bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the Number of Levels on Adverse Events and Length of Stay Following Posterior Lumbar Fusion Procedures
Authors: Bohl Daniel D. , Haws Brittany E. , Khechen Benjamin , Patel Dil V. , Mayo Benjamin C. , Ahn Junyoung , Louie Philip K. , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern 
Published: November 2018

Study design:
Retrospective

Summary of background data:
Little is known regarding the impact of the number of operative levels on the risk for adverse events following spinal procedures.

Objective:
The objective of this study was to test for associations between the number of operative levels and occurrence of adverse events following posterior lumbar fusion (PLF).

Methods:
Patients undergoing 1-, 2-, or 3-level PLFs were identified in the American College of Surgeons National Surgical Quality Improvement Program database. The number of operative levels was tested for association with occurrence of adverse events in the 30-days following the procedure using multivariate regression. Post hoc pairwise comparisons were made between 1- and 2-level and between 2- and 3-level procedures. Analyses were adjusted for differences in baseline characteristics.

Results:
In total, 8162 underwent 1-level, 3,527 underwent 2-level, and 718 underwent 3-level procedures. Patients undergoing 2-level procedures had a higher rate of anemia requiring blood transfusion than 1-level procedures (23.4% vs. 8.6%; adjusted relative risk [RR]=2.5; P<0.001). Furthermore, patient undergoing 3-level procedures had a higher rate of anemia requiring blood transfusion than 2-level procedures (29.9% vs. 23.4%; adjusted RR=1.3; P<0.001). In addition, patients undergoing 3-level procedures had a longer length of stay than 2-level procedures (4.6 vs. 3.9 d; P<0.001) and 2-level procedures had a longer length of stay than 1-level procedures (3.9 vs. 3.5 d; P<0.001).

Conclusions:
Increasing the number of operative levels by one level has minimal impact on the rates of most short-term postoperative adverse events following PLF. This is true both for an increase from 1 to 2 levels and from 2 to 3 levels. While surgeons should consider that an increase in the number of operative levels may increase the risk for blood transfusion and will almost certainly prolong the hospital stay, they need not fear a major increase in the rates of postoperative adverse events.
Risk Factors Associated with Reconstructive Complications Following Sacrectomy
Authors: Vartanian Emma D. , Lynn Jeremy V. , Perrault David P. , Wolfswinkel Erik M. , Kaiser Andreas M. , Patel Ketan M. , Carey Joseph N. , Hsieh Patrick C. , Wong Alex K. 
Published: November 2018

Background:
Sacral pathology requiring partial or total sacrectomy is rare, and reconstructing the ensuing defects requires careful decision-making to minimize morbidity. The purpose of this study was to review the experience of a single institution with reconstructing large sacral defects, to identify risk factors for suboptimal outcomes.

Methods:
A retrospective chart review was conducted of all patients who underwent sacrectomy over a 10-year period. Univariate analysis of differences in risk factors between patients with and without various postoperative complications was performed. Multivariate logistic regression was used to identify predictive variables.

Results:
Twenty-eight patients were identified. The most common diagnosis leading to sacrectomy was chordoma (39%). Total sacrectomy was performed on 4 patients, whereas 24 patients underwent partial resection. Reconstructive modalities included 15 gluteal advancement flaps, 4 pedicled rectus abdominis myocutaneous flaps, and 9 paraspinous muscle or other flap types. There was an overall complication rate of 57.1% (n = 12) and a 28.6% (n = 8) incidence of major complications. There were significantly more flap-related complications in patients who underwent total sacrectomy (P = 0.02). Large defect size resulted in significantly more unplanned returns to the operating room (P < 0.01).

Conclusion:
Consistent with other published series', the overall complication rate exceeded 50%. Defect volume and sacrectomy type were the strongest predictors of postoperative complications and return to the operating room, while reconstructive strategy showed limited power to predict patient outcomes. We recommend that patients anticipated to have large sacral defects should be appropriately counseled regarding the incidence of wound complications, regardless of reconstructive approach.
Emphysematous pyelonephritis and cystitis in a patient with uremia and anuria
Authors: Wang Qiang , Sun Meifeng , Ma Chengjun , Lv Hailin , Lu Peng , Wang Qi , Liu Guangyi , Hu Zhao , Gao Yanxia 
Published: November 2018

Abstract

Introduction:
Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD)

Case presentation:
A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully.

