bluuebunny/crossref_metadata_2025_split huggingface dataset:
Male Gender Associated with Post-Treatment Seizure Risk of Pediatric Arteriovenous Malformation Patients
Authors: Yang Wuyang , Westbroek Erick M. , Anderson-Keightly Heather , Caplan Justin M. , Rong Xiaoming , Hung Alice L. , Braileanu Maria , Wang Joanna Y. , Colby Geoffrey P. , Coon Alexander L. , Tamargo Rafael J. , Ahn Edward S. , Huang Judy 
Published: April 2017

Abstract

BACKGROUND: Seizure risk has not been fully characterized in pediatric patients with arteriovenous malformations (AVMs).

OBJECTIVE: To describe the progression and risk factors of post-treatment seizure in children with AVMs.

METHODS: We retrospectively reviewed pediatric patients diagnosed with intracranial AVMs at our institution between 1990 and 2013. Clinical and angiographic variables were included in univariate and multivariate Cox proportional hazard models to explore risk factors associated with time-related seizure outcomes. The outcome event is defined as first seizure occurrence after initial treatment. Kaplan–Meier survival curve is depicted for each significant variable, and survival differences were confirmed by Log-rank test.

RESULTS: We included 90 pediatric patients with complete data in our study cohort. Average age is 13.3 ± 3.8 years with 43.3% male patients. Thirty-seven patients had a hemorrhagic presentation, and 39 patients presented with seizure. Post-treatment seizure occurred in 33 patients (36.7%) over an average follow-up period of 8.1 ± 10.6 years; average time to onset is 5.3 ± 8.2 years, with partial seizures as the most common presentation. Multivariate Cox proportional hazard regression revealed seizure presentation (P = .005), male gender (P = .026), and nonconservative treatment modality to be significantly associated with earlier onset of post-treatment seizure after adjusting for AVM location and deep venous drainage. Overall annualized seizure risk is 7.4% for patients with pretreatment seizure, and 1.4% for those without.

CONCLUSION: Risk of seizure persists after treatment in pediatric AVM patients. Seizure presentation, male gender, and nonconservative management are associated with increased risk of post-treatment seizure. Early identification of these risk factors provides important information for determining seizure management strategies.
Quality of Life in Patients with Vestibular Schwannomas Following Gross Total or Less than Gross Total Microsurgical Resection: Should We be Taking the Entire Tumor Out?
Authors: Link Michael J , Lund-Johansen Morten , Lohse Christine M , Driscoll Colin L W , Myrseth Ehrling , Tveiten Oystein Vesterli , Carlson Matthew L 
Published: April 2017

Abstract

BACKGROUND
The goal of microsurgical removal of a vestibular schwannoma is to completely remove the tumor, to provide long-term durable cure. In many cases, less than gross total resection (GTR) is performed to preserve neurological, and especially facial nerve function.

OBJECTIVE
To analyze long-term quality of life (QoL) in a cohort of patients who received either GTR or less than GTR.

METHODS
Patients operated for vestibular schwannoma less than 3.0 cm in posterior fossa diameter at 1 of 2 international tertiary care centers were surveyed using generic and disease-specific QoL instruments.

RESULTS
A total of 143 patients were analyzed. GTR was performed in 122, and 21 underwent less than GTR. QoL was assessed at a mean of 7.7 yr after surgery (interquartile range: 5.7-9.6). Patients who underwent GTR had smaller tumors; otherwise, there were no baseline differences between groups. Patients who underwent GTR, after multivariable adjustment for baseline features and facial nerve and hearing outcomes, reported statistically significantly better Short Form Health Survey-36 (SF-36) physical and mental scores, Patient-Reported Outcomes Measurement Information System (PROMIS-10) physical and mental scores, and Penn Acoustic Neuroma Quality of Life (PANQOL) facial, energy, general health, and total scores compared to patients receiving less than GTR.

