bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Rates of LSS Surgery in Norwegian Public Hospitals
Authors: Grøvle Lars , Fjeld Olaf Randall , Haugen Anne Julsrud , Helgeland Jon , Småstuen Milada Cvancarova , Solberg Tore Kristian , Zwart John-Anker , Grotle Margreth 
Published: September 2018

Study Design.
Retrospective administrative database study.

Objective.
To assess temporal and regional trends, and length of hospital stay, in lumbar spinal stenosis (LSS) surgery in Norwegian public hospitals from 1999 to 2013.

Summary of Background Data.
Studies from several countries have reported increasing rates of LSS surgery over the last decades. No such data have been presented from Norway.

Methods.
A database consisting of discharges from all Norwegian public hospitals was established. Inclusion criteria were discharges including a surgical procedure of lumbar spinal decompression and/or fusion in combination with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnosis of Spinal Stenosis (M48.0) or Other Spondylosis with Radiculopathy (M47.2), and a patient age of 18 years or older. Discharges with diagnoses indicating deformity, that is, spondylolisthesis or scoliosis were not included.

Results.
During the 15-year period, 19,543 discharges were identified. The annual rate of decompressions increased from 10.7 to 36.2 and fusions increased from 2.5 to 4.4 per 100,000 people of the general Norwegian population. The proportion of fusion surgery decreased from 19.3% to 10.9%. Among individuals older than 65 years, the annual rate of surgery per 10,000, including both decompressions and fusions, more than quadrupled from 40.2 to 170.3. The regional variation was modest, differing with a factor of 1.4 between the region with the highest and the lowest surgical rates. The mean length of hospital stay decreased from 11.0 (standard deviation 8.0) days in 1999 to 5.0 (4.6) days in 2013, but patients who received fusion surgery stayed on average 3.6 days longer than those who received decompression only.

Conclusion.
The rate of LSS surgery more than tripled in Norway from 1999 to 2013. The mean length of hospital stay was reduced from 11 to 5 days.

Level of Evidence: N/A
Time Taken to Return to Work Does Not Influence Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Liow Ming Han Lincoln , Goh Graham Seow-Hng , Yeo William , Ling Zhixing Marcus , Yue Wai-Mun , Guo Chang Ming , Tan Seang Beng 
Published: September 2018

Study Design.
Retrospective cohort study using prospectively collected registry data.

Objective.
To determine factors which influence return-to-work (RTW) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and to determine if early RTW affects functional outcomes.

Summary of Background Data.
MIS-TLIF has been associated with accelerated return to work. RTW in non-WC working-age adults after MIS-TLIF is not well understood.

Methods.
Prospectively collected registry data of 907 patients who underwent MIS-TLIF at a single institution from 2004 to 2013 were reviewed. One hundred ten working adults who underwent single-level MIS-TLIF with complete preoperative and 5-year postoperative follow-up data were included. Patients were assigned into Early RTW (≤60 d, n = 40) and Late RTW (>60 d, n = 70). All patients were assessed pre- and postoperatively at 2 and 5 years. Length of operation, length of stay, and comorbidities were also recorded.

Results.
The Early RTW group had significantly lower Oswestry Disability Index (ODI), North American Spine Society score for neurogenic symptoms (NASS NS), numerical pain rating scale (NPRS) back and leg pain scores than the Late RTW group (<0.01) There were no significant differences in age, body mass index (BMI) and prevalence of medical comorbidities (P > 0.05). In addition, there were no differences in terms of duration of surgery or length of hospitalization. There were no significant differences in ODI, NASS NS, Short-form 36 physical and mental component scores (SF-36 PCS/MCS), NPRS, satisfaction/expectation fulfilment between the Early and Late RTW groups at 2-year and 5-year follow-up. Both groups reported similar proportions that RTW without limitations and return-to-function (RTF) at 2-years and 5-years.

Conclusion.
Patients who RTW late have significantly poorer preoperative SF-36 physical component scores and higher ODI, NASS NS, NPRS back/leg pain scores. Surgeons should be cognizant that working adults with poorer preoperative function will tend to return to work later, but should reassure them that they will likely achieve similar clinical outcomes, satisfaction and expectation fulfilment when compared with patients who returned to work early.