Conclusion:
This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.
Glucose-regulated protein 78 in the aqueous humor in diabetic macular edema patients
Authors: Kwon Jin-woo , Jung Ilyoung , Jee Donghyun 
Published: November 2018

Abstract
In this study, we explored the presence and elevation of glucose-regulated protein 78 (GRP78) in aqueous humor of patients with diabetic macular edema (DME).
After comparing DME patients with the controls, we analyzed GRP78 and vascular endothelial growth factor (VEGF) levels in DME patients. We examined factors associated with GRP78 levels in DME patients.
GRP78 was detected in aqueous humor with elevated levels in DME patients. Stepwise backward regression analysis showed that GRP78 levels were associated with the VEGF levels and the duration of diabetes (P < .001 and P = .002, respectively). However, no statistical significance was observed between GRP78 levels and the decrease in CST following 3 monthly anti-VEGF treatments in univariate regression analysis (P = .695).
We showed that GRP78 is elevated in DME patients. In addition, there is a correlation between GRP78 and VEGF levels in aqueous humor. However, GRP78 levels were not associated with the responsiveness of anti-VEGF in DME patients.
XRCC1 polymorphism and overall survival in ovarian cancer patients treated with platinum-based chemotherapy
Authors: Zhang Zhuo , Xiang Qian , Mu Guangyan , Xie Qiufen , Chen Shuqing , Zhou Shuang , Hu Kun , Cui Yi-min 
Published: November 2018

Abstract

Objectives:
Although platinum-based chemotherapy is widely used for advanced ovarian cancer (OC), genetic polymorphisms can influence the chemotherapeutic response. This study investigated the association between XRCC1 polymorphisms Arg194Trp, Arg280His, and Arg399Gln, and overall survival (OS) in OC patients who received platinum-based chemotherapy.

Methods:
We systematically searched PubMed, Embase, the Cochrane library, Chinese National Knowledge Infrastructure, Wanfang, and Weipu databases for relevant studies from inception to October, 2017. OS was calculated using a random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed.

Results:
Five studies involving 1159 OC patients were included. When compared with 194ArgArg, 194TrpTrp (hazard ratio [HR] 1.09, 95% confidence interval [CI] 0.71–1.69, P = .69) and 194TrpArg (HR 1.00, 95% CI 0.78–1.28, P = .98) carriers were not associated with OS. Similarly, compared with 280ArgArg carriers, neither 280HisHis (HR 1.39, 95% CI 0.82 to −2.34, P = .22) nor 280HisArg (HR 0.98, 95% CI 0.73 to −1.31, P = .90) affected OS. Furthermore, there were no significant differences in OS between 399GlnGln (HR 1.00, 95% CI 0.46–2.16, P > .99), 399GlnArg (HR 1.05, 95% CI 0.81–1.37, P = .70), and 399ArgArg. Finally, subgroup analysis suggested that 399GlnGln significantly decreased OS when the percentage of III or IV cases was >80.0% (HR 1.79, 95% CI 1.22–2.62, P = .003), while OS was increased when this percentage was <80.0% (HR 0.47, 95% CI 0.28–0.79, P = .004).

Conclusions:
This study indicated that XRCC1 Arg194Trp, Arg280His, and Arg399Gln did not affect OS after platinum-based chemotherapy in OC patients. However, disease status could affect the relationship between Arg399Gln and OS in these patients.
Genetic polymorphism (rs6776158) in CaSR gene is associated with risk of nephrolithiasis in Chinese population
Authors: Zhou Hai , Huang Huaxing , You Zebin , Shadhu Kamleshsingh , Ramlagun Dadhija , Qiang Cao , Li Pu , Qi Lezhong , Shen Yuyong , Zhou Ming , Chen Yuming , Fei Shangchun , Wang Xiaoxiang 
Published: November 2018