CONCLUSION
GTR is associated with better QoL using the general QoL measures SF-36 and PROMIS-10 and the disease-specific PANQOL, even after controlling for baseline and outcome differences. This is especially significant in the assessment of mental health, indicating there may indeed be a psychological advantage to the patient that translates to overall well-being to have the entire tumor removed if microsurgical resection is undertaken.
Intraoperative Angiography for Arteriovenous Malformation Resection in the Prone and Lateral Positions, Using Upper Extremity Arterial Access
Authors: Nossek Erez , Chalif David J. , Buciuc Razvan , Gandras Eric J. , Anderer Erich G. , Insigna Sal , Dehdashti Amir R. , Setton Avi 
Published: April 2017

Abstract

BACKGROUND: Intraoperative angiography is routinely utilized for aneurysms and arteriovenous malformations (AVMs) to verify complete occlusion and resection. Surgery for spinal and posterior fossa neurovascular lesions is usually performed in prone position. Intraoperative angiography in the prone position is challenging and there is no standardized protocol for this procedure.

OBJECTIVE: To describe our experience with intraoperative angiography in the prone and lateral positions, using upper extremity arterial access.

METHODS: We reviewed our experience with intraoperative angiography in the prone position between 2014 and 2015, where vascular access was obtained via the upper extremity arteries. Patients were treated in a hybrid endovascular operating room. High cervical and intracranial lesions were studied via brachial or radial access. All accesses were obtained using ultrasonographic guidance and a small caliber arterial sheath (4F).

RESULTS: Five patients were treated in the prone and lateral positions using brachial/radial artery access. Patients harbored cerebellar AVM, lateral medullary AVM, cervical arteriovenous fistula (AVF), tentorial dural AVF, and tentorial-incisural dural AVF. Patients were positioned prone (n = 2), semiprone (n = 2), and lateral (n = 1) for the surgery. Three patients were treated via right brachial artery access. Two patients were treated via radial arteries access. All patients tolerated the procedures without technical or clinical complications. Intraoperative angiography verified complete occlusion and resection in all cases prior to surgical closure.

CONCLUSIONS: Intraoperative angiography in the prone and lateral positions using upper extremity access is an important adjunct. Brachial or radial access can be obtained safely and provides comfortable and quick approaches.
Does Music Positively Impact Preterm Infant Outcomes?
Authors: O'Toole Alexa , Francis Kim , Pugsley Lori 
Published: April 2017

Background:
The hospital environment leaves preterm infants (PTIs) exposed to various stressors that can disrupt their growth and development. Developmental interventions such as music may be an important strategy to mitigate PTI's stress. This brief evaluates current evidence regarding the impact of music therapy on outcomes for PTIs.

Purpose:
The question guiding this brief is “Do various types of music therapy positively affect physiologic indicators, feeding behaviors/length of stay (LOS) and pain management outcomes for PTIs?”

Search Strategy:
CINAHL/MEDLINE Complete and PubMed databases were searched using keywords preterm infants, premature infants, preterm baby, premature baby, NICU baby, music, and music therapy. The search was limited to 5 years for English studies evaluating the effects of music therapy on physiological indicators, feeding, pain outcomes, and length of stay. The search yielded 12 studies addressing these concerns.

Findings:
Music therapy was shown to positively affect physiologic indicators, feeding, length of stay, and pain outcomes for PTIs. In addition, music decreased parental stress.

Implications for Practice:
Thoughtful consideration should be given regarding the value of diverse types of music and parental involvement when incorporating music into an individualized plan of care. Furthermore, the development of guidelines with a focus on ambient sound reduction is an important strategy when adding music as an intervention.

Implications for Research:
Further research is needed to investigate ambient sound levels in conjunction with musical interventions. In addition, the impact of various types of music, differences in gender, reduction of stress, pain for infants, and parental role in music requires further evaluation.
Quality Improvement Project to Reduce Delayed Vaccinations in Preterm Infants
Authors: Cuna Alain , Winter Lindy 
Published: April 2017

Background:
Preterm infants are especially vulnerable to infectious diseases. Although vaccinations are a safe and effective measure to protect preterm infants from vaccine-preventable diseases, delays in vaccinations are not uncommon.

Purpose:
The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit.

Methods:
The Plan-Do-Study-Act model of quality improvement was adopted to develop, test, and implement interventions aimed at improving timely vaccination of preterm infants. The primary outcome measure of interest was the rate of on time vaccination, which was defined as the proportion of medically eligible preterm infants who received vaccinations within 2 weeks of the recommended schedule.