Level of Evidence: 3
Predictive Factors of Postoperative Dysphagia in Single-Level Anterior Cervical Discectomy and Fusion
Authors: Vaishnav Avani S. , Saville Philip , McAnany Steven , Patel Dil , Haws Brittany , Khechen Benjamin , Singh Kern , Gang Catherine Himo , Qureshi Sheeraz A. 
Published: September 2018

Study Design.
Retrospective review of prospectively collected data.

Objective.
To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
Dysphagia rates following ACDF have been reported to be as high as 83%, most cases are self-limiting, but chronic dysphagia can continue in up to 35% of patients. Zero profile devices were developed to limit dysphagia, and other plate specific complications, however the literature is currently divided regarding their efficacy.

Methods.
Dysphagia was assessed by swallowing quality of life (SWAL-QOL) scores preoperatively, at 6 weeks and 12 weeks. Patient reported outcome measures (PROMs) including visual analog scale (VAS) and Neck Disability Index (NDI) were collected preoperatively, at 6 weeks and at 6 months. Univariate and multivariate regression analysis was conducted with SWAL-QOL score as the dependent variable.

Results.
Sixty-four patients were included, 41 received a zero profile device, and 23 received plate-graft construct. Both groups were similar regarding patient demographics, except operative time, with the zero-profile group having a shorter procedure time than the cage-plate group (44.88 ± 6.54 vs. 54.43 ± 14.71 min, P = 0.001). At all timepoints dysphagia rates were similar between the groups. Regression analysis confirmed preoperative SWAL-QOL and operative time were the only significant variables. PROMs were also similar between groups at all time points, except VAS neck at 6 months, which was lower in the plate-graft group (1.05 ± 1.48 vs. 3.43 ± 3.21, P = 0.007).

Conclusion.
Operative time and preoperative SWAL-QOL scores are predictive of dysphagia in single level ACDF. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard.

Level of Evidence: 3
Replication Study for the Association of GWAS-associated Loci With Adolescent Idiopathic Scoliosis Susceptibility and Curve Progression in a Chinese Population
Authors: Man Gene Chi-Wai , Tang Nelson Leung-Sang , Chan Ting Fung , Lam Tsz Ping , Li Jing Woei , Ng Bobby Kin-Wah , Zhu Zezhang , Qiu Yong , Cheng Jack Chun-Yiu 
Published: September 2018

Study Design.A genetic association (replication) study.Objective.The aim of this study was to replicate and further evaluate the association among seven genome-wide association studies (GWAS)-identified single nucleotide polymorphisms (SNPs) in Chinese girls with adolescent idiopathic scoliosis (AIS) with disease onset, curve types, and progression.Summary of Background Data.AIS is the most common pediatric spinal deformity with a strong genetic predisposition. Recent GWAS identified 10 new disease predisposition loci for AIS.Methods.Three hundred nineteen female AIS patients with Cobb angle ≥ 10oand 201 healthy controls were studied for the association with disease onset. Seven GWAS-identified SNPs (rs11190870 inLBX1, rs12946942 inSOX9/KCNJ2, rs13398147 inPAX3/EPH4, rs241215 inAJAP1, rs3904778 inBNC2, rs6570507 inGPR126, and rs678741 inLBX1-AS1) were analyzed. In subgroup analysis, AIS patients were subdivided by curve types and disease progression to examine for genotype association.Results.We replicated the association with disease onset in four common SNPs rs11190870, rs3904778, rs6570507, and rs678741. In addition, rs1190870 and rs678741 remained significantly associated in the right thoracic curves only subgroup. However, no significant difference was observed with both clinical curve progression or Cobb angle.Conclusion.This study replicated the associations of four GWAS-associated SNPs with occurrence of AIS in our Chinese population. However, none of these SNPs was associated with curve severity and progression. The results suggest that curve progression may be determined by environmental (nongenetic) factor, but further study with a larger sample size is required to address this issue.Level of Evidence:4
30-day Mortality Following Surgery for Spinal Epidural Abscess
Authors: Du Jerry Y. , Schell Adam J. , Kim Chang-yeon , Trivedi Nikunj N. , Ahn Uri M. , Ahn Nicholas U. 
Published: September 2018

Study Design.
Retrospective case-control study.

Objective.
To determine incidence and timing of mortality following surgery for spinal epidural abscess (SEA), identify risk factors for mortality, and identify complications associated with mortality.

