bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Opioid Use, Complications, and Costs in Surgical Management of Lumbar Spondylolisthesis
Authors: Vail Daniel , Azad Tej D. , O’Connell Chloe , Han Summer S. , Veeravagu Anand , Ratliff John K. 
Published: December 2017

Study Design.
Retrospective analysis on a national longitudinal database (2007–2014).

Objective.
To determine the association between arthrodesis and complication rates, costs, surgical revision, and postoperative opioid prescription.

Summary of Background Data.
Arthrodesis in patients receiving laminectomy for lumbar spondylolisthesis remains controversial. However, population-level evidence to support the use of arthrodesis remains limited.

Methods.
We identified 73,176 patient records and used coarsened exact matching to create comparable populations of patients who received laminectomy or laminectomy with arthrodesis. We use linear and logistic regression models to analyze the relationship between arthrodesis and postoperative complications, length of stay, costs, readmissions, surgical revisions, and postoperative opioid prescribing.

Results.
Patients who underwent arthrodesis spent 1 more day in the hospital on average (P < 0.01), and had higher costs of care at their index visit ($24,126, P < 0.01), which were partially offset by lower costs of care over the 2 years following their procedure ($14,667 less in arthrodesis patients, P = 0.01). Patients with arthrodesis were less likely to have a surgical revision (odds ratio = 0.66, P < 0.01). Patients with arthrodesis used more opioids in the first 2 months following their procedure, but had comparable opioid use to patients undergoing laminectomy without arthrodesis in all other postoperative months over the next 2 years, and were not more or less likely to convert to chronic opioid use. Postoperative opioid prescription varied dramatically across states (P < 0.01); geographic variation in opioid use is substantially greater than differences in opioid use based on procedure performed.

Conclusion.
Arthrodesis is associated with reduced likelihood of surgical revision and increased use of opioids in the first 2 months following surgery, but not associated with greater or lesser opioid use beyond the initial 2 postoperative months. Geographic variation in opioid use is substantial even after accounting for patient characteristics and for whether patients underwent arthrodesis.

Level of Evidence: 3
Sex Differences for Anterior Cervical Fusion
Authors: Basques Bryce A. , Hijji Fady Y. , Khechen Benjamin , Haws Brittany E. , Mayo Benjamin C. , Massel Dustin H. , Louie Philip K. , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern 
Published: December 2017

Study Design.
Retrospective cohort.

Objective.
To assess differences in baseline characteristics between sexes of patients undergoing anterior cervical discectomy and fusion (ACDF) and risk factors for adverse outcomes according to sex.

Summary of Background Data.
ACDF is a common treatment for cervical spine disease. To reduce the rate of complications, risk factors associated with adverse events have been identified. However, few studies have examined the risk for inferior outcomes or complications after ACDF by sex.

Methods.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent ACDF from 2005 through 2014. Data collected included demographics, comorbidities, operative characteristics, and postoperative adverse events. Demographic and comorbidity variables were compared between men and women using chi-squared analysis. Perioperative outcomes were compared between groups using multivariate linear regression or Poisson regression with robust error variance controlling for preoperative characteristics.

Results.
In the 20,383 patients who met inclusion criteria, the male cohort was slightly older, less likely to be normal weight or morbidly obese, and had a higher incidence of diabetes and hypertension (P < 0.001 for each). Male sex was associated with a greater risk of any adverse event (relative risk = 1.2; P = 0.043), as well as any severe adverse event (relative risk  = 1.4; P = 0.001). Moreover, male sex exhibited longer operative times compared to the female group (127 vs. 117 min; β = 10; P < 0.001).

Conclusion.
The results of the current study suggest male sex is associated with an increased risk of adverse events following ACDF. Male sex has previously been demonstrated to correlate with medical comorbidities, which may be partly responsible for the increased morbidity. Because of the contrasting evidence throughout the literature, further studies are required to better elucidate this effect.

