bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach
Authors: Abraham Edward , Toby David , Welborn Michelle C. , Helder Cory W. , Murphy Angela 
Published: January 2017

Background:
Successful surgical treatment of late-presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure.

Methods:
Medical records of 23 consecutive children (7 to 18 y) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range, 2 to 22 y). Indications for the corrective surgery were any child 7 year or older with a varus mechanical axis angle ≥10 degrees or a varus anatomic axis angle ≥11 degrees and a medial tibial angle (MTA) slope <60 degrees. The deformities were corrected with a dome-shaped osteotomy proximal to the tibial tubercle with a midline vertical extension to the subchondral region of the joint and a lateral hemi-epiphysiodesis.

Results:
At latest follow-up, means and medians of each tibial radiographic axis measurement improved significantly from preoperative values (P<0.001): mechanical axis angle from 23 degrees to 4 degrees varus, anatomic axis angle from 25 degrees varus to 1 degree valgus, MTA downward slope from 30 to 78 degrees, posterior MTA from 59 to 80 degrees. In total, 79% and 74% had good to excellent results based on radiographic criteria and clinical questionnaire for satisfaction, pain and function, respectively. Two abnormal medial tibial plateau types were described.

Conclusions:
This is the first study to use a single-stage double osteotomy performed proximal to the tibial tubercle for the late-presenting ITV for children 7 years of age or older. In addition to the effective correction of the 4 major tibial deformities, a lateral proximal tibial hemi-epiphysiodesis minimizes recurrence of tibia vara. A contralateral proximal tibial epiphysiodesis is recommended for treated skeletally immature patients with unilateral disease.

Level of Evidence:
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
Uniplanar Versus Fixed Pedicle Screws in the Correction of Thoracic Kyphosis in the Treatment of Adolescent Idiopathic Scoliosis (AIS)
Authors: Badve Siddharth A. , Goodwin Ryan C. , Gurd David , Kuivila Thomas , Kurra Swamy , Lavelle William F. 
Published: January 2017

Background:
The aim of surgical treatment of scoliosis is to obtain fusion of the spinal column, balanced in the coronal and sagittal planes. Great success has been attained with coronal correction; however, the sagittal profile has received less attention, resulting in little correction of sagittal plane alignment. The purpose of this study was to compare uniplanar and fixed pedicle screws in the correction of the thoracic sagittal alignment in the treatment of adolescent idiopathic scoliosis (AIS).

Methods:
The sagittal profile of 2 groups of patients undergoing posterior spinal fusion (PSF) for AIS was compared. One group had uniplanar screws (n=16) as bone anchors, and the second group had fixed screws (n=20). Consecutive patients with AIS treated by PSF during 2004 to 2006 with fixed screws; and those treated in 2008 with uniplanar screws were included in the study. Data included: patient demographics, medical conditions, curve type, Risser stage, coronal and sagittal curve magnitude, curve flexibility, osteotomies, fusion levels, type and location of instrumentation, curve magnitude at the initial postoperative visit and at final follow-up. ANOVA and χ2 testing was completed. A P<0.05 was considered significant.

Results:
Both groups were comparable demographically, medically, in relation to the curve characteristics and the surgical treatment. Immediate postcorrection sagittal curvature measurements were greater using the uniplanar than fixed screws, 36 versus 26 degrees and was also statistically significant at final follow-up (P=0.006). There was no difference between groups with respect to coronal thoracic deformity. In the Lenke 1 and Lenke 2 curve population, similar results were found.

Conclusions:
In patients undergoing PSF for AIS, uniplanar screws achieved superior correction of the sagittal thoracic alignment than fixed screws. This advantage was maintained in the postoperative follow-up period. The ability of the uniplanar screws to adapt to variable sagittal orientation appears to contribute to better radiographic outcomes.

