bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Stroke Volume Variation to Guide Donor Management Is Associated With Increased Organs Transplanted per Donor
Authors: Bergstrom Benjamin , de la Cruz J. Salvador , Sally Mitch , Louis Scott , Friedman Melissa , Petersen Floyd , Malinoski Darren 
Published: April 2017

Background: There is a national shortage of organs available for transplantation, and utilization rates for thoracic organs are less than 40%. In addition, the optimal method of assessing cardiovascular status during donor management is uncertain. FloTrac is a noninvasive hemodynamic technique that measures cardiac output and fluid responsiveness. Our objective was to measure the impact of using this technique to guide management on fluid balance, vasopressor usage, thyroid hormone usage, and pulmonary function. We hypothesized that FloTrac guidance will increase thoracic organs transplanted per donor (OTPD). Methods: Data were prospectively collected on a convenience sample of 38 donors after neurologic determination of death. Organs transplanted, net fluid balance, dosage of vasopressors, dosage of thyroid hormone, and Pao2:Fio2 were compared between treatment and control groups. Results: The treatment group had greater thoracic OTPD (1.3 [1.0] vs 0.4 [0.6], P = .004) and overall OTPD (4.3 [1.5] vs 2.7 [1.5], P = .002). Donors in the treatment group maintained a neutral fluid balance, had more thyroid hormone used, and had an improvement in oxygenation. Conclusion: The implementation of this technology to aid providers may help ameliorate the shortage of thoracic and overall organs available for transplantation.
Recovery of mechanical detection thresholds after direct digital nerve repair versus conduit implantation
Authors: Huber J. L. , Maier C. , Mainka T. , Mannil L. , Vollert J. , Homann H.-H. 
Published: April 2017

The purpose of this study was to assess sensory and functional nerve recovery after digital nerve injury in patients with an end-to-end suture (S) or with implantation of a collagen conduit (C) to bridge a nerve gap. Fifteen S and 11 C with a follow-up of 6–36 months and 28 healthy control participants were enrolled. Methods of assessments were quantitative sensory testing, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), range of motion and the painDetect questionnaire. After both procedures, sensory profiles showed largely recovered function of C and Aδ fibres but severe loss of Aβ-fibre function leading to increased mechanical detection thresholds. There was only minimal allodynia. Severe pain was absent. Patients with conduits reported more functional impairment, especially in work performance, which correlated with the assessed loss of Aß-fibre function. Level of evidence: III
The effects of tolterodine on anterior segment and choroidal thickness in patients with overactive bladder syndrome
Authors: Telek Hande Hüsniye , Doluoglu Omer Gokhan , Burcu Ayse , Demirok Gulizar , Ornek Firdevs , Ayyildiz Ali 
Published: April 2017

Background: To evaluate the effects of tolterodine on anterior segment and choroidal thickness by using the Pentacam system and optical coherence tomography (OCT) (Pentacam). Methods: A total of 122 eyes of 61 patients (34 female; 27 male) were included in the study. All patients underwent a regular ocular examination and intraocular pressure measurements before and after 3 months of antimuscarinic drug tolterodine treatment, in addition, pupil diameter, anterior chamber depth, anterior chamber volume, anterior chamber angle, and lens thickness were measured through Pentacam (Oculus Inc., Wetzlar, Germany) system. Measurements of choroidal thickness were performed by OCT (Spectralis®, Heidelberg Engineering, Heidelberg, Germany). Results: The mean age was 58.4 ± 7.3 years and 56.5 ± 11.1 years for female and male patients. The mean intraocular pressure was 15.10 ± 2.75 mmHg before treatment and 15.18 ± 2.65 mmHg after treatment. Pupil diameters were 3.09 ± 0.48 mm before treatment and 3.12 ± 0.43 mm after treatment. Anterior chamber depth, before and after treatment were 2.68 ± 0.65 mm and 2.70 ± 0.61 mm. The mean value for subfoveal choroidal thickness was 267.92 ± 81.35 μm before the administration of tolterodine, whereas the mean choroidal thickness was 271.83 ± 75.42 μm after the administration of tolterodine. The alterations in the subfoveal choroidal thickness were not statistically significant ( p = 0.862). Conclusions: After 3 months of therapy with tolterodine, there were no significant changes in anterior segment parameters and choroidal thickness.
Better, Sooner, More Convenient? The reality of pursuing greater integration between primary and secondary healthcare providers in New Zealand
Authors: Lovelock Kirsten , Martin Greg , Gauld Robin , MacRae Jayden 
Published: April 2017

