bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis
Authors: Khan Nickalus R. , Patel Prayash G. , Sharpe John P. , Lee Siang Liao , Sorenson Jeffrey 
Published: December 2017

OBJECTIVEVenous thromboembolism (VTE) is a common and potentially life-threatening complication. The risk of serious hemorrhagic complications when starting chemical prophylaxis for VTE prevention is a substantial concern for neurosurgeons. The objective of this study was to perform an updated systematic review and meta-analysis to determine if the rates of VTE and bleeding complications are different in patients undergoing chemoprophylaxis compared with placebo or mechanical prophylaxis alone following cranial or spinal procedures.METHODSIn February 2016 a systematic literature review was performed identifying 3944 articles from 4 different databases. A random-effects meta-analysis was performed after identifying the articles that met inclusion criteria.RESULTSNine articles that met the inclusion criteria were included. The quality of the studies was good, with all of them being classified as Level 2 evidence, with moderate Jadad scores. A meta-analysis comparing chemoprophylaxis with placebo in the prevention of deep venous thrombosis showed a significant benefit to chemical prophylaxis (OR 0.51, 95% CI 0.37–0.71; p < 0.0001). No significant increase in major intracranial hemorrhage (p = 0.60), major extracranial hemorrhage (p = 0.98), or minor bleeding complications (p = 0.60) was found.CONCLUSIONSBased on moderate-to-good quality of evidence, chemoprophylaxis is beneficial in preventing VTE, with no significant increase in either major or minor bleeding complications in patients undergoing cranial and spinal procedures. Further research is needed to determine whether this conclusion holds true for more specific subpopulations.
Pedicle screw placement accuracy using ultra-low radiation imaging with image enhancement versus conventional fluoroscopy in minimally invasive transforaminal lumbar interbody fusion: an internally randomized controlled trial
Authors: Nayar Gautam , Blizzard Daniel J. , Wang Timothy Y. , Cook Steven , Back Adam G. , Vincent David , Karikari Isaac O. 
Published: December 2017

OBJECTIVEA previous study found that ultra-low radiation imaging (ULRI) with image enhancement significantly decreases radiation exposure by roughly 75% for both the patient and operating room personnel during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) (p < 0.001). However, no clinical data exist on whether this imaging modality negatively impacts patient outcomes. Thus, the goal of this randomized controlled trial was to assess pedicle screw placement accuracy with ULRI with image enhancement compared with conventional, standard-dose fluoroscopy for patients undergoing single-level MIS-TLIF.METHODSAn institutional review board–approved, prospective internally randomized controlled trial was performed to compare breach rates for pedicle screw placement performed using ULRI with image enhancement versus conventional fluoroscopy. For cannulation and pedicle screw placement, surgery on 1 side (left vs right) was randomly assigned to be performed under ULRI. Screws on the opposite side were placed under conventional fluoroscopy, thereby allowing each patient to serve as his/her own control. In addition to standard intraoperative images to check screw placement, each patient underwent postoperative CT. Three experienced neurosurgeons independently analyzed the images and were blinded as to which imaging modality was used to assist with each screw placement. Screw placement was analyzed for pedicle breach (lateral vs medial and Grade 0 [< 2.0 mm], Grade 1 [2.0–4.0 mm], or Grade 2 [> 4.0 mm]), appropriate screw depth (50%–75% of the vertebral body’s anteroposterior dimension), and appropriate screw angle (within 10° of the pedicle angle). The effective breach rate was calculated as the percentage of screws evaluated as breached > 2.0 mm medially or postoperatively symptomatic.RESULTSTwenty-three consecutive patients underwent single-level MIS-TLIF, and their sides were randomly assigned to receive ULRI. No patient had immediate postoperative complications (e.g., neurological decline, need for hardware repositioning). On CT confirmation, 4 screws that had K-wire placement and cannulation under ULRI and screw placement under conventional fluoroscopy showed deviations. There were 2 breaches that deviated medially but both were Grade 0 (< 2.0 mm). Similarly, 2 breaches occurred that were Grade 1 (> 2.0 mm) but both deviated laterally. Therefore, the effective breach rate (breach > 2.0 mm deviated medially) was unchanged in both imaging groups (0% using either ULRI or conventional fluoroscopy; p = 1.00).CONCLUSIONSULRI with image enhancement does not compromise accuracy during pedicle screw placement compared with conventional fluoroscopy while it significantly decreases radiation exposure to both the patient and operating room personnel.
Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery
Authors: Nunley Pierce D. , Mundis Gregory M. , Fessler Richard G. , Park Paul , Zavatsky Joseph M. , Uribe Juan S. , Eastlack Robert K. , Chou Dean , Wang Michael Y. , Anand Neel , Frank Kelly A. , Stone Marcus B. , Kanter Adam S. , Shaffrey Christopher I. , Mummaneni Praveen V. , _ _ 
Published: December 2017