Level of Evidence:
This is a level III respective review study conducted at a single center from a single, pediatric spine surgeon.
Influence of Insurance Type on the Access to Pediatric Care for Children With Distal Radius Torus Fractures
Authors: Potak Harrison , Iobst Christopher A. 
Published: January 2017

Background:
Previous literature has demonstrated that pediatric orthopaedic patients with private insurance have less difficulty obtaining appointments than those with Medicaid. Not all injuries of an orthopaedic nature, however, require specialist care. This study evaluated the willingness of pediatricians to provide care for minor orthopaedic injuries and whether or not the patient’s insurance status influenced the decision to provide care.

Methods:
Ninety-nine pediatric primary care offices were randomly selected from 2 regions in Florida. Each office was contacted twice, 2 to 3 months apart, and presented with a fictionalized account of a patient that had sustained a torus (“buckle”) fracture of the distal radius. In the first call, the patient was presented as having private insurance, and in the second call as having Medicaid insurance. If the patient was denied an appointment, the reason was recorded.

Results:
Of the 99 offices, 100% were willing to treat the patient’s injury if the child had private insurance, compared with 76% if the child had Medicaid. All Medicaid patient refusals were based on the insurance status of the patient. No office refused to see the patient due to the nature of the injury. Ninety-four percent of offices in South Florida were willing to see the Medicaid patient, compared with 58% in Central Florida. These differences were statistically significant (P<0.0001).

Conclusions:
It was previously unknown whether pediatricians felt comfortable managing minor orthopaedic injuries. This study demonstrates that 100% of the pediatricians surveyed were willing to treat a child with a distal radius buckle fracture with proper insurance. This information potentially can provide additional avenues for patients to achieve timely access to care. However, as seen in previous studies, there was a statistically significant difference in access to care for the same child with Medicaid. Until reimbursement rates for Medicaid improve, these patients will continue to have difficulty obtaining access to care to both primary care providers and specialists.

Level of Evidence:
Prospective survey study.
Assessment of Splints Applied for Pediatric Fractures in an Emergency Department/Urgent Care Environment
Authors: Abzug Joshua M. , Schwartz Brandon S. , Johnson Aaron J. 
Published: January 2017

Background:
Fractures are common in the pediatric population. The initial evaluation is rarely by an orthopaedic surgeon, but commonly an emergency room or urgent care center physician/extender. This typically involves splint application by a nonorthopaedist to immobilize the extremity and provide stabilization. Iatrogenic injuries from inappropriate splint placement are a potential public health and legal concern that can lead to complications. The primary purpose of this study was to prospectively evaluate the adequacy of all splints placed on patients who presented to a pediatric orthopaedic office; secondary outcomes included assessing prevalence and types of complications that were associated with inadequate splints.

Methods:
Patients aged 0 to 18 years who presented with a splint were prospectively enrolled. Information was obtained regarding demographics of the patient and splint placement. Splints were evaluated for functional position, appropriate length, and presence of elastic bandage on the skin. Photographs were taken of each splint, and the extremity was examined for any soft tissue complications. Splints were not removed in 31 patients who had undergone fracture reduction.

Results:
In total, 275 patients were prospectively enrolled. Splints were improperly placed in 93%, with application of elastic bandage directly to the skin accounting for 77%. Improper positioning was observed in 59%, and inappropriate splint length was present in 52%. Skin and soft tissue complications were observed in 40%. The most common iatrogenic splint-related complication was excessive edema, seen in 28%. Direct injury to the skin and soft tissue was seen in 6%.

Conclusions:
Many practitioners incorrectly apply splints, potentially leading to suboptimal results or causing injury. Complications of poor splint placement include excessive swelling, skin breakdown, and poor immobilization. Health care workers who treat pediatric fractures may benefit from more extensive education regarding proper splinting techniques.

Level of Evidence:
Level 2—therapeutic study.
Characterization of Readmission by Day of Rehospitalization After Colorectal Surgery
Authors: Al-Mazrou Ahmed M. , Suradkar Kunal , Mauro Christine M. , Kiran Ravi P. 
Published: January 2017

BACKGROUND:
Factors associated with readmission stratified by the day of postdischarge rehospitalization after colorectal surgery have not been characterized previously.

