bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Conventional and Navigation-assisted Techniques for Lateral Opening-wedge Femoral Varus Osteotomy
Authors: da Costa Sergio R. , da Mota e Albuquerque Roberto F. 
Published: April 2018

Objective:
The aim of this study was to assess short-term clinical and radiographic results of opening-wedge distal femoral varus osteotomy performed using either the conventional technique or a navigation (NAV)-assisted technique.

Materials and Methods:
This study included 25 patients; 12 patients underwent femoral osteotomy with NAV, and 13 patients underwent the conventional procedure.

Results:
In the NAV osteotomy group, the mean duration of surgery was 73.69 minutes (SD, 12.53 min), and the mean tourniquet time was 59 minutes. Mean preoperative mechanical alignments were 13.84 degrees in the conventional osteotomy group and 14.4 degrees in the NAV osteotomy group (P=0.7432; 95% confidence interval=12.8-15.4 degrees), and the final postoperative mechanical alignment varied between −2 and 3 degrees in both groups, with no significant difference between the results obtained using the 2 techniques (P=0.1316; 95% confidence interval=0.08-1.24 degrees). However, the correlation between initial alignment and postoperative result was strong (P=−0.68) in the NAV osteotomy group and weak (P=−0.07) in the conventional osteotomy group.

Conclusions:
Duration of surgery and tourniquet time were longer in the NAV osteotomy group. The use of NAV for femoral varus osteotomy did not result in any significant difference in final alignment.
The Role of Provider Characteristics in the Selection of Surgery or Radiation for Localized Prostate Cancer and Association With Quality of Care Indicators
Authors: Satkunasivam Raj , Lo Mary , Stern Mariana , Gill Inderbir S. , Fleming Steven , Wu Xiao-Cheng , Anderson Roger T. , Thompson Trevor D. , Hamilton Ann S. 
Published: April 2018

Introduction:
We sought to identify the role of provider and facility characteristics in receipt of radical prostatectomy (RP) or external beam radiation therapy (EBRT) and adherence to quality of care measures in men with localized prostate cancer (PCa).

Materials and Methods:
Subjects included 2861 and 1630 men treated with RP or EBRT, respectively, for localized PCa whose records were reabstracted as part of the Centers for Disease Control and Prevention Breast and Prostate Patterns of Care Study. We utilized multivariable generalized estimating equation regression analysis to assess patient, clinical, and provider (year of graduation, urologist density) and facility (group vs. solo, academic/teaching status, for-profit status, distance to treatment facility) characteristics that predicted use of RP versus EBRT as well as quality of care outcomes.

Results:
Multivariable analysis revealed that group (vs. solo) practice was associated with a decreased risk of RP (odds ratio, 0.47; 95% confidence interval, 0.25-0.91). Among RP patients with low-risk disease, receipt of a bone scan that was not recommended was significantly predicted by race and insurance status. Surgical quality of care measures were associated with physician’s year of graduation and receiving care at a teaching facility.

Conclusions:
In addition to demographic factors, we found that provider and facility characteristics were associated with treatment choice and specific quality of care measures. Long-term follow-up is required to determine whether quality of care indicators are related to PCa outcomes.
Impact of Right-sided Primary Tumor Location Among Patients With Oligometastatic Colorectal Cancer Treated With Stereotactic Body Radiotherapy
Authors: Bates James E. , Choi Gyujae , Usuki Kenneth Y. , Katz Alan W. , Milano Michael T. 
Published: April 2018

Introduction:
Among patients with colorectal cancer, those with right-sided primary tumors have worse outcomes in both the primary and metastatic setting. Patients with oligometastatic colorectal cancer (OMCC) have improved prognosis relative to those with diffusely metastatic disease. We aimed to assess if the trend toward worse outcomes with right-sided tumors remained in the oligometastatic setting.

Patients and Methods:
We analyzed 31 patients treated at a single institution with stereotactic body radiotherapy for OMCC from 2011 to 2014 to assess the impact that primary tumor location had on overall survival (OS) and progression-free survival (PFS).

