bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity
Authors: Zygourakis Corinna C , Liu Caterina Y , Keefe Malla , Moriates Christopher , Ratliff John , Dudley R Adams , Gonzales Ralph , Mummaneni Praveen V , Ames Christopher P 
Published: April 2017

Abstract

BACKGROUND
Several studies suggest significant variation in cost for spine surgery, but there has been little research in this area for spinal deformity.

OBJECTIVE
To determine the utilization, cost, and factors contributing to cost for spinal deformity surgery.

METHODS
The cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses.

RESULTS
The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission (P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive (P < .05).

CONCLUSION
The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery.
Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review
Authors: Rhome Ryan , Germano Isabelle M , Sheu Ren-Dih , Green Sheryl 
Published: April 2017

Abstract

Background
Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT.

Methods
We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly.

Results
With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes.

Conclusions
Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.
Technique for Mini-open Decompression of Chiari Type I Malformation in Adults
Authors: Pakzaban Peyman 
Published: April 2017

Abstract

BACKGROUND: The technique for decompression of Chiari type I malformation relies on open exposure of craniocervical junction for suboccipital craniectomy and upper cervical laminectomy with or without duraplasty. There is no detailed technical report of a minimally invasive approach for Chiari decompression in adults.

OBJECTIVE: To describe a mini-open technique for decompression of Chiari type I malformation (including duraplasty) in adults.

METHODS: Six consecutive adult patients with symptomatic Chiari type I malformation underwent decompression through a 3 to 4 cm midline incision via a speculum retractor. All patients underwent a limited suboccipital craniectomy and C1 laminectomy with an ultrasonic bone scalpel. All patients underwent duraplasty with a synthetic dural substitute. In the 2 patients with syringomyelia, the arachnoid was opened and intradural dissection was carried out. In the remaining 4 patients, the arachnoid was left intact.

RESULTS: All operations were completed successfully through the mini-open exposure. Mean surgery time, blood loss, and length of stay were 114 min, 55 mL, and 1.3 days, respectively. Mean follow-up was 13.2 months (range 9-18). All patients had excellent clinical outcomes as defined by scores of 15 (3 patients) or 16 (3 patients) on Chicago Chiari Outcome Scale. There were no neurological complications or cerebrospinal fluid leaks. Postop computed tomography revealed good boney decompression. In the 2 patients with syringomyelia, MRI at 6 months revealed resolution of the syrinx.

CONCLUSION: Decompression of Chiari type I malformation in adults can be performed safely and effectively through the mini-open exposure described in this report.
Treatment of Recurrent Intracranial Aneurysms After Neck Clipping: Novel Classification Scheme and Management Strategies
Authors: Kobayashi Shinya , Moroi Junta , Hikichi Kentaro , Yoshioka Shotaro , Saito Hiroshi , Tanabe Jun , Ishikawa Tatsuya 
Published: April 2017

Abstract

BACKGROUND
Recurrent aneurysms after initial clipping have been discussed as an important issue in the surgical management of aneurysm.

OBJECTIVE
To report our experience with recurrent cerebral aneurysms after neck clipping and to discuss classification and recommended management.

METHODS
Aneurysm treatments from a single institution over a 20-year period were retrospectively reviewed. Twenty-three recurrent aneurysms in 23 patients were managed during the study period. Recurrent aneurysms were classified using the concepts of closure line and closure plane, as follows. Type 1: neck situated in an almost different site from the previous clip. Type 2: existing closure plane and reconstructive closure plane are almost the same. Type 3: existing closure plane and reconstructive closure plane cross (type 3a); in rare cases, the existing closure line is sufficiently distant from the neck (type 3b). Type 4: no reconstructive closure line is identifiable.

RESULTS
Nine patients presented with subarachnoid hemorrhage at recurrence. The mean interval to recurrence was 15.0 years. Management comprised clipping with elective subsequent old-clip removal (n = 7), clipping with preceding old-clip removal (n = 2), bypass occlusion (n = 1), coating (n = 1), combined surgery (n = 1), endovascular surgery (n = 4), and observation (n = 3). Therapeutic intervention was not indicated in 4 patients. Types 3a and 4 required more complex surgical procedures or coil embolization. Procedural complications were observed in 2 patients.