OBJECTIVE:
The purpose of this study was to identify factors leading to readmission on a day-to-day basis after discharge from colorectal surgery.

DESIGN:
This was a retrospective analysis of patients readmitted within 30-days after colorectal surgery. Reasons and factors associated with readmission each day after discharge were evaluated. Early readmitted patients (day 0–5 postdischarge) were compared with those readmitted later (day 6–29 postdischarge).

SETTINGS:
The study was conducted at a tertiary center.

PATIENTS:
Patients included those who had undergone primary colorectal resection from the American College of Surgeons National Surgical Quality Improvement Program (2012–2013).

MAIN OUTCOME MEASURES:
The study intended to identify factors associated with any early versus late hospital readmission and to evaluate diagnoses for unplanned readmissions on a day-to-day basis after discharge.

RESULTS:
For 69,222 elective colorectal procedures, 7476 patients (10.8%) were readmitted to the hospital within 30 days. Early (median, 3 days) and late (median, 11 days) readmissions were 3278 (43.8%) and 4198 (56.2%). Except for sex, patient demographics were similar between groups. Neurologic comorbidity; wound disruption; sepsis or septic shock; unplanned reintubation and reoperation; anastomotic leak and ileus; and neurological, cardiovascular, and pulmonary complications were significantly higher in the early readmission, whereas disseminated malignancy, stoma creation, and renal/urological complications were significantly higher in the late readmission group. On multivariable analysis, early readmission was significantly associated with male patients, wound disruption, sepsis or septic shock, reoperation, reintubation, and postoperative neurological complications. Disseminated malignancy, ostomy creation, and postoperative renal dysfunction/urological infection were associated with delayed readmission.

LIMITATIONS:
Thirty-day readmissions and reasons for unplanned rehospitalizations were evaluated.

CONCLUSIONS:
Differing factors are associated with early versus late readmission after colorectal resection. These data suggest that early readmission is intricately related to patient and operative complexity and hence may be inevitable, whereas delayed hospital presentation is associated with identifiable perioperative predictors at the time of discharge and hence more likely to be targetable.
Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement After Colorectal Surgery
Authors: Stokes Audrey L. , Adhikary Sanjib D. , Quintili Ashley , Puleo Frances J. , Choi Christine S. , Hollenbeak Christopher S. , Messaris Evangelos 
Published: January 2017

BACKGROUND:Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery.OBJECTIVE:The purpose of this study was to evaluate liposomal bupivacaine use in transversus abdominis plane blocks on postoperative pain scores and opioid use after colorectal surgery.DESIGN:This was a retrospective cohort study comparing outcomes between patients receiving nonliposomal anesthetic (n = 104) and liposomal bupivacaine (n = 303) blocks.SETTINGS:The study was conducted at a single tertiary care center.PATIENTS:Patients included those identified within an institutional database as inpatients undergoing colorectal procedures between 2013 and 2015 who underwent transversus abdominis plane block for perioperative analgesia.MAIN OUTCOME MEASURES:The study measured postoperative pain scores and opioid requirements.RESULTS:Patients receiving liposomal bupivacaine had significantly lower pain scores for the first 24 to 36 postoperative hours. Pain scores were similar after 36 hours. The use of intravenous opioids among the liposomal bupivacaine group decreased by more than one third during the hospitalization (99.1 vs 64.5 mg;p= 0.040). The use of ketorolac was also decreased (49.0 vs 18.3 mg;p< 0.001). In subgroup analysis, the decrease in opioid use was observed between laparoscopic and robotic procedures but not with laparotomies. No significant differences were noted in the use of oral opioids, acetaminophen, or ibuprofen. Postoperative length of stay and total cost were decreased in the liposomal bupivacaine group but did not achieve statistical significance.LIMITATIONS:The study was limited by its retrospective, single-center design and heterogeneity of block administration.CONCLUSIONS:Attenuated pain scores observed with liposomal bupivacaine use were associated with significantly lower intravenous opioid and ketorolac use, suggesting that liposomal bupivacaine-containing transversus abdominis plane blocks are well aligned with the opioid-reducing goals of many enhanced recovery protocols.
Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience
Authors: O’Neill Conor H. , Platz Joseph , Moore Jesse S. , Callas Peter W. , Cataldo Peter A. 
Published: January 2017

BACKGROUND:
There is debate regarding the appropriate use of transanal endoscopic microsurgery for rectal cancer.