Level of Evidence: 3
PET-CT in Critically Ill Patients: Diagnosing the Unsuspected
Authors: Fort Romain , Ledochowski Stanislas , Friggeri Arnaud 
Published: December 2017

Objective:
Quick identification of septic source is fundamental in patients with severe sepsis of unknown origin. The purpose of this case report was to assess the benefit and feasibility of an early PET-CT in critically ill patients with undiagnosed sepsis.

Data Sources:
Clinical observations of two patients.

Study Selection:
Case reports.

Data Extraction:
Data extracted from medical records, after patient’s consent. Illustrations were collected from the imaging software.

Data Synthesis:
We admitted two critically ill patients for suspected sepsis and altered mental state. As all bacteriological samples were initially sterile, diagnostic workups in both patients led us to suspect underlying malignant hemopathy. In fact, the lumbar puncture of the first patient revealed a large B-cell lymphoma, and an acquired thrombotic thrombocytopenic purpura was suspected in the second patient. However, PET-CTs performed in both patients displayed infra-clinical underlying infectious foci. Within 48 hours, both patients developed a clearly identified sepsis linked to the described focus, and favorable outcome thanks to the precious information delivered by the PET-CT.

Conclusions:
PET-CT precisely detected the deep foci of infection about 48 hours prior to the diagnosis of sepsis. The cases reports suggested the use of this image technique in ICU for patients with sepsis of unknown origin.
Prevention of Ventilator-Associated and Early Postoperative Pneumonia Through Tapered Endotracheal Tube Cuffs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Maertens Bert , Blot Koen , Blot Stijn 
Published: December 2017

Objective:
Microaspiration of subglottic secretions is considered a major pathogenic mechanism of hospital-acquired pneumonia, either early postoperative or ventilator-associated pneumonia. Tapered endotracheal tube cuffs have been proposed to provide a better seal of the extraluminal airway, thereby preventing microaspiration and possibly hospital-acquired pneumonia. We performed a systematic review and meta-analysis to assess the value of endotracheal tubes with tapered cuffs in the prevention of hospital-acquired pneumonia.

Data Sources:
A systematic search of MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, and ICTRP was conducted up to March 2017.

Study Selection:
Eligible trials were randomized controlled clinical trials comparing the impact of tapered cuffs versus standard cuffs on hospital-acquired pneumonia.

Data Extraction:
Random-effects meta-analysis calculated odds ratio and 95% CI for hospital-acquired pneumonia occurrence rate between groups. Secondary outcome measures included mortality, duration of mechanical ventilation, length of hospital and ICU stay, and cuff underinflation.

Data Synthesis:
Six randomized controlled clinical trials with 1,324 patients from intensive care and postoperative wards were included. Only two studies concomitantly applied subglottic secretion drainage, and no trial performed continuous cuff pressure monitoring. No significant difference in hospital-acquired pneumonia incidence per patient was found when tapered cuffs were compared with standard cuffs (odds ratio, 0.97; 95% CI, [0.73–1.28]; p = 0.81). There were likewise no differences in secondary outcomes.

Conclusions:
Application of tapered endotracheal tube cuffs did not reduce hospital-acquired pneumonia incidence among ICU and postoperative patients. Further research should examine the impact of concomitant use of tapered cuffs with continuous cuff pressure monitoring and subglottic secretion drainage.
Trends in Surgeon-Level Utilization of Sacral Nerve Stimulator Implantation for Fecal Incontinence in New York State
Authors: Xu Zhaomin , Fleming Fergal J. , Justiniano Carla F. , Becerra Adan Z. , Boodry Courtney I. , Aquina Christopher T. , Temple Larissa K. , Speranza Jenny R. 
Published: December 2017

BACKGROUND:
There is a paucity of real-world data regarding surgeon utilization of sacral nerve stimulation for fecal incontinence compared with anal sphincteroplasty.

OBJECTIVE:
This study aims to examine trends in sacral nerve stimulation use compared with sphincteroplasty for fecal incontinence and surgeon-level variation in progression to implantation of the pulse generator.

DESIGN:
This is a population-based study.