CONCLUSION
A small but definite propensity toward recurrence after neck clipping exists, and most recurrent aneurysms require some form of retreatment. The novel classification scheme may provide conceptual clarity and therapeutic guidance for decision making.
Intraparenchymal Cysts Following Deep Brain Stimulation: Variable Presentations and Clinical Courses
Authors: Katlowitz Kalman , Pourfar Michael H. , Israel Zvi , Mogilner Alon Y. 
Published: April 2017

Abstract

BACKGROUND: The development of cysts at the electrode lead is a rare complication of deep brain stimulation (DBS), with only 3 cases reported in the literature. A better understanding of the variable clinical presentations and courses of these cysts may help increase awareness of this potentially life-threatening complication.

OBJECTIVE: To review the clinical presentation of patients with intraparenchymal cysts following DBS implantations.

METHODS: We report 3 patients who developed a cyst along the course of the DBS lead. These patients received DBS for different indications and in different brain locations.

RESULTS: Clinical courses differed considerably with 1 asymptomatic patient followed conservatively, 1 mildly symptomatic patient who had the DBS hardware removed for insidious worsening over months, and 1 who had it emergently removed for acute development of hydrocephalus. Serial imaging revealed spontaneous reduction in cyst size over time in the asymptomatic patient, and following removal in 1 of the symptomatic patients.

CONCLUSION: This report highlights the variable clinical presentation and course of patients who develop cysts along the DBS lead. It suggests that some cases can be followed clinically without removal of hardware but that ongoing vigilance is required given the potential for serious adverse events.
Patient Selection and Clinical Efficacy of Urgent Superficial Temporal Artery-Middle Cerebral Artery Bypass in Acute Ischemic Stroke Using Advanced Magnetic Resonance Imaging Techniques
Authors: Park Hyun-Seok , Kim Sang-Hyeon , Nah Hyun-Wook , Choi Jae-Hyung , Kim Dae-Hyun , Kang Myong-Jin , Cha Jae-Kwan , Huh Jae-Taeck 
Published: April 2017

Abstract

BACKGROUND: Selected patients with acute ischemic stroke might benefit from superficial temporal artery-middle cerebral artery (STA-MCA) bypass, but the indications for urgent STA-MCA bypass are unknown.

OBJECTIVE: To report our experiences of urgent STA-MCA bypass in patients requiring urgent reperfusion who were ineligible for other reperfusion therapies, using advanced magnetic resonance imaging (MRI) techniques.

METHODS: The inclusion criteria for urgent STA-MCA bypass were as follows: acute infarct volume <70 mL with a ratio of perfusion/diffusion lesion volume ≥1.2, and a regional cerebral blood volume ratio >0.85. From January 2013 to October 2015, 21 urgent STA-MCA bypass surgeries were performed. The control group included 19 patients who did not undergo bypass surgery mainly due to refusal of surgery or the decision of the neurologist. Clinical and radiological data were compared between the surgery and control group.

RESULTS: The median age of the control group (70 years, interquartile range [IQR] 58-76) was higher than that of the surgery group (62 years, IQR 49-66), but the median preoperative diffusion and perfusion lesion volumes of the surgery group (13.8 mL, IQR 7.5-26.0 and 120.9 mL, IQR 84.9-176.0, respectively) were higher than those of the control group (5.6 mL, IQR 2.1-9.1 and 69.7 mL, IQR 23.9-125.3, respectively). Sixteen (76.2%) patients in the surgery group and 2 (10.5%) patients in the control group had favorable outcomes (P < .001). Logistic regression analysis identified bypass surgery as the strongest predictive factor.

CONCLUSION: STA-MCA bypass can be used as a therapeutic tool for acute ischemic stroke. Advanced MRI techniques are helpful for selecting patients and for decision making.
Intraoperative FLOW 800 Analysis for Intramedullary Cystic Lesion: A Technical Case Report
Authors: Sawada Masahiro , Munemitsu Toshihiro , Hojo Masato 
Published: April 2017

Abstract

BACKGROUND AND IMPORTANCE: During intramedullary lesion surgery, the lesion site and the posterior median sulcus (PMS) should be accurately identified prior to myelotomy to avoid severe injury of the posterior funiculus. However, intramedullary lesions are fundamentally invisible until the myelotomy is performed. Furthermore, the PMS location is frequently unclear due to lesion-induced swelling or distortion of the spinal cord. Intraoperative indocyanine green videoangiography (ICG-VA) followed by FLOW 800 analysis, which shows vascularization of the spinal parenchyma, may provide a solution for these problems in specific cases.