Abstract
The objective of this study is to find about the association between calcium-sensing receptor (CaSR) genetic variants and susceptibility to nephrolithiasis in the Chinese Han population.
This hospital-based case-control study included 319 nephrolithiasis cases and 378 healthy controls subjects. Two SNPs in CaSR were genotyped using the TaqMan assay.
We found that subjects carrying the G allele of rs6776158 (AG and GG) had significantly higher risk of nephrolithiasis compared to the AA genotype (P = .015 and .009, respectively).
Our results indicate that rs6776158 polymorphism that might elevate the risk of nephrolithiasis in the Chinese population.
Pneumocardia and septic pulmonary embolism due to nongas-forming liver abscess
Authors: Yao Zhoujia , Zheng Jun , Si Youguang , Wang Wenhong 
Published: November 2018

Abstract

Rationale:
Pneumocardia and septic pulmonary embolism are uncommon complications of Klebsiella pneumoniae primary liver abscess (KPLA); however, they may lead to a poor clinical outcome.

Patient concerns:
A 67-year-old woman was admitted to our hospital with fever, chills, cough, and dyspnea for 4 days. She had a previous history of diabetes mellitus.

Diagnoses:
The chest computed tomography (CT) revealed multiple peripheral nodules in both lungs and wedge-shaped peripheral infiltrative lesions abutting the pleura, suggestive of septic pulmonary embolism. An abdominal CT on the following day showed a large liver abscess without gas formation and pneumocardia of the right ventricle.

Interventions:
After the antibiotic therapy of intravenous imipenem and drainage of the liver abscess, our patient made a complete recovery.

Outcomes:
The patient was discharged on the 25th hospital day after full recovery and was doing well on follow-up at 10 months.

Lessons:
KPLA is potentially fatal due to the associated serious metastatic complications. Attention must be paid not only to the primary focus of infection but also to infection of other organs. It is important to detect to diagnose the spread of infection accurately, in a timely manner, to improve the prognosis of this condition.
Age, sex, and the association of chronic kidney disease with all-cause mortality in Buddhist priests
Authors: Kim Hyo Jin , Kim Yunmi , Kim Sejoong , Chin Ho Jun , Lee Hajeong , Lee Jung Pyo , Kim Dong Ki , Oh Kook-Hwan , Joo Kwon Wook , Kim Yon Su , Nah Deuk-Young , Shin Sung Joon , Kim Kyung Soo , Park Jae Yoon , Yoo Kyung Don 
Published: November 2018

Abstract
Buddhist priests lead a unique lifestyle, practicing asceticism, with a vegetarian diet. Such behavior may have an impact on clinical outcomes. Hence, we explored the mortality among Korean Buddhist priests as compared with the general population.
This study is a single-center, retrospective study. Among the 3867 Buddhist priests who visited Dongguk University Gyeongju Hospital between January 2000 and February 2016, 3639 subjects were available for mortality data from Statistics Korea. Standardized mortality ratio (SMR) was computed for all causes of death and compared with the general population using national statistics in Korea. Information regarding end-stage renal disease (ESRD) was investigated from the Korean Society of Nephrology registry. Among the 3639 patients, the baseline laboratory results were obtained in 724 patients. Chronic kidney disease (CKD) was defined as dipstick proteinuria ≥1 or an estimated glomerular filtration rate <60 mL/min/1.73 m2.
The mean age was 50.0 ± 12.5 years, and 51.0% were men. During the follow-up period for 31.1 ± 35.6 months, 55 (7.6%) patients died. During the follow-up period, 3 (0.4%) and 23 (3.2%) patients developed ESRD and urinary stone, respectively. The SMR for all causes of death was 0.76 (95% confidence interval [CI] 0.57–0.99; men 0.91, 95% CI 0.65–1.23; women 0.52, 95% CI 0.28–0.87). Among 724 patients, 74 (10.2%) patients had CKD. The SMR for non-CKD patients (0.61, 95% CI 0.43–0.85) was significantly lower than the general population. Female and patients older than 50 years (0.74, 95% CI 0.55–0.98) had a significantly lower SMR. In the Cox proportional hazards model with adjustment, older age (adjusted HR 1.04, 95% CI 1.10–1.07) and presence of CKD (adjusted HR 2.55, 95% CI 1.07–6.06) were independently associated with increased all-cause mortality.
Buddhist priests and especially Buddhist priests without CKD showed a significantly lower mortality compared with the general population.
Management of chronic pain in Ehlers–Danlos syndrome
Authors: Zhou Zhengyang , Rewari Abhitej , Shanthanna Harsha 
Published: November 2018