PATIENTS:
Patients with fecal incontinence between 2011 and 2014 in New York who underwent stage 1 of the sacral nerve stimulation procedure were selected. For the comparison with sphincteroplasty, patients with fecal incontinence who underwent anal sphincteroplasty between 2008 and 2014 were included.

MAIN OUTCOME MEASURES:
The main outcomes after sacral nerve stimulation generator placement were unplanned 30-day admission, emergency department visit within 30 days, revision or explant of leads or generator, and 30-day mortality.

RESULTS:
Six hundred twenty-one patients with fecal incontinence underwent a stage 1 procedure with 79.7% progressing to stage 2. There has been an increase in the number of sacral nerve stimulation cases per year as well as the number of surgeons performing the procedure. The rate of progression to stage 2 among patients treated by colorectal surgeons was 80.2% compared with 77.0% among those treated by noncolorectal surgeons. Among those who completed stage 2, there were 3 (0.5%) unplanned 30-day admissions, 24 (4.4%) emergency department visits within 30 days, and 0 mortalities within 30 days. Thirty-two (6.5%) patients had their leads or pulse generator revised or explanted. There was a significant decrease in annual sphincteroplasty cases and the number of providers performing the procedure starting in 2011.

LIMITATIONS:
We lacked data regarding patient and physician decision making and the severity of disease.

CONCLUSIONS:
Sacral nerve stimulation for fecal incontinence is increasing in popularity with an increasing number of surgeons utilizing sacral nerve stimulation for fecal incontinence rather than sphincteroplasty. See Video Abstract at http://links.lww.com/DCR/A450.
Tranexamic Acid for Lower GI Hemorrhage: A Randomized Placebo-Controlled Clinical Trial
Authors: Smith Stephen R. , Murray David , Pockney Peter G. , Bendinelli Cino , Draganic Brian D. , Carroll Rosemary 
Published: December 2017

BACKGROUND:
Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolytic that has been shown to reduce blood loss in a variety of clinical conditions. Information regarding the use of tranexamic acid in treating lower GI hemorrhage is lacking.

OBJECTIVE:
The aim of this trial was to determine the clinical efficacy of tranexamic acid when used for lower GI hemorrhage.

DESIGN:
This was a prospective, double-blind, placebo-controlled, randomized clinical trial.

SETTINGS:
The study was conducted at a tertiary referral university hospital in Australia.

PATIENTS:
Consecutive patients aged >18 years with lower GI hemorrhage requiring hospital admission from November 2011 to January 2014 were screened for trial eligibility (N = 265).

INTERVENTIONS:
A total of 100 patients were recruited after exclusions and were randomly assigned 1:1 to either tranexamic acid or placebo.

MAIN OUTCOME MEASURES:
The primary outcome was blood loss as determined by reduction in hemoglobin levels. The secondary outcomes were transfusion rates, transfusion volume, intervention rates for bleeding, length of hospital stay, readmission, and complication rates.

RESULTS:
There was no difference between groups with respect to hemoglobin drop (11 g/L of tranexamic acid vs 13 g/L of placebo; p = 0.9445). There was no difference with respect to transfusion rates (14/49 tranexamic acid vs 16/47 placebo; p = 0.661), mean transfusion volume (1.27 vs 1.93 units; p = 0.355), intervention rates (7/49 vs 13/47; p = 0.134), length of hospital stay (4.67 vs 4.74 d; p = 0.934), readmission, or complication rates. No complications occurred as a direct result of tranexamic acid use.

LIMITATIONS:
A larger multicenter trial may be required to determine whether there are more subtle advantages with tranexamic acid use in some of the secondary outcomes.

CONCLUSIONS:
Tranexamic acid does not appear to decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage in the context of this trial. see Video Abstract at http://links.lww.com/DCR/A453.
Optimal Surveillance Protocols After Curative Resection in Patients With Stage IV Colorectal Cancer: A Multicenter Retrospective Study
Authors: Kishiki Tomokazu , Lapin Brittany , Matsuoka Hiroyoshi , Watanabe Takeshi , Takayasu Kohei , Kojima Koichiro , Sugihara Kenichi , Masaki Tadahiko 
Published: December 2017

BACKGROUND:
After patients with stage IV colorectal cancer undergo curative surgical resection, there is a large risk for recurrence. To establish optimal surveillance guidelines, an understanding of the temporal risk factors for recurrence is necessary.