Objectives: This article focuses on the results of evaluations of two business plans developed in response to a policy initiative which aimed to achieve greater integration between primary and secondary health providers in New Zealand. We employ the Consolidated Framework for Implementation Research to inform our analysis. The Better, Sooner, More Convenient policy programme involved the development of business plans and, within each business plan, a range of areas of focus and associated work-streams. Methods: The evaluations employed a mixed method multi-level case study design, involving qualitative face-to-face interviews with front-line staff, clinicians and management in two districts, one in the North Island and the other in the South Island, and an analysis of routine data tracked ambulatory sensitive hospitalisations and emergency department presentations. Two postal surveys were conducted, one focussing on the patient care experiences of integration and care co-ordination and the second focussing on the perspectives of health professionals in primary and secondary settings in both districts. Results: Both evaluations revealed non-significant changes in ambulatory sensitive hospitalisations and emergency department presentation rates and slow uneven progress with areas of focus and their associated work-streams. Our evaluations revealed a range of implementation issues, the barriers and facilitators to greater integration of healthcare services and the implications for those who were responsible for putting policy into practice. Conclusion: The business plans were shown to be overly ambitious and compromised by the size and scope of the business plans; dysfunctional governance arrangements and associated accountability issues; organisational inability to implement change quickly with appropriate and timely funding support; an absence of organisational structural change allowing parity with the policy objectives; barriers that were encountered because of inadequate attention to organisational culture; competing additional areas of focus within the same timeframe; and consequent overloading of front-line staff which led to workload stress, fatigue and disillusionment. Where success was achieved, this largely hinged on the enthusiasm of a small pool of front-line workers and their initial buy-into the idea of integrated care.
Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years
Authors: Imagama Shiro , Ando Kei , Kobayashi Kazuyoshi , Ishikawa Yoshimoto , Nakamura Hiroshi , Hida Tetsuro , Ito Kenyu , Tsushima Mikito , Matsumoto Akiyuki , Morozumi Masayoshi , Tanaka Satoshi , Machino Masaaki , Ota Kyotaro , Nakashima Hiroaki , Takamatsu Junki , Matsushita Tadashi , Nishida Yoshihiro , Ishiguro Naoki , Matsuyama Yukihiro 
Published: April 2017

Study Design: Prospective clinical study. Objective: Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years. Methods: A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery. Results: Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery ( P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery ( P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks ( P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up. Conclusions: Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.
Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease
Authors: Gruenberg Marcelo , Mereles Maximiliano E. , Willhuber Gastón O. Camino , Valacco Marcelo , Petracchi Matias G. , Solá Carlos A. 
Published: April 2017

Study Design: Retrospective study. Objective: Spinal metastasis can produce pain, deformity, neurological compromise and can decrease life expectancy. Surgical management is usually indicated for pain control, neurological decompression, and to avoid deformity progression. Tokuhashi et al created a scoring system to estimate survival and stratify surgical treatment based on established parameters. Our objective was to evaluate the usefulness of Tokuhashi scoring (TS) system by comparing the predicted and real survival times and analyze the survival time according to the type of tumor. Methods: From 2004 to 2014, 105 patients with vertebral metastasis who underwent surgical treatment were enrolled and retrospectively analyzed. Preoperative TS was performed in all cases. Patients were classified into 3 groups according to TS; group 1 (TS 0-8), group 2 (TS 9-11), and group 3 (TS 12-15). Patients’ average age was 61.5 years, main primary tumor site were as follows: kidney (23%), lung (19%), and breast (18%). Results: The Tokuhashi general concordance was 67.6%. Per group concordance was as follows: group 1 80%, in group 2, only 33% of concordance was observed. In group 3, 100% of concordance was observed. In group 2, the most common primary sites were breast and kidney and the mean survival was 20 and 22.3 months, respectively, both longer than that expected for this group. Conclusions: Tokuhashi concordance was acceptable in our study, particularly in lower and higher scores. The lesser concordance observed in group 2 (33.3%) was observed in almost all tumors. For our practice, TS constitutes an acceptable tool to define survival, particularly in lower and higher scores.
Assessing Foraminal Stenosis in the Cervical Spine: A Comparison of Three-Dimensional Computed Tomographic Surface Reconstruction to Two-Dimensional Modalities
Authors: Schell Adam , Rhee John M. , Holbrook John , Lenehan Eric , Park Kun Young 
Published: April 2017