Abstract

Rationale:
Ehlers–Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis. Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities. Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals. Overall, approximately 90% or more EDS patients suffer from chronic pain. There are no existing guidelines to manage chronic pain in EDS patients. In this article, we illustrate 2 case reports of EDS patients with chronic pain and review the relevant literature regarding the pathological considerations and management of chronic pain in EDS.

Patient concerns:
Our first patient had worsening multiple joint pains despite treatment with medications and a recent diagnosis of EDS-type 3. The second patient had a complicated history including longstanding EDS and multiple previous surgeries. She was referred due to concern about complex regional pain syndrome (CRPS) in her upper extremity.

Diagnoses:
For the first patient, apart from chronic pain due to her EDS, her history also revealed that she suffered from kinesiophobia. For the second patient, a detailed clinical assessment revealed no signs of CRPS but instead a generalized worsening of EDS symptoms.

Interventions:
Both patients were evaluated by the multidisciplinary team consisting of a pain physician, nurse, pain psychologist, and a kinesiologist. Their treatment involved optimization of daily medications, participation in pain self-management sessions that included cognitive behavioral therapy, graded exercises, coping, and relaxation strategies.

Outcomes:
Both patients demonstrated significantly better pain control and achieved overall improvement in daily living.

Lessons:
EDS is a complex illness with a multitude of symptoms. As in our patients, EDS patients also suffer from panic and anxiety disorders that increase the burden of pain. Apart from optimization of medications, EDS patients are best managed by a multidisciplinary approach that includes pain education and life style changes. The caution that they are resistant to local anesthetics is unwarranted. Appropriate pain interventions in selected patients may have a role to decrease pain intensity.
Staplers or clips?
Authors: Liu Yu , Huang Zhongli , Chen Yuntian , Liao Banghua , Luo Deyi , Gao Xiaoshuai , Wang Kunjie , Li Hong 
Published: November 2018

Abstract

Background:
Controlling of the renal vessels is a critical step in live donor nephrectomy (LDN). Currently, mainly 2 devices, Hem-o-Lok clips and staplers, are utilized to control vessels during LDN. Both of them have advantages and disadvantages.

Methods:
This systematic review and meta-analysis was aimed to compare the safety and the efficacy of the 2 devices and to identify the better one in LDN. A systematic search for related publications in the databases of PubMed, Medline, Embase, the Cochrane Library, and Web of Science through February 2018 was performed. Eight studies were selected and evaluated with the Newcastle-Ottawa Scale (NOS).

Results:
The meta-analysis result showed that utilization of Hem-o-Lok clips resulted in greater amount of estimated blood loss (mean differences [MD]: 40.10; 95% confidence interval [CI] 4.37–75.84) and longer time of warm ischemia (WIT) (MD: 55.61; 95% CI 36.79–74.43) than using staplers. Residual vascular length of grafts in clip group was longer than that in stapler group (MD: 2.51; 95% CI 0.78–4.24). However, the differences in primary outcomes such as device failure rate, death rate, and severe hemorrhage rate, were not significant between these 2 groups. In addition, utilization of Hem-o-Lok clips costed approximate $400 lower than staplers per patient.