Results:
Overall, patient local control was fair (66% at 2 y); however, distant control was only 37.4% at 2 years. The median OS was 2.4 years; the median PFS was 6.5 months. Patients with right-sided primary tumors had numerically worse median OS than those with left-sided or rectal primary tumors (1.4 vs. 3.7 y, P=0.09). Median PFS was significantly worse among those with right-sided primaries (2.9 vs. 10.8 mo, P=0.05). This held on multivariate analysis.

Conclusions:
These results affirm that patients with OMCC have extended OS periods and that stereotactic body radiotherapy offers strong local control in these settings. We show that even in the oligometastatic setting those with right-sided primary tumors have worse outcomes relative to those with left-sided or rectal primary tumors. This suggests more aggressive treatment may be needed for those with oligometastatic right-sided colorectal cancer.
Pouch Volvulus in Patients Having Undergone Restorative Proctocolectomy for Ulcerative Colitis: A Case Series
Authors: Landisch Rachel M. , Knechtges Paul M. , Otterson Mary F. , Ludwig Kirk A. , Ridolfi Timothy J. 
Published: April 2018

BACKGROUND:
Restorative proctocolectomy with IPAA improves quality of life in patients with medically refractory ulcerative colitis. Although bowel obstruction is common, pouch volvulus is rare and described only in case reports. Diagnosis can be challenging, resulting in delayed care and heightened morbidity.

OBJECTIVE:
The purpose of this study was to delineate the symptoms and successful management strategies used in patients with IPAA volvulus that result in pouch salvage.

DESIGN:
This study was a case series.

SETTINGS:
The study was conducted at a tertiary referral center for ulcerative colitis in Milwaukee, Wisconsin.

PATIENTS:
Patients included those with volvulus of the IPAA.

MAIN OUTCOME MEASURES:
Over the study period (2010–2015), 6 patients were diagnosed with IPAA volvulus. The primary outcomes were symptom manifestation, diagnostic practices, and treatment of pouch volvulus.

RESULTS:
Six patients with ulcerative colitis were identified with pouch volvulus. The majority (n = 4) underwent a laparoscopic pouch creation and had early symptom manifestation after surgery. Complications preceding volvulus included pouch ulceration (n = 5) and pouchitis (n = 4). The most common presenting symptoms of volvulus were abdominal pain (n = 4) and obstipation (n = 4). Multiple imaging modalities were used, but volvulus was most frequently identified by CT scan. Management was primarily operative (n = 5), composed of excision of the pouch (n = 3), pouch-pexy (n = 1), and detorsion with defect closure (n = 1). Both operative and nonoperative treatment with endoscopic detorsion resulted in low morbidity and improved patient symptoms.

LIMITATIONS:
This single-institution study is limited by its retrospective design and small number of patients.

CONCLUSIONS:
IPAA volvulus is a rare and challenging cause of bowel obstruction in ulcerative colitis. Heralding signs and symptoms, such as pouch ulceration and acute obstipation, should initiate a workup for a twisting pouch. Diagnosis, which is multimodal, must occur early to avert necrosis and allow for preservation of a well-functioning pouch. See Video Abstract at http://links.lww.com/DCR/A561.
Should we consider telomere length and telomerase activity in male factor infertility?
Authors: Balmori Carlos , Varela Elisa 
Published: April 2018

Purpose of review
The purpose of this review is to analyze what is known to date about the relation between telomeres and male fertility, and if it is possible for telomeres, or elements related to them, to be used as new prognostic biomarkers in fertility treatment.

Recent findings
Cells in germ series, including spermatozoids, have longer telomeres (10–20 kb), and do not seem to undergo the shortening that takes place in somatic cells with age as they present telomerase activity. Longer telomere length found in the sperm of older fathers, influences their offspring possessing cells with longer telomere length. Infertile patients have spermatozoids with shorter telomere length than fertile people, but telomere length does neither correlate with the sperm concentration, mobility or morphology, nor with the DNA fragmentation indices (DFI) of spermatozoids. Embryo quality rate and transplantable embryo rate are related with the telomere length of spermatozoids (STL), but pregnancy rates are not affected.