Results:
Baseline on time vaccination rate was only 36%. Following several Plan-Do-Study-Act cycles, a steady increase in on time vaccinations of eligible infants was observed, and a new baseline on time vaccination rate of 82% was achieved.

Implications for Practice:
Simple interventions implemented within the context of Plan-Do-Study-Act cycles are effective in improving timely vaccinations among preterm infants.

Implications for Research:
Future research that focuses on vaccinations in preterm infants is needed to further reinforce the safety and efficacy of vaccines. Effective methods on how to disseminate and apply this knowledge to practice should also be studied.

Video Abstract available at
http://links.lww.com/ANC/A27.
Noise in the Neonatal Intensive Care Unit
Authors: Casavant Sharon G. , Bernier Katherine , Andrews Sheena , Bourgoin Allison 
Published: April 2017

Background:
In 2014, more than 10% of all births in the United States were preterm (born at <37-weeks' gestation). These high-risk infants will often spend weeks to months within the neonatal intensive care unit (NICU), where noise levels can easily reach 120 decibels adjusted (dBA) on a regular and sometimes consistent basis. The American Academy of Pediatrics recommends that NICU sound levels remain below 45 dBA to promote optimal growth and development.

Purpose:
The purpose of this evidence-based brief is to critically appraise the literature concerning preterm infant response to noise within the NICU as well as the use of noise interventions to improve health outcomes for the vulnerable preterm infant population.

Methods/Search Strategy:
Systematic searches of databases included the Cochrane Library, CINAHL, PubMed, and Science Direct. Included studies were appraised and then synthesized into a narrative summary.

Findings/Results:
Twenty studies met inclusion criteria for this review. While there are numerous methods that have been shown to reduce noise levels within the NICU, most NICU noise levels remain consistently above the American Academy of Pediatrics recommendations. Studies that assessed interventions found that staff reeducation was critical to sustaining appropriate noise levels.

Implications for Practice:
Implementing interventions with rigorous attention to initial and continued staff education with engagement and ownership is recommended. This review identifies gaps in intervention studies targeting vulnerable NICU populations.

Implications for Research:
While noise interventions show promise in the NICU, additional focused research is needed to further strengthen the evidence and inform clinical practice.
Preoperative acetabular angle measurement as a tool in acetabular cup positioning during total hip arthroplasty
Authors: Rodriguez Hugo A. 
Published: April 2017

Background:
Acetabular cup positioning within the Lewinnek safe zone reduces the risk of complications related to prosthesis dislocation. However, it has been demonstrated that angles of abduction of the native acetabulum do not lie within this range, possibly leading to cup malpositioning. The purpose of this study was to determine whether the preoperative radiographic measurements of acetabular abduction correlate with those obtained intraoperatively with the use of an inclinometer.

Methods:
Preoperative and intraoperative angles of abduction from 100 consecutive patients who underwent total hip arthroplasty between July 2007 and November 2008. An intraclass correlation coefficient (ICC) and its 95% confidence interval (95% CI) were calculated to determine the level of agreement between the preoperative and the intraoperative angles.

Results:
Mean preoperative angle of abduction was 48.9±6.1 degrees and mean intraoperative angle was 49±5.7 degrees. The mean difference between these angles was 0.06 degrees. Twenty-eight percent of patients had preoperative angles of abduction of>50 degrees. An ICC of 0.96 (95% CI: 0.94–0.97) was obtained. This indicates that preoperative and intraoperative measures of acetabular abduction are almost identical.

Conclusions:
Preoperative and intraoperative measures of acetabular inclination are highly correlated. Measurements of acetabular inclination on preoperative plain anteroposterior radiographs of the pelvis should be considered for acetabular cup positioning during total hip arthroplasty. The systematic use of this simple, valid, and effective measurement might be useful.
Pediatric Femoral Shaft Fractures: A Multicenter Review of the AAOS Clinical Practice Guidelines Before and After 2009
Authors: Roaten John D. , Kelly Derek M. , Yellin Joseph L. , Flynn John M. , Cyr Micaela , Garg Sumeet , Broom Alexander , Andras Lindsay M. , Sawyer Jeffrey R. 
Published: April 2017

Background:
To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013).