Conclusion:
This study revealed that Hem-o-Lok clips and staplers have the similar function in LDN renal ligation, regarding the device failure rate, death rate, and severe hemorrhage rate. However, the surgeons would benefit from the clips in terms of the residue length of vessels, these outstanding features provide operation convenience and flexibility, such as right-sided donor nephrectomies, early vascular bifurcation, and rare vascular variation. In addition, the clips have potential economic advantages. In some developing countries, it would reduce the healthcare expenditure.
Vertigo caused by longus colli tendonitis
Authors: Shen Yifeng , Zhou Qiaoyin , Zhu Xinyue , Qiu Zuyun , Jia Yan , Liu Zixiang , Li Shiliang 
Published: November 2018

Abstract

Rationale:
Tendinitis of the longus colli muscle is an aseptic inflammatory process leading to acute posterior neck pain, neck stiffness, and dysphagia or odynophagia. We present a patient exhibiting an infrequent symptom, vertigo. This is the first description of the occurrence of vertigo symptoms caused by longus colli tendinitis.

Patient concerns:
A 38-year-old man was diagnosed with vertigo, presenting with a 1-month history of dizziness, palpitations, and numbness in the hands.

Diagnosis:
Longus colli tendinitis. The diagnosis was established using magnetic resonance imaging fat-suppression sequences.

Interventions:
Treatment with corticosteroid injections and acupotomy.

Outcomes:
The symptoms relieved immediately after the treatment and complete resolution of the symptoms was observed after 1 week.

Lessons:
Longus colli tendinitis with vertigo is an under-reported condition in the literature and physicians should be aware of its existence. A lack of familiarity with the anatomy of the prevertebral space and its variable radiographic appearance makes the diagnosis of longus colli tendinitis clinically difficult. Misdiagnosis of this condition may lead to unnecessary interventions in vertigo.
3.0T Contrast-enhanced whole-heart coronary magnetic resonance angiography for simultaneous coronary artery angiography and myocardial viability in chronic myocardial infarction
Authors: Chen Zhiyong , Sun Bin , Duan Qing , Xue Yunjing , Chen Lianglong 
Published: November 2018

Abstract
To evaluate the accuracy of contrast-enhanced whole-heart magnetic resonance coronary angiography at 3.0T for assessing significant stenosis (≥50% lumen diameter reduction) in patients with myocardial infarction, by using conventional coronary artery angiography as the reference standard, and also test the performance of that for the detection and assessment of chronic myocardial infarction (MI), compared with standard delayed-enhancement coronary magnetic resonance (DE-CMR) for the determination of infarct size.
We studied 42 consecutive patients (37 men, 5 women, mean age 58.5 ± 10.7 years) with MI scheduled for conventional coronary angiography. Contrast-enhanced whole-heart coronary magnetic resonance angiography (CMRA) was employed after sublingual nitroglycerin (NTG) with the abdominal banding rolled tightly along the side of ribs. Finally, a 3D phase-sensitive inversion-recovery gradient-echo (3D-PSIR-GRE) sequence was performed during free breathing. The assessment of MI sizes on WH-CMRA reconstructed images and 3D-PSIR-GRE images were compared using a paired student t test.
The acquisition of CMRA was completed in 40 (95.2%) of 42 patients, with an imaging time averaged at 9.5 ± 3.1 minutes. The average navigator efficiency was 47%. The sensitivity, specificity, and positive and negative predictive values of whole-heart CMRA for the detection of significant lesions on a segment-by-segment analysis were 91.7% (95% confidence interval [CI] 83.8–96.1), 84.0% (95% CI 80.0–87.4), 57.9% (95% CI 50.0–65.8), 97.7% (95% CI 95.3–98.9), respectively, and on a patient-based analysis 93.5% (95% CI 77.2–98.9), 88.9% (95% CI 50.7–99.4), 96.7% (95% CI 80.9–99.8), and 80.0% (95% CI 44.2–96.5), respectively. Infarcts were generally higher on the CE-CMRA technique compared with the standard technique (18.0 ± 7.2 cm3 vs 16.1 ± 6.4 cm3; P < .0001).
Contrast-enhanced whole-heart CMRA with 3.0-T not only may permit reliable detection of significant obstructive coronary artery disease in patients with myocardial infarction, but also could identify and quantify the volume of myocardial infarction. This technique could be considered the preferred approach in patients who could not overcome longer scanning times or unable to hold their breath instead of delayed-enhancement magnetic resonance imaging for detection of infarcted myocardium. However, compared with standard imaging, the volume of myocardial infarction is slightly overestimated.