Summary
Telomere length and telomerase levels can be used as biomarkers of male fertility. Higher STL can have beneficial effects on fertility, thus the use of spermatozoids with longer telomere length in an assisted reproduction technique (ART) could be one way of solving some infertility cases.
Extracellular vesicles: a promising tool for assessment of embryonic competence
Authors: Marin Diego , Scott Richard T. 
Published: April 2018

Purpose of review
Extracellular vesicles have recently emerged as a promising field of research due to their pivotal roles in intercellular communication and potential to serve as biomarkers. This review focuses on extracellular vesicles secreted by the human preimplantation embryo. The most recent findings on embryo-derived extracellular vesicles are described and discussed, as well as current technical challenges to study them.

Recent findings
So far, only a few studies have addressed extracellular vesicles of embryonic origin and explored their potential as biomarkers for embryo selection. Two main hypotheses have driven interest in studying extracellular vesicles in IVF embryo-conditioned culture media. On the one hand, the potential roles of extracellular vesicles in mediating the embryo-endometrial crosstalk for proper implantation. On the other hand, the profile of secreted extracellular vesicles as an indicator of embryonic fitness irrespective of any involvement or communication with the endometrium. Embryo-derived extracellular vesicles have already been investigated to design diagnostic tests for embryo viability, however with small sample sizes or without extensive technology validation.

Summary
Extracellular vesicles offer indeed a novel means to assess embryonic fitness. Further validation studies, technology development and more complex study designs are certainly required to implement the profiling of embryonic extracellular vesicles as a diagnostic test for embryo selection.
PRIMARY CORE VITRECTOMY TECHNIQUE BEFORE CATARACT SURGERY IN COMBINED PHACOVITRECTOMY FOR EYES WITH DENSE VITREOUS HEMORRHAGES
Authors: Shin Kyung Sup , Lim Hyung Bin , Shin Yong Il , Lee Seong Eun , Jo Young Joon , Kim Jung Yeul 
Published: April 2018

Purpose:
To investigate the efficacy and safety of a primary core vitrectomy technique for combined phacovitrectomy in eyes showing a poor red reflex because of dense vitreous hemorrhage before cataract surgery.

Methods:
A total of 156 eyes from 156 patients, who underwent combined phacovitrectomy because of cataract and dense vitreous hemorrhage, and who were followed up for at least 6 months were included. The patients were divided into a primary phacoemulsification group (Group A, 80 eyes) who underwent phacoemulsification first followed by total vitrectomy and a primary vitrectomy group (Group B, 76 eyes) who underwent core vitrectomy first followed by cataract surgery and followed by total vitrectomy. A conventional 23-gauge combined phacovitrectomy was performed in all patients. The operation time, including the total continuous curvilinear capsulorhexis time and total cataract surgery time, and the incidence of surgery-related complications were evaluated in the two groups.

Results:
Diabetic retinopathy was the most common cause for vitreous hemorrhage in both groups (Group A: 51 eyes; Group B: 39 eyes). The total continuous curvilinear capsulorhexis time (P = 0.001) and total cataract surgery time (P = 0.036) were significantly shorter in Group B than in Group A. Among the complications, radial tears occurred more frequently in Group A than Group B, but these differences were not statistically significant (P = 0.211). Pupil size reduction during cataract surgery was greater in Group B than in Group A (P = 0.034). There were no significant differences in posterior capsular ruptures or posterior capsular opacities between the two groups. Other postoperative complications were not observed in either group until 6 months after surgery.

Conclusion:
Primary core vitrectomy combined with phacovitrectomy of patients who had dense vitreous hemorrhage helped to obtain a good red reflex and enabled surgeons to perform successful cataract surgery. In addition, primary core vitrectomy was an easy and safe technique, which reduced the surgery time and surgery-related complications. This surgical technique would, therefore, be helpful to vitreoretinal surgeons.
Atypical Presentation of Iridocorneal Endothelial Syndrome With Band Keratopathy but No Corneal Edema Managed With Descemet Membrane Endothelial Keratoplasty
Authors: Zygoura Vasiliki , Lavy Itay , Verdijk Robert M. , Santander-García Diana , Baydoun Lamis , Dapena Isabel , Melles Gerrit R. J. 
Published: April 2018

Purpose:
To report an unusual presentation of iridocorneal endothelial (ICE) syndrome associated with band keratopathy and its management with ethylenediamine-tetraacetic acid (EDTA) chelation and Descemet membrane endothelial keratoplasty (DMEK).