OBJECTIVEThe aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery.METHODSMedicare’s Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion.RESULTSPooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay.CONCLUSIONSReimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.
Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment
Authors: Hosseini Pooria , Mundis Gregory M. , Eastlack Robert K. , Bagheri Ramin , Vargas Enrique , Tran Stacie , Akbarnia Behrooz A. 
Published: December 2017

OBJECTIVESagittal malalignment decreases patients’ quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique.METHODSA retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied.RESULTSThe patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m2. The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence–lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy at the level of ACR were not statistically significant. Total visual analog score, Oswestry Disability Index, and Scoliosis Research Society–22 scores all improved from preoperative to postoperative and preoperative to 1-year follow-up. Fourteen patients (35.9%) experienced 26 complications (15 major and 11 minor). Eleven patients required reoperation. The most common complication was proximal junctional kyphosis (6/26 complications, 23%) followed by vertebral body/endplate fracture (3/26, 12%).CONCLUSIONSThis study showed satisfactory radiographic and clinical outcomes at the 1-year follow-up. Proximal junctional kyphosis was the most common complication followed by fracture, complications that are commonly associated with sagittal realignment surgery and may not be mitigated by the anterior approach.
Does prior spine surgery or instrumentation affect surgical outcomes following 3-column osteotomy for correction of thoracolumbar deformities?
Authors: Lau Darryl , Chan Andrew K. , Deverin Vedat , Ames Christopher P. 
Published: December 2017

OBJECTIVEAdult spinal deformity (ASD) develops in the setting of asymmetrical arthritic degeneration, and can also be due to iatrogenic causes, such as prior surgery. Many patients who present with ASD have undergone prior spine surgery with instrumentation. Unfortunately, contemporary studies that evaluate the effect of prior surgery or instrumentation on perioperative outcomes, readmission rates, and need for reoperation are lacking.METHODSAll ASD patients who underwent a 3-column osteotomy performed by the senior author at the authors’ institution for correction of thoracolumbar spinal deformity between 2006 and 2016 were identified. The authors compared surgical outcomes between primary (first-time) and revision cases. Further subgroup analysis was conducted to investigate the effect of the number of prior surgeries (0, 1, 2, 3, 4, and 5 or more) and the presence of spinal instrumentation on outcomes. Multivariate analysis was used to adjust for relevant and significant confounders.RESULTSA total of 300 patients were included; 38.3% of patients were male. The overall perioperative complication rate was 24.7%, and the mean length of hospitalization was 8.2 days. The 90-day readmission rate was 9.0%, and the overall follow-up reoperation rate was 26.7%. There were no significant differences in complication rates (26.6% vs 24.0%, p = 0.645), length of hospitalization (8.7 vs 7.9 days, p = 0.229), readmission rates (11.4% vs 8.1%, p = 0.387), or reoperation rates (26.6% vs 26.7%, p = 0.984) between primary and revision cases. There was no significant difference in wound complications (infections/dehiscence) requiring reoperation (5.1% vs 6.3%, p = 0.683). Subgroup analysis conducted to evaluate the effect of the number of prior spinal surgeries or the presence of spinal instrumentation did not reveal significant differences for the aforementioned surgical outcomes. In adjusted multivariate analysis, there were no significant associations between history of prior surgery (number of prior surgeries and prior instrumentation) and all of the surgical outcomes of interest.CONCLUSIONSThe findings from this study suggest that patients who have undergone prior spine surgery with or without instrumentation are not at increased risk for perioperative complications, need for readmission, or reoperation following 3-column osteotomy of the thoracolumbar spine.
Hodgkin lymphoma: A review and update on recent progress
Authors: Shanbhag Satish , Ambinder Richard F. 
Published: December 2017