CLINICAL PRESENTATION: A 61-year-old woman suffering from claudication visited our department. Magnetic resonance imaging (MRI) revealed a cystic lesion at the level of Th11. A solid portion was not detected in the T1-weighted images following gadolinium administration. We made a diagnosis of ventriculus terminalis and performed a lesion resection. Prior to opening the PMS, ICG-VA was performed, which revealed an avascular area representing the intramedullary cyst. The PMS was the most avascular area observed in the time–intensity analysis executed using FLOW 800 software (Zeiss, Oberkochen, Germany). Thus, it was helpful in determining the site for myelotomy, which should be performed at the center of the extent of the lesion. The patient was discharged 23 days after the operation, ambulating independently.

CONCLUSION: Intraoperative ICG-VA followed by FLOW 800 analysis was applied to a case of intramedullary cystic lesion. This technique may be helpful in performing safer intramedullary cystic lesion surgery because it enables visualization of the lesion location and confirmation of the PMS.
Reliability, Validity, and Minimal Detectable Change of Four-Step Stair Climb Power Test in Community-Dwelling Older Adults
Authors: Ni Meng , Brown Lorna G. , Lawler Danielle , Bean Jonathan F. 
Published: April 2017

Abstract
Background. Stair climb power is an important clinical measure of lower-extremity power. The stair climb power test (SCPT) was validated by requiring individuals to climb a full flight of stairs. A 4-step SCPT (4SCPT) would be more clinically feasible and easier to perform, yet its reliability and validity are unknown.
Objective. To evaluate reliability, validity, and minimal detectable change of 4SCPT among community-dwelling older adults.
Design. This study is a cross-sectional analysis of baseline data from a clinical trial.
Methods. Fifty older adults ≥65 years of age, at risk for mobility decline, consented to participate in this ancillary study. Test-retest reliability was derived from 2 measurements within each participant measured by a single assessor. Pearson correlation analyses among leg power measures (4SCPT, SCPT, single leg press power at 40% and 70% of the 1-repetition maximum [SLP40, SLP70]) were performed. Separate multivariate linear regressions were conducted evaluating the associations between each leg power measure and 2 mobility outcomes, the Short Physical Performance Battery (SPPB) and habitual gait speed (HGS). Minimal detectable change was based on a 90% confidence interval (MDC90).
Results. The 4SCPT had excellent test-retest reliability (ICC(2,1) = 0.951), and strong correlation with SCPT, SLP40, and SLP70 (r = 0.85-0.96). The 4SCPT explained a greater amount of variance in the SPPB (R2 = 0.31) than other leg power measurements (R2 = 0.23-0.25). The 4SCPT (R2 = 0.41) and SCPT (R2 = 0.42) described equivalent amounts of variance in HGS, and greater than that with SLP40 (R2 = 0.28) and SLP70 (R2 = 0.30). The MDC90 for 4SCPT was 44.0 watts.
Limitations. This was a cross-sectional analysis within a small, nonrepresentative sample. Interrater reliability was not evaluated.
Conclusions. The 4SCPT shows scientific promise as a valid and reliable leg power measurement among community-dwelling older adults.
Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact
Authors: Brooklyn John R. , Sigmon Stacey C. 
Published: April 2017

Background:
Opioid use disorders (OUDs) are reaching epidemic proportions in the United States, and many geographic areas struggle with a persistent shortage in availability of opioid agonist treatment. Over the past 5 years, Vermont addiction medicine physicians and public health leaders have responded to these challenges by developing an integrated hub-and-spoke opioid treatment network.

Methods:
In the present report, we review the development, implementation, and impact of this novel hub-and-spoke model for expanding OUD treatment in Vermont.

Results:
Vermont's hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state's OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed.

Conclusions:
Development and implementation of a hub-and-spoke system of care has contributed substantially to improvements in opioid agonist treatment capacity in Vermont. This system may serve as a model for other states grappling with the current opioid use epidemic.
Silicone breast implants and autoimmune rheumatic diseases: myth or reality
Authors: Cohen Tervaert Jan Willem , Colaris Maartje J. , van der Hulst René R. 
Published: April 2017

Purpose of review
In the present review, recent findings regarding silicone breast implants (SBIs) complicated by rheumatic autoimmune diseases are described.