Methods:
A 57-year-old female patient presented with unilateral progressive painless visual impairment, corneal band keratopathy, and morphological corneal endothelial changes without corneal edema or any previous ophthalmic, medical, or family history. Routine specular and confocal microscopy imaging, as well as biomicroscopy, best-corrected visual acuity, and pachymetry measurements were performed before and after the surgical procedures. Histopathologic and immunohistochemical evaluations of the surgically excised diseased DM–endothelium were performed.

Results:
Superficial epithelial keratectomy with EDTA chelation was performed. After an initial period of a few months of corneal clearance, the patient presented with recurrence of visually significant band keratopathy. After 1 year, she underwent retreatment with superficial epithelial keratectomy and EDTA chelation, followed by DMEK. Histopathologic and immunohistochemical analysis showed ICE syndrome. Two years after DMEK surgery, the cornea was still clear and band keratopathy had not recurred.

Conclusions:
To the best of our knowledge, this is the first case in the literature that reports the association of ICE syndrome with band keratopathy. As band keratopathy recurred shortly after EDTA chelation, endothelial keratoplasty (DMEK) may be indicated to successfully treat such cases.
Long-term Hearing Outcome of Canaloplasty With Partial Ossicular Replacement in Congenital Aural Atresia
Authors: Ahn Jungmin , Ryu Gwanghui , Kang Minwoong , Cho Yang-Sun 
Published: April 2018

Objective:
The aim of this study was to correlate the postoperative hearing outcomes with regard to the length of prosthesis of the partial ossicular replacement prosthesis (PORP) in patients with congenital aural atresia.

Study Design:
Retrospective review of medical records.

Setting, Patients, Intervention, Main Outcome Measure:
The medical records of 131 patients (132 ears) who underwent canaloplasty with PORP by a single surgeon from 2011 to 2016 were reviewed for demographic data, Jahrsdoerfer score, grade of microtia, length of prosthesis, and audiometric outcomes. Air conduction, bone conduction threshold, and air-bone gap were measured preoperatively and at 3-, 6-, 12-, and 24-months of follow-up. Patients were divided into two groups according to the postoperative hearing outcomes, and the length of PORP was compared between the two groups. Univariable and multivariable generalized estimating equations were used to investigate other favorable prognostic factors for long-term postoperative hearing results.

Results:
When the improvement of the air-bone gap within 30 dB was defined as successful hearing outcome, no significant differences were observed for prosthesis length between two groups at 3, 6, and 12 months postoperatively. However, at 2-year follow-up, mean length of prosthesis was significantly shorter (p = 0.006) for the success group (2.30 ± 0.53 mm) than for the nonsuccess group (2.77 ± 0.73 mm). Generalized estimating equations revealed PORP length as the only factor significantly associated with favorable long-term hearing results.

Conclusion:
Long-term hearing outcome of canaloplasty with PORP is likely to be affected by prosthesis length. For that reason, making the neo-annulus as medial as possible to shorten the length of the appropriate prosthesis is important for successful long-term hearing outcomes.
Short and Long-Term Outcomes of Titanium Clip Ossiculoplasty
Authors: Kahue Charissa N. , O’Connnell Brendan P. , Dedmon Matthew M. , Haynes David S. , Rivas Alejandro 
Published: April 2018

Objective:
To report short (∼4 mo) and long-term (>12 mo) audiometric outcomes following ossiculoplasty using a titanium clip partial ossicular reconstruction prosthesis.

Methods:
Case series at a single tertiary referral center reviewing 130 pediatric and adult patients with conductive hearing loss (CHL) secondary to chronic otitis media (n = 121, 93%) or traumatic ossicular disruption (n = 9, 7%) who underwent partial ossiculoplasty from January 2005 to December 2015 with the CliP prosthesis.

