.1 years (interquartile range, 2.1–13.8 yr). There was a significant trend (p < 0.02) toward plasma level decrease of six micronutrients (selenium, zinc, copper, vitamin E, vitamin C, and β-carotene) while oxidative stress intensity increased. Biological markers of oxidative stress (glutathione peroxidase and glutathione) were in accordance with the clinical definition of the three groups.

Conclusions:
A multiple micronutrient deficiency or redistribution occurs in critically ill children presenting with severe oxidative stress. These findings will help to better identify children who might benefit from micronutrient supplementation and to design adapted supplementation trials in this particular setting.