Summary of Background Data.
SEA is a serious condition with potentially devastating sequelae. There is a paucity of literature characterizing mortality following surgery for SEA.

Methods.
The National Surgical Quality Improvement Program (NSQIP) database was used. Patients with a diagnosis of SEA were included. A Cox proportional hazards model identified independent risk factors for 30-day mortality. A predictive model for mortality was created. Multivariate models identified postoperative complications associated with mortality.

Results.
There were 1094 patients included, with 40 cases of mortality (3.7%), the majority of which occurred within 2 weeks postoperatively (70%). Independent risk factors for 30-day mortality were age>60 years (hazard ratio [HR]: 2.147, P = 0.027), diabetes (HR: 2.242, P = 0.015), respiratory comorbidities (HR: 2.416, P = 0.037), renal comorbidities (HR: 2.556, P = 0.022), disseminated cancer (HR: 5.219, P = 0.001), and preoperative thrombocytopenia (HR: 3.276, P = 0.001). A predictive algorithm predicts a 0.3% mortality for zero risk factors up to 37.5% for 4 or more risk factors. A ROC area under curve (AUC) was 0.761, signifying a fair predictor (95% CI: 0.683–0.839, P < 0.001). Cardiac arrest (adjusted odds ratio [aOR]: 72.240, 95% confidence interval [CI]: 27.8–187.721, P < 0.001), septic shock (aOR: 15.382, 95% CI: 7.604–31.115, P < 0.001), and pneumonia (aOR: 2.84, 95% CI: 1.109–7.275, P = 0.03) were independently associated with mortality.

Conclusion.
The 30-day mortality rate following surgery for SEA was 3.7%. Of the mortalities that occurred within 30 days of surgery, the majority occurred within 2 weeks. Independent risk factors for mortality included older age, diabetes, hypertension, respiratory comorbidities, renal comorbidities, metastatic cancer, and thrombocytopenia. Risk for mortality ranged from 0.3% to 37.5% based on number of risk factors. Septic shock, cardiac arrest, and pneumonia were associated with mortality.

Level of Evidence: 3
Does Surgery Reduce the Risk of Complications Among Patients with Multiple Rib Fractures? A Meta-analysis
Authors: Liang Yu-Shiuan , Yu Kai-Ching , Wong Chung-Shun , Kao Yuan , Tiong Tung-Yu , Tam Ka-Wai 
Published: September 2018

Abstract

Background
Multiple rib fractures are common in trauma patients, who are prone to trauma-associated complications. Surgical or nonsurgical interventions for the aforementioned conditions remain controversial.

Questions/purposes
The purpose of our study was to perform a meta-analysis to evaluate the clinical prognosis of surgical fixation of multiple rib fractures in terms of (1) hospital-related endpoints (including duration of mechanical ventilation, ICU length of stay [LOS] and hospital LOS), (2) complications, (3) pulmonary function, and (4) pain scores.

Methods
We screened PubMed, Embase, and Cochrane databases for randomized and prospective studies published before January 2018. Individual effect sizes were standardized; the pooled effect size was calculated using a random-effects model. Primary outcomes were duration of mechanical ventilation, intensive care unit length of stay (ICU LOS), and hospital LOS. Moreover, complications, pulmonary function, and pain were assessed.

Results
The surgical group had a reduced duration of mechanical ventilation (weighted mean difference [WMD], -4.95 days; 95% confidence interval [CI], -7.97 to -1.94; p = 0.001), ICU LOS (WMD, -4.81 days; 95% CI, -6.22 to -3.39; p < 0.001), and hospital LOS (WMD, -8.26 days; 95% CI, -11.73 to -4.79; p < 0.001) compared with the nonsurgical group. Complications likewise were less common in the surgical group, including pneumonia (odds ratio [OR], 0.41; 95% CI, 0.27–0.64; p < 0.001), mortality (OR, 0.24; 95% CI, 0.07–0.87; p = 0.030), chest wall deformity (OR, 0.02; 95% CI. 0.00–0.12; p < 0.001), dyspnea (OR, 0.23; 95% CI, 0.09–0.54; p < 0.001), chest wall tightness (OR, 0.11; 95% CI, 0.05–0.22; p < 0.001) and incidence of tracheostomy (OR, 0.34; 95% CI, 0.20–0.57; p < 0.001). There were no differences between the surgical and nonsurgical groups in terms of pulmonary function, such as forced vital capacity (WMD, 6.81%; 95% CI: -8.86 to 22.48; p = 0.390) and pain scores (WMD, -11.41; 95% CI: -42.09 to 19.26; p = 0.470).