Results:
At both short and long-term follow-up, postoperative air-bone gap (ABG) was significantly improved (18 dB HL, IQ range 13–26, p < 0.0001 and 18 dB HL, IQ range 13–29, p = 0.0002, respectively) when compared with preoperative values (29 dB HL, IQ range 19–37). No significant change in ABG was noted when comparing short and long-term intervals (18 versus 18 dB HL, p = 0.44). Fifty seven percent of cases (51/89) achieved a long-term ABG less than or equal to 20 dB at the time of their last follow-up. The extrusion and displacement rates were 1.5% (2/130), and 0.8% (1/130), respectively. There were no cases of iatrogenic sensorineural hearing loss.

Conclusions:
Partial ossiculoplasty with the titanium CliP produces good hearing outcomes with a favorable safety profile. At long-term follow-up (minimum of 12 mo), median ABG was 18 dB and remained stable when compared with short-term follow-up. The majority of patients had successful long-term results, with 57% of patients achieving an ABG is less than or equal to 20 dB. Low rates of extrusion (1.5%) and prosthesis displacement off the stapes (0.8%) support the long-term stability of the CliP prosthesis in the middle ear.
Examining Parental Medication Adherence as a Predictor of Child Medication Adherence in Pediatric Anxiety Disorders
Authors: Bushnell Greta A. , Brookhart M. Alan , Gaynes Bradley N. , Compton Scott N. , Dusetzina Stacie B. , Stürmer Til 
Published: April 2018

Background:Selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety disorders but adherence remains difficult to predict.Objectives:To estimate SSRI adherence in children with anxiety disorders and determine if prior parental medication adherence is predictive of child high SSRI adherence.Methods:We identified children (3–17 y) initiating SSRI treatment after an anxiety disorder diagnosis in a commercial claims database (2005–2014). We evaluated parent SSRI, statin, and antihypertensive adherence [6-mo proportion days covered (PDC), high adherence=PDC≥0.80] in the year before child SSRI initiation. We estimated risk differences (RD) of child high SSRI adherence (6-mo PDC) stratified by parent adherence and multivariable risk ratios using modified Poisson regression. We estimated change inc-statistic and risk reclassification when adding parent-level covariates with child-level covariates to predict child adherence.Results:In 70,979 children with an anxiety disorder (59%=female, 14=median age), the mean 6-month SSRI PDC was 0.72, with variation by anxiety disorder. Overall 64% of children had high adherence if their parent had high SSRI adherence versus 53% of children with parents with low SSRI adherence (RD, 12%; multivariable risk ratios, 1.17; 95% confidence interval, 1.14–1.20). Findings were similar for parent statin (RD=10%) and antihypertensive adherence (RD=8%) and when stratified by child age and parent sex. There was minor improvement in risk reclassification and thec-statistic after adding parent adherence and parent-level covariates.Conclusions:Parental medication adherence could help providers identify children at risk of nonadherence to inform the treatment decision, reduce unnecessary medication switches, and lead to broader effective interventions.
Case-Mix for Performance Management
Authors: Gao Jian , Moran Eileen , Almenoff Peter L. 
Published: April 2018

Background:Accurate risk adjustment is the key to a reliable comparison of cost and quality performance among providers and hospitals. However, the existing case-mix algorithms based on age, sex, and diagnoses can only explain up to 50% of the cost variation. More accurate risk adjustment is desired for provider performance assessment and improvement.Objective:To develop a case-mix algorithm that hospitals and payers can use to measure and compare cost and quality performance of their providers.Methods:All 6,048,895 patients with valid diagnoses and cost recorded in the US Veterans health care system in fiscal year 2016 were included in this study. The dependent variable was total cost at the patient level, and the explanatory variables were age, sex, and comorbidities represented by 762 clinically homogeneous groups, which were created by expanding the 283 categories from Clinical Classifications Software based on ICD-10-CM codes. The split-sample method was used to assess model overfitting and coefficient stability. The predictive power of the algorithms was ascertained by comparing theR2, mean absolute percentage error, root mean square error, predictive ratios, andc-statistics.Results:The expansion of the Clinical Classifications Software categories resulted in higher predictive power. TheR2reached 0.72 and 0.52 for the transformed and raw scale cost, respectively.Conclusions:The case-mix algorithm we developed based on age, sex, and diagnoses outperformed the existing case-mix models reported in the literature. The method developed in this study can be used by other health systems to produce tailored risk models for their specific purpose.