Methods:
Consecutive series of pediatric femoral shaft fractures (ages, birth to 18 y) treated at the 4 centers were reviewed. Treatment methods were analyzed by age and treatment method for each center and in aggregate.

Results:
Of 2646 fractures, 1476 (55.8%) were treated nonoperatively and 1170 fractures operatively. Of the operative group, flexible intramedullary nails (IMN) were used for 568 patients (21.5%), locked intramedullary nails (LIMNs) for 309 (11.7%), and plating for 188 (7.1%). In total, 105 fractures were treated with external fixation or skeletal traction. Analysis before and after the CPG publication revealed a significant increase in the use of interlocked IMNs in patients younger than 11 years (0.5% before, 3.8% after; P<0.001). Over the same time period there was an increase in surgical management, regardless of technique, for patients younger than 5 years (6.4% before, 8.4% after; P=0.206). There were considerable differences in treatment among centers: 74% of fractures treated with plating were from a single center (center A), which also contributed 68% of patients younger than 5 years treated with plating; center B had the highest rate (41%) of flexible IMN in children younger than 5 years; center C had the highest rate (63%) of LIMN in children younger than 11 years; and center D treated the fewest patients outside the CPG guidelines.

Conclusions:
Following publication of the AAOS CPG, there was a significant increase in the use of LIMNs in patients younger than 11 years old and a trend toward surgical treatment in patients younger than 5 years. The considerable variability among centers in treatment methods and adherence to the CPG highlights the need for further outcome studies to better define optimal treatment methods and perhaps update the AAOS CPG guidelines.

Level of Evidence:
Level III—therapeutic.
Clubfoot Infants Initially Thought to be Idiopathic, But Later Found Not to Be. How do They do With Nonoperative Treatment?
Authors: Richards B. Stephens , Faulks Shawne 
Published: April 2017

Background:
Infants thought to be normal with idiopathic clubfeet when nonoperative treatment begins may later be found to have other complicating diagnoses. The purpose of this study was to determine the incidence of this occurrence, and to compare the clinical outcomes of these “nonidiopathic” patients with idiopathic clubfoot patients.

Methods:
Infants below 3 months old with clubfeet who were thought to be normal (idiopathic) at presentation and had ≥2-year follow-up were studied. Treatment consisted of either the Ponseti method or the French physical therapy method. In total, 789 patients with 1174 clubfeet were identified. Those who were idiopathic (group 1) were compared with those later found to be nonidiopathic (group 2). The outcomes at 2 years were assessed as good (plantigrade foot±heelcord tenotomy only), fair (limited procedures), or poor (full-posteromedial release). For those feet rated good at age 2 years, outcomes were again assessed age 5 years and above.

Results:
In total, 70 patients (8.9%) of the 789 enrolled patients were eventually found to have another disorder including neurological, syndromic, chromosomal, or spinal abnormalities. The remaining 719 idiopathic patients with 1062 clubfeet (group 1) were compared with these 70 nonidiopathic patients with 112 clubfeet (group 2). At age 2 years, in group 1 81% of the feet were rated good, 11% fair, and 8% poor, whereas in group 2 70% of the feet were rated good, 11% fair, and 19% poor (P=0.0004).
With follow-up exceeding age 5 years in those rated good at age 2 years: in group 1, 73% continued to do well, but 22% rated fair, and 5% poor. In group 2, 59% continued to do well, but 31% rated fair, and 10% poor (P=0.046).

Conclusions:
For infants with clubfeet who were initially thought to be idiopathic, nearly 9% were later found to have a complicating disorder. Despite this, these patients’ clubfeet can be expected to respond favorably to nonoperative treatment. However, they will require more surgical intervention early (by age 2 years) and later (age, 5 years and above) when compared with normal infants with idiopathic clubfeet.