OBJECTIVE:
This study analyzed our single-center experience with transanal endoscopic microsurgery for early rectal cancer.

DESIGN:
Medical charts of patients who underwent transanal endoscopic microsurgery were reviewed to determine lesion characteristics, as well as operative and treatment characteristics. Complications and recurrences were recorded.

SETTINGS:
The study was conducted at a single academic medical center.

PATIENTS:
Patients with early stage cancer (T1 or T2, N0, and M0) of the rectum were included.

MAIN OUTCOME MEASURES:
Local and overall recurrence and disease-specific survival were measured.

RESULTS:
A total of 92 patients were analyzed. Median follow-up was 4.6 years. Negative margins were obtained in 98.9%. Length of stay was 1 day for 95.4% of patients. The complication rate was 10.9% (n = 10), including urinary retention at 4.3% (n = 4) and postoperative bleeding at 4.3% (n = 4). Preoperative staging included 54 at T1 (58.7%) and 38 at T2 (41.3%). Adjuvant therapy was recommended for all of the T2 and select T1 lesions with adverse features on histology. The final pathologic stages of tumors were ypT0 at 8.7% (n = 8), pT1 at 58.7% (n = 54), pT2 at 23.9% (n = 22), and ypT2 at 8.7% (n = 8). The 3-year local recurrence risk was 2.4% (SE = 1.7), and overall recurrence was 6.7% (SE = 2.9). There were no recurrences among patients with complete pathologic response to neoadjuvant therapy. Mean time to recurrence was 2.5 years (SD = 1.43). A total of 89.2% of patients with very low tumors underwent curative resection without a permanent stoma (33/37). The 3-year disease-specific survival rate was 98.6% (95% CI, 90.4%–99.8%), and overall survival rate was 89.4% (95% CI, 79.9%–94.6%).

LIMITATIONS:
The study was limited by its single-center retrospective experience.

CONCLUSIONS:
Transanal endoscopic microsurgery provides comparable oncologic outcomes to radical resection in properly selected patients with early rectal cancer. Sphincter preservation rates approach 90% even in patients with very distal rectal cancer.
Does Hospital Transfer Impact Outcomes After Colorectal Surgery?
Authors: Chow Christopher J. , Gaertner Wolfgang B. , Jensen Christine C. , Sklow Bradford , Madoff Robert D. , Kwaan Mary R. 
Published: January 2017

BACKGROUND:
With increasing public reporting of outcomes and bundled payments, hospitals and providers are scrutinized for morbidity and mortality. The impact of patient transfer before colorectal surgery has not been well characterized in a risk-adjusted fashion.

OBJECTIVE:
We hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables.

DESIGN:
We constructed a retrospective cohort of 158,446 patients who underwent colorectal surgery using the 2009–2013 American College of Surgeons National Surgical Quality Improvement Program database.

SETTINGS:
The study was conducted at a tertiary care hospital.

PATIENTS:
All of the patients who underwent colorectal surgery during the study period were included. Patients were excluded for unknown transfer status or transfer from a chronic care facility.

MAIN OUTCOME MEASURES:
Baseline characteristics were compared by transfer status. Multivariate logistic regression was used to evaluate the impact of transfer on major complications and mortality.

RESULTS:
A total of 7259 operations (4.6%) were performed after transfer. Transferred patients had higher rates of complications (p < 0.0001) with significant differences in unplanned endotracheal reintubation, bleeding, organ-space surgical site infection, wound dehiscence, postoperative sepsis, cardiac arrest requiring cardiopulmonary resuscitation, deep venous thrombosis, and myocardial infarction. Transferred patients also had longer hospital stays (9 vs 6 days; p < 0.0001) and a higher risk of death (13.2% vs 2.6%; p < 0.0001). On multivariate analysis, transferred patients had higher mortality rates despite risk adjustment (OR = 1.13 (95% CI, 1.02–1.25); p = 0.019) and were also more likely to have serious complications (OR = 1.12 (95% CI, 1.06–1.19); p < 0.001).