AbstractHodgkin lymphoma (HL) is a unique hematopoietic neoplasm characterized by cancerous Reed‐Sternberg cells in an inflammatory background. Patients are commonly diagnosed with HL in their 20s and 30s, and they present with supradiaphragmatic lymphadenopathy, often with systemic B symptoms. Even in advanced‐stage disease, HL is highly curable with combination chemotherapy, radiation, or combined‐modality treatment. Although the same doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapeutic regimen has been the mainstay of therapy over the last 30 years, risk‐adapted approaches have helped de‐escalate therapy in low‐risk patients while intensifying treatment for higher risk patients. Even patients who are not cured with initial therapy can often be salvaged with alternate chemotherapy combinations, the novel antibody‐drug conjugate brentuximab, or high‐dose autologous or allogeneic hematopoietic stem cell transplantation. The programmed death‐1 inhibitors nivolumab and pembrolizumab have both demonstrated high response rates and durable remissions in patients with relapsed/refractory HL. Alternate donor sources and reduced‐intensity conditioning have made allogeneic hematopoietic stem cell transplantation a viable option for more patients. Future research will look to integrate novel strategies into earlier lines of therapy to improve the HL cure rate and minimize long‐term treatment toxicities. CA Cancer J Clin 2018;68:116‐132. © 2017 American Cancer Society.
Conditions for Optimal Growth of Black Hole Seeds
Authors: Pacucci Fabio , Natarajan Priyamvada , Volonteri Marta , Cappelluti Nico , Urry C. Megan 
Published: December 2017

Abstract
Supermassive black holes weighing up to ∼109
M
⊙ are in place by z ∼ 7, when the age of the universe is ≲1 Gyr. This implies a time crunch for their growth, since such high masses cannot be easily reached in standard accretion scenarios. Here, we explore the physical conditions that would lead to optimal growth wherein stable super-Eddington accretion would be permitted. Our analysis suggests that the preponderance of optimal conditions depends on two key parameters: the black hole mass and the host galaxy central gas density. In the high-efficiency region of this parameter space, a continuous stream of gas can accrete onto the black hole from large to small spatial scales, assuming a global isothermal profile for the host galaxy. Using analytical initial mass functions for black hole seeds, we find an enhanced probability of high-efficiency growth for seeds with initial masses ≳104
M
⊙. Our picture suggests that a large population of high-z lower-mass black holes that formed in the low-efficiency region, with low duty cycles and accretion rates, might remain undetectable as quasars, since we predict their bolometric luminosities to be ≲1041 erg s−1. The presence of these sources might be revealed only via gravitational wave detections of their mergers.
Afterglows and Kilonovae Associated with Nearby Low-luminosity Short-duration Gamma-Ray Bursts: Application to GW170817/GRB 170817A
Authors: Xiao Di , Liu Liang-Duan , Dai Zi-Gao , Wu Xue-Feng 
Published: December 2017

Abstract
Very recently, the gravitational-wave (GW) event GW170817 was discovered to be associated with the short gamma-ray burst (GRB) 170817A. Multi-wavelength follow-up observations were carried out, and X-ray, optical, and radio counterparts to GW170817 were detected. The observations undoubtedly indicate that GRB 170817A originates from a binary neutron star merger. However, the GRB falls into the low-luminosity class that could have a higher statistical occurrence rate and detection probability than the normal (high-luminosity) class. This implies the possibility that GRB 170817A is intrinsically powerful, but we are off-axis and only observe its side emission. In this Letter, we provide a timely modeling of the multi-wavelength afterglow emission from this GRB and the associated kilonova signal from the merger ejecta, under the assumption of a structured jet, a two-component jet, and an intrinsically less-energetic quasi-isotropic fireball, respectively. Comparing the afterglow properties with the multi-wavelength follow-up observations, we can distinguish between these three models. Furthermore, a few model parameters (e.g., the ejecta mass and velocity) can be constrained.
Identifying Information Resources for Patients in the Intensive Care Unit and Their Families
Authors: Schnock Kumiko O. , Ravindran Sucheta S. , Fladger Anne , Leone Kathleen , Williams Donna M. , Dwyer Cynthia L. , Vu Thanh-Giang , Thornton Kevin , Gazarian Priscilla 
Published: December 2017