Level of Evidence:
Level IV—therapeutic, case series.
Rectus Femoris Transfer Surgery Worsens Crouch Gait in Children With Cerebral Palsy at GMFCS Levels III and IV
Authors: Sousa Ted C. , Nazareth Alexander , Rethlefsen Susan A. , Mueske Nicole M. , Wren Tishya A.L. , Kay Robert M. 
Published: April 2017

Background:
Previous study has shown that children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels III and IV do not benefit from distal rectus femoris transfer (DRFT) due to lack of improvement in stance knee extension. The fate of knees in such subjects who do not undergo DRFT is unknown. The purpose of this study was to compare knee kinematic outcomes in patients with CP and stiff knee gait who underwent single-event multilevel surgery with and without DRFT.

Methods:
Preoperative and postoperative gait analysis data were retrospectively reviewed for ambulatory (GMFCS levels I to IV) patients with CP with crouch and stiff knee gait whom underwent single-event multilevel surgery, including hamstring lengthening either with DRFT (N=34) or without DRFT (N=40). Statistical analyses included t tests and χ2 tests, and multiple regression analysis was performed to adjust for covariates. Data were stratified by GMFCS level groups I/II and III/IV.

Results:
Improved maximum knee extension in stance was seen for both the DRFT (P=0.0002) and no DRFT groups (P≤0.0006) at GMFCS levels I/II, and the no DRFT group at GMFCS levels III/IV (P=0.02). Excessive stance knee flexion persisted for those at GMFCS level III/IV after DRFT. Maximum knee flexion in swing was maintained after DRFT, but significantly decreased in the no DRFT group (P<0.002) for both GMFCS groups. Change in total knee range of motion improved after DRFT only in the GMFCS I/II group subjects with unilateral involvement (P=0.01). Timing of maximum knee flexion in swing improved for all patients regardless of DRFT or GMFCS level group (P<0.0001).

Conclusions:
In patients with CP functioning at GMFCS levels III and IV, DRFT results in persistent crouch postoperatively. Given the importance of maintaining upright posture in these patients, we do not recommend DRFT in patients functioning at GMFCS levels III and IV.

Level of Evidence:
Level III—retrospective comparative study.
Propionibacterium acnes Incubation in the Discs Can Result in Time-Dependent Modic Changes
Authors: Shan Zhi , Zhang Xuyang , Li Shengyun , Yu Tianming , Liu Junhui , Zhao Fengdong 
Published: April 2017

Study Design.
A case-control study of animal model of Modic changes (MCs) on rabbits.

Objective.
To evaluate the feasibility of inducing of MCs by injection of Propionibacterium acne (P. acnes) into the lumbar intervertebral discs of rabbits.

Summary of Background Data.
MCs have been widely observed, and assume to be closely associated with low back pain and P. acnes, but there are few animal models showing the progression of MCs.

Methods.
Ten rabbits were used for the study. The L3–4 and L4–5 discs of all rabbits were injected with 100 μL P. acnes (1.6 × 107 CFU/mL) as P. acnes group, L2–3 disc were injected with 100 μL normal saline as vehicle, and L5–6 disc was untreated (blank). MCs were investigated by magnetic resonance imaging before operation and at 2 weeks, 1, 3, 4.5, 6, and 9 months postoperatively. Following sacrifice, histological analysis, blood test and micro-computed tomography were performed. Cytokine expression in nucleus and endplate tissues was quantified using real-time polymerase chain reaction.

Results.
From 3 months postoperatively, the P. acnes group showed significantly decreased T1-weighted signal intensity, whereas the T2-weighted signal was significantly higher at 3 and 4.5 months, and then decreased remarkably at 6 and 9 months. Eleven of 20 inferior endplates were identified as type I MCs at 4.5 months, and 9 of 20 were identified as type II MCs at 9 months. Real-time polymerase chain reaction showed that expression of interleukin-1β, tumor necrosis factor α, interferon-γ, matrix metalloproteinase-9, and thrombospondin motifs-5 in the nucleus pulposus, and interleukin-1β, tumor necrosis factor α, and thrombospondin motifs-5 in the endplates, were significantly upregulated after injection of P. acnes. Histological slices of discs injected with P. acnes showed disc degeneration, endplate abnormalities, and inflammatory response, with micro-computed tomography confirming bone resorption.

Conclusion.

P. acnes infection of the disc can induce degeneration of the disc and an inflammatory response in the endplate region, presenting as MCs type I and II time dependently.

Level of Evidence: N/A