Study Design: Retrospective radiographic study. Objective: The optimal radiographic modality for assessing cervical foraminal stenosis is unclear. Determination on conventional axial cuts is made difficult due in part to the complex, oblique orientation of the cervical neuroforamen. The utility of 3-dimensonal (3D) computed tomography (CT) reconstruction in improving neuroforaminal assessment is not well understood. The objective of this study is to determine inter-rater variability in grading cervical foraminal stenosis using 3 different CT imaging modalities: 3D CT surface reconstructions (3DSR), 2D sagittal oblique multiplanar reformations (2D-SOMPR), and conventional 2D axial CT imaging. Methods: Pretreatment CT scans of 25 patients undergoing surgery for cervical spondylotic radiculopathy were analyzed at 2 levels: C5-C6 and C6-C7. Simple interrater agreement and kappa-Fleiss coefficients were calculated for each imaging modality and stenosis grade. Image reviewers (attending spine surgeon, attending neuroradiologist, spine fellow) interpreted each CT scan in 3 different formats: axial, 2D-SOMPR, and 3DSR. Four cervical foramina at 2 spinal levels were graded as normal (no stenosis), mild (≤25% stenosis), moderate (25%-50% stenosis), or severe (>50% stenosis). Results: Across all imaging modalities, interrater reliability was fair when grading foraminal stenosis (κ < 0.4). Agreement was lowest for the axial images (κ = 0.119) and highest for the 3D CT reconstructions (κ = 0.334). 2D-SOMPR images also led to improved interrater reliability when compared with axial images (κ = 0.255). Conclusion: Grading cervical foraminal stenosis using conventional axial CT imaging is difficult with low interrater reliability. CT modalities that provide a circumferential view of the cervical foramen, such as 2D-SOMPR and 3D CT reconstruction, had higher rates of interobserver reliability in grading foraminal stenosis than conventional axial cuts, with 3D having the highest. As these 3D reconstructions can be obtained at no additional cost or radiation exposure over a conventional CT scan, and because they can provide useful information in determining levels being considered for surgical decompression, we recommend they be utilized when evaluating cervical foramina.
Postoperative Kinetics of C-Reactive Protein and Erythrocyte Sediment Rate in One-, Two-, and Multilevel Posterior Spinal Decompressions and Instrumentations
Authors: Kunakornsawat Sombat , Tungsiripat Rachata , Putthiwara Dechporn , Piyakulkaew Chaiwat , Pluemvitayaporn Tinnakorn , Pruttikul Pritsanai , Kittithamvongs Piyabuth 
Published: April 2017

Study design: Prospective study. Objective: To characterize the normal pattern of kinetics of postoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after decompression, spinal instrumentation, and posterolateral fusion in 1, 2, and more than 2 levels. Methods: Blood specimens were obtained from patients who underwent posterior decompression, instrumentation with pedicular screws, and posterolateral fusion from June 2009 to January 2011. CRP and ESR levels were measured on the day before surgery and on postoperative days 1, 3, 7, 11, 14, 28, and 42. Results: Mean CRP levels peaked on the third day postoperatively in all groups. By day 7 postoperatively, it had dropped rapidly. At the 14th and 28th postoperative days, decreases to normal CRP levels were found in 16% and 80% of all patients, respectively. The pattern of decline in CRP was similar among groups. Values of ESR increased and peaked between the third and seventh postoperative days. ESR values gradually decreased. At the 42 day postoperatively, ESR level still remain above normal values in all groups. Conclusions: We compared conventional operation groups of 1-, 2-, and more than 2-level posterior instrumentation and found no statistically significant differences in the peak of CRP level, the ESR value, and the pattern of decline. CRP levels of 80% of the patients returned to normal within 4 weeks.
Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
Authors: Merrill Robert K. , Kim Jun S. , Leven Dante M. , Kim Joung Heon , Cho Samuel K. 
Published: April 2017