Conclusions
This meta-analysis lends stronger support to surgical fixation, rather than conservative treatment, for multiple rib fractures. Nevertheless, additional trials should be conducted to investigate surgical indications, timing, and followup for quality of life.

Level of Evidence
Level I, therapeutic study.
Radiation Protection Around High-intensity Laser Interactions with Solid Targets
Authors: Liang Taiee Ted , Bauer Johannes M. , Liu James C. , Rokni Sayed H. 
Published: September 2018

Abstract
Interaction of a high-intensity optical laser with a solid target can generate an ionizing radiation hazard in the form of high-energy “hot” electrons and bremsstrahlung, resulting from hot electrons interacting with the target itself and the surrounding target chamber. Previous studies have characterized the bremsstrahlung dose yields generated by such interactions for lasers in the range of 1017 to 1022 W cm−2 using particle-in-cell code EPOCH and Monte Carlo code FLUKA. In this paper, electron measurements based on a depth-dose approach are presented for two laser intensities, which indicate a Maxwellian distribution is more suitable for estimating the hot electrons’ energy distribution. Also, transmission factors for the resulting bremsstrahlung for common shielding materials are calculated with FLUKA, and shielding tenth-value-layer thicknesses are also derived. In combination with the bremsstrahlung dose yield, the tenth-value layers provide radiation protection programs the means to evaluate radiation hazards and design shielding for high-intensity laser facilities.
Navigating Speed Bumps on the Innovation Highway in Hemophilia Therapeutics
Authors: DiMichele Donna M. 
Published: September 2018

AbstractThe unprecedented emergence of novel therapeutics for both hemophilia A and B during the last half decade has been accompanied by the promise of even more extraordinary progress in ameliorative and curative strategies for both disorders. Paradoxically, the speed of innovation has created new dilemmas for persons with hemophilia and their physicians with respect to optimizing individual choices from the expanding menu of standard and novel therapies and approaches to symptom or risk reduction, and ultimately, to normalizing the hemophilia phenotype. Among the most disruptive new approaches, challenges remain in the form of the adverse reactions that have been observed with nonfactor therapies, as well as in the uncertain long‐term safety profile of potentially curative gene therapy. Together, these challenges have generated uncertainty as to how to adopt novel therapies and treatment strategies across a diverse patient population, creating speed bumps on the hemophilia innovation highway. It is from this perspective that this article discusses the current state of gene therapy and bleeding prophylaxis for hemophilia A and B, as well as prevention and treatment of the factor VIII inhibitor phenotype in hemophilia A. It further posits that these speed bumps may provide important clues to the mechanistic understanding of both symptom manifestation and resilience within the hemophilia phenotype, as well as opportunities to reconsider and reconfigure the current paradigms for symptom prediction and individualized therapeutic decision making.
Using Decision Tree Methodology to Predict Employment After Moderate to Severe Traumatic Brain Injury
Authors: Stromberg Katharine A. , Agyemang Amma A. , Graham Kristin M. , Walker William C. , Sima Adam P. , Marwitz Jennifer H. , Harrison-Felix Cynthia , Hoffman Jeanne M. , Brown Allen W. , Kreutzer Jeffrey S. , Merchant Randall 
Published: September 2018

Objective:
To build decision tree prediction models for long-term employment outcomes of individuals after moderate to severe closed traumatic brain injury (TBI) and assess model accuracy in an independent sample.

Setting:
TBI Model Systems Centers.

Participants:
TBI Model Systems National Database participants injured between January 1997 and January 2017 with moderate to severe closed TBI. Sample sizes were 7867 (year 1 postinjury), 6783 (year 2 postinjury), and 4927 (year 5 postinjury).

Design:
Cross-sectional analyses using flexible classification tree methodology and validation using an independent subset of TBI Model Systems National Database participants.

Main Measures:
Competitive employment at 1, 2, and 5 years postinjury.