Recent findings
Despite changes in the principal constituents of the silicone implants during the past 50 years, silicone remained an adjuvant that may ’bleed’ and subsequently may be a chronic stimulus to the immune system resulting in similar clinical manifestations as 50 years ago. Silicones are spread throughout the body and can be detected in tissues and the central nervous system. Autoimmune/inflammatory syndrome by adjuvants (ASIA), allergies, autoimmune diseases, immune deficiencies and lymphomas occur in patients with SBIs. There is a need for adequately adjusted epidemiological studies to ascertain the frequency of these diseases. Explantation of the breast implants, however, should be advised to patients with complaints, as 60–80% of patients show an amelioration of the signs and symptoms after explantation.

Summary
SBIs are associated in a proportion of patients with complaints such as fatigue, cognitive impairment, arthralgias, myalgias, pyrexia, dry eyes and dry mouth. Silicones can migrate from the implant through the body and can induce a chronic inflammatory process. Explantation of SBI results in the majority of patients in an amelioration of the symptoms.
Cost-Effectiveness of Pediatric Cochlear Implantation in Rural China
Authors: Qiu Jianxin , Yu Chongxian , Ariyaratne Thathya V. , Foteff Chris , Ke Zhangmin , Sun Yi , Zhang Li , Qin Feifei , Sanderson Georgina 
Published: April 2017

Objectives:
To evaluate the cost utility of cochlear implantation (CI) for severe to profound sensorineural hearing loss (SNHL) among children from rural settings in P.R. China (China).

Research Design:
A cost-utility analysis (CUA) was undertaken using data generated from a single-center substudy of the CochlearTM Pediatric Implanted Recipient Observational Study (Cochlear P-IROS). The data were projected over a 20-year time horizon using a decision tree model.

Setting:
The Chinese healthcare payer and patient perspectives were adopted.

Intervention:
Unilateral CI of children with a severe-to-profound SNHL compared with their preimplantation state of no treatment or amplification with hearing aids (“no CI” status).

Main Outcome Measure/s:
Incremental costs per quality adjusted life year (QALY) gained.

Results:
The mean total discounted cost of unilateral CI was CNY 252,506 (37,876 USD), compared with CNY 29,005 (4,351 USD) for the no CI status from the healthcare payer plus patient perspective. A total discounted benefit of 8.9 QALYs was estimated for CI recipients compared with 6.7 QALYs for the no CI status. From the healthcare payer plus patient perspective, incremental cost-effectiveness ratio (ICER) for unilateral CI compared with no CI was CNY 100,561 (15,084 USD) per QALY. The healthcare payer perspective yielded an ICER of CNY 40,929 (6,139 USD) per QALY. Both ICERs fell within one to three times China's gross domestic product per capita (GDP, 2011–2015), considered “cost-effective” by World Health Organization (WHO) standards.

Conclusions:
Treatment with unilateral CI is a cost-effective hearing solution for children with severe to profound SNHL in rural China. Increased access to mainstream education and greater opportunities for employment, are potential downstream benefits of CI that may yield further societal and economic benefits. CI may be considered favorably for broader inclusion in medical insurance schemes across China.
Metrics save lives: value and hurdles faced
Authors: Goodloe Jeffrey M. , Idris Ahamed H. 
Published: April 2017

Purpose of review
Affirmation of the importance of precision in fundamentals of resuscitation practices with improving neurologically intact survival from sudden cardiac arrest, correlated with both measurements of resuscitation metrics generically and recently further refined metric parameters specifically.

Recent findings
Quality of baseline cardiopulmonary resuscitation (CPR) in historic intervention trials may not be ‘high quality’ as once assumed. Optimal chest compression rates are within the narrow spectrum of 106–108/min for adults. Optimal ventilation rates remain within the 8–10/min range.

Summary
Although traditional CPR teaching of ‘hard and fast’ chest compressions has promoted a relatively easy to remember directive, the reality is that laypersons and medical professionals alike may unwittingly provide markedly suboptimal chest compression depths and rates. Prior resuscitation studies that focused upon airway adjuncts, defibrillation strategies, and/or pharmaceutical interventions that did not simultaneously gauge the underlying CPR chest compression rates, chest compression fraction of time, and ventilation rates should be cautiously interpreted in light of discovery that assumption of ‘high-quality CPR’ without measurement of the metrics of such is likely a faulty assumption.