Study Design: Retrospective cohort study. Objective: To determine if patients fused with multi-rod constructs to the pelvis have a lower incidence of lumbosacral rod failure and pseudarthrosis than those fused with dual-rod constructs. Methods: We performed a retrospective review of consecutive adult spinal deformity patients who underwent long fusion to the pelvis. Inclusion criteria were >5 levels, primary fusion or revision for L5-S1 pseudarthrosis, and minimum 1-year follow-up. Revision patients with indications other than L5-S1 pseudarthrosis were excluded. One-year follow-up plain radiographs were reviewed for rod integrity, and computed tomography scan (CT) was obtained whenever rod breakage was observed. Dual-rod and multi-rod (3 or 4 rods) cohorts were statistically compared. Results: There were 31 patients with 15 in the dual-rod group and 16 in the multi-rod group, with average ages of 68 ± 9 and 63 ± 12 years, respectively. No patients in the multi-rod group experienced rod fracture, whereas 6 in the dual-rod group fractured a rod ( P = .007), with 4 occurring at the lumbosacral junction ( P = .04). CT scan in the 4 lumbosacral rod fracture cases, and surgical exploration in 3, confirmed pseudarthrosis and hypertrophic nonunion at the L5-S1 junction. Conclusion: Patients with dual-rod constructs had a statistically greater incidence of lumbosacral pseudarthrosis with implant failure than those with multi-rod constructs. CT and surgical exploration showed hypertrophic nonunion as opposed to oligo- or atrophic nonunion. This suggests that mechanical instability, not biology, is the main reason for failure, and could be addressed with the use of multi-rods.
Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ando Kei , Ishiguro Naoki , Yamashita Masaomi , Eguchi Yawara , Matsumoto Morio , Ishii Ken , Hikata Tomohiro , Seki Shoji , Terai Hidetomi , Suzuki Akinobu , Tamai Koji , Aramomi Masaaki , Ishikawa Tetsuhiro , Kimura Atsushi , Inoue Hirokazu , Inoue Gen , Miyagi Masayuki , Saito Wataru , Yamada Kei , Hongo Michio , Matsuoka Yuji , Suzuki Hidekazu , Nakano Atsushi , Watanabe Kazuyuki , Chikuda Hirotaka , Ohya Junichi , Aoki Yasuchika , Shimizu Masayuki , Futatsugi Toshimasa , Mukaiyama Keijiro , Hasegawa Masaichi , Kiyasu Katsuhito , Iizuka Haku , Iizuka Yoichi , Kobayashi Ryoichi , Nishida Kotaro , Kakutani Kenichiro , Nakajima Hideaki , Murakami Hideki , Demura Satoru , Kato Satoshi , Yoshioka Katsuhito , Namikawa Takashi , Watanabe Kei , Nakanishi Kazuyoshi , Nakagawa Yukihiro , Yoshimoto Mitsunori , Fujiwara Hiroyasu , Nishida Norihiro , Imajo Yasuaki , Yamazaki Masashi , Sakane Masataka , Abe Tetsuya , Fujii Kengo , Kaito Takashi , Furuya Takeo , Orita Sumihisa , Ohtori Seiji 
Published: April 2017

Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.
Clonal selection and asymmetric distribution of human leukemia in murine xenografts revealed by cellular barcoding
Authors: Belderbos Mirjam E. , Koster Taco , Ausema Bertien , Jacobs Sabrina , Sowdagar Sharlaine , Zwart Erik , de Bont Eveline , de Haan Gerald , Bystrykh Leonid V. 
Published: April 2017

Key Points
Patient-derived leukemia xenografts are highly polyclonal and show stochastic and clone-size–driven selection. Leukemia clones are asymmetrically distributed in xenografts and preferentially localize to the bone marrow or to extramedullary sites.
Zika and chikungunya virus infections in hematopoietic stem cell transplant recipients and oncohematological patients
Authors: Machado Clarisse Martins , Pereira Bárbara Brito de Souza , Felix Alvina Clara , Oliveira Maria Carolina , Darrigo Luiz Guilherme , de Souza Mair Pedro , Paton Eduardo José de Alencar , Neves Fabia , Colturato Vergilio Rensi , Simoes Belinda Pinto 
Published: April 2017

Key Points
This article describes the first reports of Zika and chikungunya infections in HSCT recipients and oncohematological patients. Fever and exanthema should prompt arbovirus diagnosis, especially in areas at risk or in patients returning from endemic or epidemic regions.
Laparoscopic uterovaginal prolapse surgery in the elderly: feasibility and outcomes
Authors: King Samuel W. , Jefferis Helen , Jackson Simon , Marfin Alexander G. , Price Natalia 
Published: April 2017

Abstract
Background
Uterovaginal prolapse in very elderly women is a growing problem due to increased life expectancy. Surgeons and anaesthetists may be wary of performing quality of life surgery on this higher risk group. Where surgery is undertaken, it is commonly performed vaginally; there is a perception that this is better tolerated than abdominal surgery.
Little data is published about laparoscopic prolapse surgery tolerability in this population, and laparoscopic surgery is perceived within the urogynaecological community as complex and lengthy and hence inherently unsuitable for the very elderly.
In Oxford, UK, laparoscopic abdominal surgical techniques are routinely employed for urogynaecological reconstructive surgery. The authors offer abdominal laparoscopic prolapse surgery to patients suitable for general anaesthesia with apical vaginal prolapse, irrespective of age. We here report outcomes in this elderly patient cohort and hypothesise these to be acceptable.
This is a retrospective case note review of all patients aged 79 years old and above undergoing laparoscopic prolapse surgery (hysteropexy or sacrocolpopexy) in two centres in Oxford, UK, over a 5-year period (n = 55). Data were collected on length of surgery, length of stay, intraoperative complications, early and late post-operative complications and surgical outcome.

Results
Mean age was 82.6 years (range 79–96). There were no deaths. Minor post-operative complications such as UTI and constipation were frequent, but there were no serious (Clavien-Dindo grade III or above) complications; 80% achieved objective good anatomical outcome.

Conclusions
Laparoscopic prolapse surgery appears well tolerated in the elderly with low operative morbidity and mortality.