OBJECTIVE:
The primary aim of our study was to determine predictors for early (within 1 year), middle (1–2 years), and late (2 years or later) recurrence following curative resection in patients with stage IV colorectal cancer.

DESIGN:
This was a retrospective cohort study.

SETTINGS:
The study was conducted at multiple institutions.

PATIENTS:
The retrospective cohort study comprised 1070 patients with stage IV colorectal cancer after an R0 resection for the primary and metastatic lesions in 19 institutions from January 1997 to December 2007.

MAIN OUTCOME MEASURES:
Risk factors for early, middle, and late recurrence were determined by logistic regression and Cox proportional hazards models.

RESULTS:
The overall recurrence rate was 73% (784/1070). Cancer-specific survival was 29.5 months, and recurrence-free survival was 8.9 months. Early recurrence occurred in 488 (62%), middle recurrence in 184 (24%), and late recurrence in 112 (14%). In multivariable analysis, early recurrence risk factors included rectum site, depth of tumor invasion (T4), increasing N-staging, venous invasion, and liver metastasis. Late recurrence risk factors were tumor size ≤50 mm, and peritoneal dissemination.

LIMITATIONS:
Because of the retrospective nature of this study, postoperative therapy was not standardized.

CONCLUSIONS:
Risk factors differ for early, middle, and late recurrences of stage IV colorectal cancer following curative resection. Early (within 1 year) recurrence factors were rectum site, T4, N-staging, venous invasion, and liver metastasis, whereas late (2 years or later) recurrence risk factors were small tumor size and peritoneal dissemination. Our study provides important data to guide a surveillance protocol following stage IV colorectal cancer curative resection. See Video Abstract at http://links.lww.com/DCR/A460.
The cross-sectional association between chemerin and bone health in peri/pre and postmenopausal women: results from the EPIC-Potsdam study
Authors: Menzel Juliane , Biemann Ronald , Aleksandrova Krasimira , Schulze Matthias B. , Boeing Heiner , Isermann Berend , Weikert Cornelia 
Published: December 2017

Abstract

Objective:
Recent in vitro data suggested that the novel adipokine chemerin may influence bone health. However, only limited evidence of the relationship between chemerin and bone health in humans is available. Therefore, this study aimed to investigate the association between chemerin and broadband ultrasound attenuation (BUA) in peri/premenopausal and postmenopausal women.

Methods:
Data from the German population-based European Prospective Investigation into Cancer and Nutrition-Potsdam cohort comprising 404 peri/premenopausal and 279 postmenopausal women were analyzed. Multivariable-adjusted analysis of covariance including age, body mass index, waist circumference, smoking status, education, physical activity, alcohol consumption, and hormone use was used to investigate potential relationships between the adipokine and BUA levels in peri/premenopausal and postmenopausal women, respectively.

Results:
The concentrations of chemerin were lower in peri/premenopausal women (median 118.0 ng/mL, interquartile range [IQR] 99.2-135.0), compared with postmenopausal women (median 140.0 ng/mL, IQR 121.0-167.0). In peri/premenopausal women chemerin was inversely associated with BUA levels; after multivariable adjustment, a 10% increase in the chemerin concentration was significantly associated with 0.83 dB/MHz lower BUA levels (P = 0.0006). In postmenopausal women chemerin was not related to BUA levels (P = 0.8).