BACKGROUNDProviding information to patients in intensive care units and their families is challenging. Patients often are admitted unexpectedly and experience stress and uncertainty. One source of stress has been identified as unclear, uncoordinated, or inconsistent communication and information. Despite the need for information, no centrally located, easily accessible, standardized intensive care unit education content exists.OBJECTIVETo identify educational content for patients in the intensive care unit and their families across 4 different hospitals, develop a general content database, and organize the general content into a framework for education of patients and their families.METHODSEducational content for patients in the intensive care units of 4 participating hospitals was collected and a gap analysis was performed.RESULTSKey content format and categories were identified. Educational content was organized into an information pathway divided into 3 phases: intensive care unit arrival; understanding the intensive care unit and partnering in care; and intensive care unit transitions. The gap analysis revealed substantial variation in content format and categories.CONCLUSIONSStructuring a digital learning center using different stages of the patient’s stay in the intensive care unit and placing resources in the context of an information pathway can help coordinate education for these patients and their families, and creates a consistent communication guide for clinicians as well. The optimal digital format should be considered in designing the learning center.
A High-Throughput Real-Time Imaging Technique To Quantify NETosis and Distinguish Mechanisms of Cell Death in Human Neutrophils
Authors: Gupta Sarthak , Chan Diana W. , Zaal Kristien J. , Kaplan Mariana J. 
Published: December 2017

Abstract
Neutrophils play a key role in host defenses and have recently been implicated in the pathogenesis of autoimmune diseases by various mechanisms, including formation of neutrophil extracellular traps through a recently described distinct form of programmed cell death called NETosis. Techniques to assess and quantitate NETosis in an unbiased, reproducible, and efficient way are lacking, considerably limiting the advancement of research in this field. We optimized and validated, a new method to automatically quantify the percentage of neutrophils undergoing NETosis in real time using the IncuCyte ZOOM imaging platform and the membrane-permeability properties of two DNA dyes. Neutrophils undergoing NETosis induced by various physiological stimuli showed distinct changes, with a loss of multilobulated nuclei, as well as nuclear decondensation followed by membrane compromise, and were accurately counted by applying filters based on fluorescence intensity and nuclear size. Findings were confirmed and validated with the established method of immunofluorescence microscopy. The platform was also validated to rapidly assess and quantify the dose-dependent effect of inhibitors of NETosis. In addition, this method was able to distinguish among neutrophils undergoing NETosis, apoptosis, or necrosis based on distinct changes in nuclear morphology and membrane integrity. The IncuCyte ZOOM platform is a novel real-time assay that quantifies NETosis in a rapid, automated, and reproducible way, significantly optimizing the study of neutrophils. This platform is a powerful tool to assess neutrophil physiology and NETosis, as well as to swiftly develop and test novel neutrophil targets.
Comparative Evaluation of Cleaning Efficacy using Four Novel Nickel–titanium Rotary Instruments: An in vitro Scanning Electron Microscope Study
Authors: Kar Prem P , Khasnis Sandhya A , Kidiyoor Krisnamurthy H 
Published: December 2017

ABSTRACT

Aim
The aim of the study was to compare the cleaning efficacy (debris and smear layer removal) of two multifile rotary systems (MTwo and Silk) and two single-file rotary systems (F6 Skytaper and NeoNiTi).

Materials and methods
Eighty mesial canals of mandibular first molars were cleaned and shaped using four nickel–titanium (NiTi) rotary instruments to size # 25 and 3% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA). Samples were randomly divided into four equal groups (n = 20) according to instrumentation: Group I, Mtwo; group II, Silk; group III, F6 Skytaper; group IV, NeoNiTi. Samples were split longitudinally and examined under scanning electron microscope (SEM) for debris and smear layer removal in coronal, middle, and apical thirds of each root canal.

Results
F6 skytaper and Mtwo groups showed significantly higher debris removal than Silk and NeoNiTi groups in apical third of root canal as well as when compared with NeoNiTi group in middle third. F6 Skytaper group showed significantly higher debris and smear layer removal than Silk group in coronal third. There was statistically significant difference among all thirds of root canal in terms of debris removal in Silk and NeoNiTi groups. There was statistically significant difference among all thirds of root canal in F6 Skytaper and NeoNiTi groups in terms of smear layer removal.

Conclusion
F6 Skytaper single-file rotary instrumentation showed the maximum cleaning efficacy followed by Mtwo multifile rotary instrumentation in all thirds of root canal.

Clinical significance
F6 Skytaper rotary instrument is most efficient followed by Mtwo rotary instrument among all rotary instruments.

How to cite this article
Kar PP, Khasnis SA, Kidiyoor KH. Comparative Evaluation of Cleaning Efficacy using Four Novel Nickel-titanium Rotary Instruments: An in vitro Scanning Electron Microscope Study. J Contemp Dent Pract 2017;18(12):1135-1143.