Results:
In the final employment prediction models, posttraumatic amnesia duration was the most important predictor of employment in each outcome year. Additional variables consistently contributing were age, preinjury education, productivity, and occupational category. Generally, individuals spending fewer days in posttraumatic amnesia, who were competitively employed preinjury, and more highly educated had better outcomes. Predictability in test data sets ranged from a C-statistic of 0.72 (year 5; confidence interval: 0.68-0.76) to 0.77 (year 1; confidence interval: 0.74-0.80).

Conclusion:
An easy-to-use decision tree tool was created to provide prognostic information on long-term competitive employment outcomes in individuals with moderate to severe closed TBI. Length of posttraumatic amnesia, a clinical marker of injury severity, and preinjury education and employment status were the most important predictors.
OPHTHALMIC VASCULAR EVENTS AFTER INTRA‐ARTERIAL CHEMOTHERAPY FOR RETINOBLASTOMA
Authors: Ancona-Lezama David , Dalvin Lauren A. , Lucio-Alvarez J. Antonio , Jabbour Pascal , Shields Carol L. 
Published: September 2018

Purpose:
To determine whether treatment order affects ophthalmic vascular event rates after intra‐arterial chemotherapy (IAC) for retinoblastoma.

Methods:
Patients who received IAC as primary or secondary treatment for retinoblastoma from January 2009 to January 2018 were included. All eyes were imaged with fundus photography and fluorescein angiography. Patient characteristics and vascular event rates were compared using t-test and Fisher's exact test.

Results:
There were 196 patients treated with 682 infusions of IAC, divided into primary (no previous therapy, 98 eyes of 98 patients, 328 infusions) and secondary (after other therapy, 105 eyes of 98 patients, 354 infusions) treatment. Overall, ophthalmic vascular events were found after 5% of infusions (17% eyes). A comparison of ophthalmic vascular events (primary vs. secondary IAC), with mean three infusions per eye (median 3, range 1–7), revealed no difference in overall percentage of eyes affected (18% vs. 15%, P = 0.57). Adverse vascular events per eye included retinal vasculature attenuation (1% vs. 0%, P = 0.99), peripheral retinal pruning (1% vs. 0%, P = 0.99), branch retinal artery occlusion (0% vs. 1%, P = 0.99), central retinal artery occlusion (0% vs. 1%, P = 0.99), macular ischemia (0% vs. 2%, P = 0.51), vitreous hemorrhage (2% vs. 3%, P = 0.92), subretinal hemorrhage (1% vs. 0%, P = 0.99), retinal pigment epithelium atrophy (6% vs. 3% P = 0.43), choroidal atrophy (4% vs. 2%, P = 0.92), optic disk pallor (1% vs. 0%, P = 0.99), and ophthalmic artery occlusion (9% vs. 6%, P = 0.35).

Conclusion:
Ophthalmic vascular events after IAC for retinoblastoma affect only 5% of eyes per infusion (17% of treated eyes). Vascular event risk per eye is similar when using IAC as primary or secondary treatment.
CLINICAL CHARACTERIZATION OF STARGARDT DISEASE PATIENTS WITH THE p.N1868I ABCA4 MUTATION
Authors: Collison Frederick T. , Lee Winston , Fishman Gerald A. , Park Jason C. , Zernant Jana , McAnany J. Jason , Allikmets Rando 
Published: September 2018

Purpose:
To investigate the Stargardt disease phenotype associated with an unusually common and “extremely hypomorphic” ABCA4 variant, p.N1868I.

Methods:
The charts of 27 patients with p.N1868I on one allele and a severe/deleterious mutation on the other allele were reviewed. Subjective age of onset, best-corrected visual acuity, and stage of disease were recorded for all 27 patients, 18 of whom had multiple visits. When available, fundus photography, spectral domain optical coherence tomography, fundus autofluorescence, full-field electroretinograms, Goldmann visual fields, and fluorescein angiography were included. Five families with multiple affected members were analyzed.

Results:
The median age at symptom onset was 41.5 years, and 3 p.N1868I patients had not developed visual symptoms as of the most recent eye examination. Median best-corrected visual acuity in the better-seeing eye at baseline was 20/25−2, and the median duration from symptom onset to legal blindness was 25 years. The five families described in this study demonstrated clinically significant intrafamilial variability, and affected family members who did not share the p.N1868I variant had relatively more severe phenotypes.

Conclusion:
This study demonstrates the consistency of foveal sparing, the variation in age at onset, the intrafamilial variability, and the prognosis with regard to visual acuity in p.N1868I-associated Stargardt disease.