Conclusion:
The present study provides evidence for an inverse association between chemerin and BUA in peri/premenopausal women. Therefore, the study suggests that high chemerin concentrations may minimize peak bone mass and thereby may promote age-related bone loss. Further studies are needed to investigate the role of chemerin in bone homeostasis in peri/premenopausal and postmenopausal women.
Novel Pressure-Sensing Smart Insole System Used for the Prevention of Pressure Ulceration in the Insensate Foot
Authors: Alfonso Allyson R. , Rao Smita , Everett Breanne , Chiu Ernest S. 
Published: December 2017

Summary:
Wounds of the foot challenge reconstructive surgeons to manage multiple factors: sensibility, stability, and durability. In this article, we focus on the insensate foot, which poses challenges to wound prevention with its propensity to develop pressure ulceration. The authors present the innovative use of a pressure-sensing smart insole system (SurroSense Rx, Orpyx Medical Technologies Inc., Calgary, Canada) in the management of the insensate foot in a patient following foot reconstruction. The pressure-sensing smart insole system provided unique feedback to both patient and provider in ways that contributed to the prevention of pressure ulcer recurrence, as well as highlight the importance of prescribed footwear in both the affected and unaffected foot. Wearable real-time monitoring and feedback faces the challenge of patient adherence. Future studies are indicated to examine the specific behaviors that are associated with favorable outcomes and long-term behavior changes.
Trends in Urodynamic Procedures, Surgical Procedures, and Overall Health Resource Utilization in the Adult Taiwanese Population With Urinary Incontinence: A Secondary Data Analysis
Authors: HSU Lan-Fang , CHANG Ling-Yin , LIAO Yuan-Mei , YEH Shauh-Der , TSAI Pei-Shan 
Published: December 2017

ABSTRACT

Background:
The prevalence and incidence of the main risk factors for urinary incontinence (UI) have both increased over time. In addition, official statistics indicate that Taiwan is on course to evolve from an aging society into an aged society within the next decade. However, most of the studies in the literature that address the natural history of UI target Western and other non-Asian populations. Taiwan lacks knowledge of the natural history of UI.

Purpose:
The aims of this research were to study the trends in the use of urodynamic and surgical procedures for various subtypes of UI and to investigate the relationship between UI and healthcare resource utilization.

Methods:
The data on 1 million, randomly selected people who were enrolled in the Taiwan National Health Insurance program between 2000 and 2008 were extracted from the Longitudinal Health Insurance Database. The population and all procedures were identified based on the International Classification of Disease, Ninth Revision, Clinical Modification codes. Annual incidence of UI was calculated on an annual basis, and trend analysis was performed using logistic regression models. The association between UI and healthcare utilization was examined using generalized linear models in a gamma distribution with a log link function.

Results:
Overall, the trend in the annual incidence for all types of UI increased significantly (p < .01). Significantly increasing trends in the use of urodynamic procedures over time were observed for mixed and other types of UI (p < .01). In addition, a significantly increasing trend was observed in the annual rates of surgical procedures that were received by patients with urge or stress UI (p < .05). Patients with UI showed significantly higher healthcare resource utilization, including number of ambulatory visits, number of hospitalizations, average ambulatory care expenditures, and average days of hospitalization, than those without UI. However, limited information is available on the conservative treatment of UI in the database.

Conclusions:
UI symptoms may lead to increased healthcare resource utilization in patients with UI.
The importance of the microbiome in pediatrics and pediatric infectious diseases
Authors: Gaufin Thaidra , Tobin Nicole H. , Aldrovandi Grace M. 
Published: December 2017

Purpose of review
Emerging research on the pediatric microbiome implicates the importance of the microbiome on the development of the immune system, nervous system, and growth. Changes to the microbiome during infancy are associated with the development of chronic illnesses such as asthma and inflammatory bowel disease. Additionally, the microbiome provides protection against certain pathogens, affects vaccine responses, and alters drug metabolism. This review highlights what is known about the microbiome, the establishment of a healthy microbiome and the significance that changes to the microbiome composition have on growth and health of children and adolescents.

Recent findings
Vaginal delivery, breastfeeding, maternal health, and nutrition help shape a healthy microbiome. Caesarian delivery, formula feeding, and antibiotic use perturb the microbiome and are associated with the development of type II diabetes, asthma, allergic diseases, and obesity later in life. Specific interventions using pre and probiotics in multiple settings are under investigation with limited success.

Summary
A better understanding of the microbiome and the interaction with the immune system may help guide interventions to alter the microbiome toward a state of lifelong health.