LIMITATIONS:
We were unable to analyze outcomes beyond 30 days, and we did not have information on preoperative evaluation or the reason for patient transfer.

CONCLUSIONS:
Hospital-to-hospital transfer independently contributed to patient morbidity and mortality in patients undergoing colorectal surgery. The impact of hospital transfer must be considered when evaluating surgeon and hospital performance, because the increased risk of serious complications or death is not fully accounted for by traditional methods.
Activation of Gαq in Cardiomyocytes Increases Vps34 Activity and Stimulates Autophagy
Authors: Liu Shengnan , Jiang Ya-Ping , Ballou Lisa M. , Zong Wei-Xing , Lin Richard Z. 
Published: January 2017

Abstract:
Receptors that activate the heterotrimeric G protein Gαq are thought to play a role in the development of heart failure. Dysregulation of autophagy occurs in some pathological cardiac conditions including heart failure, but whether Gαq is involved in this process is unknown. We used a cardiomyocyte-specific transgenic mouse model of inducible Gαq activation (termed GαqQ209L) to address this question. After 7 days of Gαq activation, GαqQ209L hearts contained more autophagic vacuoles than wild type hearts. Increased levels of proteins involved in autophagy, especially p62 and LC3-II, were also seen. LysoTracker staining and western blotting showed that the number and size of lysosomes and lysosomal protein levels were increased in GαqQ209L hearts, indicating enhanced lysosomal degradation activity. Importantly, an autophagic flux assay measuring LC3-II turnover in isolated adult cardiomyocytes indicated that autophagic activity is enhanced in GαqQ209L hearts. GαqQ209L hearts exhibited elevated levels of the autophagy initiation complex, which contains the Class III phosphoinositide 3-kinase Vps34. As a consequence, Vps34 activity and phosphatidylinositol 3-phosphate levels were higher in GαqQ209L hearts than wild type hearts, thus accounting for the higher abundance of autophagic vacuoles. These results indicate that an increase in autophagy is an early response to Gαq activation in the heart.
Differences in the Expression of Symptoms in Men Versus Women with Depression: A Systematic Review and Meta-analysis
Authors: Cavanagh Anna , Wilson Coralie J. , Kavanagh David J. , Caputi Peter 
Published: January 2017

Abstract

Objective
While some studies suggest that men and women report different symptoms associated with depression, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of gender differences in symptoms associated with depression.

Methods
PubMed, Cochrane, and PsycINFO databases, along with further identified references lists, were searched. Thirty-two studies met the inclusion criteria. They included 108,260 participants from clinical and community samples with a primary presentation of unipolar depression. All 32 studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the 26 symptoms identified across the 32 studies to assess for the effect of gender.

Results
The studies indicate a small, significant association of gender with some symptoms. Depressed men reported alcohol/drug misuse (Hedges’s g = 0.26 [95% confidence interval (CI), 0.11–0.42]) and risk taking/poor impulse control (g = 0.58 [95% CI, 0.47–0.69]) at a greater frequency and intensity than depressed women. Depressed women reported symptoms at a higher frequency and intensity that are included as diagnostic criteria for depression such as depressed mood (g = −0.20 [95% CI, −0.33 to −0.08]), appetite disturbance/weight change (g = −0.20 [95% CI, −0.28 to −0.11]), and sleep disturbance (g = −0.11 [95% CI, −0.19 to −0.03]).

Conclusions
Results are consistent with existing research on gender differences in the prevalence of substance use and mood disorders, and of their co-occurrence. They highlight the potential utility of screening for substance misuse, risk taking, and poor impulse control when assessing depression in men. Future research is warranted to clarify gender-specific presentations of depression and co-occurring symptoms.