bluuebunny/crossref_metadata_2025_split huggingface dataset:
A study on the antitumor effect of gemcitabine polybutylcy- anoacrylate nanoparticles coupled with Mucin 1 monoclonal antibody on pancreatic cancer in vitro and in vivo
Authors: Zhang Lin , Zhu Jianhua , Hou Yanhong , Li Chunmei , Liu Haorun 
Published: March 2022

Context:
Previous studies have discovered a high expression rate of Mucin 1 (MUC1) in pancreatic cancer tissue, and its abnormal glycosylation causes MUC1 to expose new protein epitopes or glycoantigens.

Aims:
To investigate the therapeutic effect of drug-loaded gemcitabine polybutylcyanoacrylate nanoparticles coupled with anti-human MUC1 monoclonal antibody (mAb) on human pancreatic cancer cell line and xenografts.

Settings and Design:
Randomized controlled trial.

Materials and Methods:
Gemcitabine-loaded nanospheres were prepared by emulsion polymerization; then, the anti-MUC1 mAb coupled with gemcitabine polybutylcyanoacrylate nanoparticles (MUC1-GEM-PBCA-NP) was prepared by chemical cross-linking. Cell-killing rates were detected by MTT assay in in vitro study, and changes in tumor cell cycle and apoptosis after treatment were detected by flow cytometry. Furthermore, in in vivo study, MUC1-GEM-PBCA-NP was injected into nude mice through the tail vein. Gemcitabine-loaded polybutylcyanoacrylate nanoparticles (GEM-PBCA-NP), gemcitabine bulk drug and empty nanoparticles (PBCA-NP), and normal saline blank control groups were established. Finally, data obtained were compared between groups.

Results:
Compared with the control group, the cell-killing rate of each experimental group was significantly different (P < 0.05) in in vitro study, among which the MUC1-GEM-PBCA-NP group was significantly higher than other groups (P < 0.05). In addition, the apoptosis rate of the MUC1-GEM-PBCA-NP treatment group was significantly higher than that of other groups (P < 0.05). Furthermore, in in vivo study, the tumor inhibition rate of the MUC1-GEM-PBCA-NP treatment group was (68.14% ±1.66%), which was significantly higher than other control groups (P < 0.05). Finally, at the end of the treatment, the average tumor mass of the MUC1-GEM-PBCA-NP treatment group was (471.61 mg ± 12.16 mg), which was significantly lower than those of other control groups (P < 0.05).

Conclusions:
MUC1-GEM-PBCA-NP could have an excellent inhibitory effect on tumors; thus, requiring further study.
Cervical facet joint effusion
Authors: Kulkarni Arvind G. , Sagane Shrikant S. 
Published: March 2022

Aims:
The aim of this study was to trace the association between cervical facet joint effusion and cervical degenerative spondylolisthesis (CDS). CDS has not received as much attention as its lumbar counterpart. Identification of features of instability on magnetic resonance imaging (MRI) is crucial to avoid missing presence of CDS.

Materials and Methods:
The authors retrospectively reviewed cervical spine MRI scans and upright lateral flexion-extension radiographs of 17 consecutive patients at a single institution between January 2017 and June 2018 that revealed CDS. Presence of cervical facet joint effusion and CDS was recorded. Data were analyzed to deduce possibility of an association between cervical facet joint effusion and CDS.

Results:
Seventeen patients fulfilled the inclusion criteria of cervical spondylotic myelopathy associated with CDS. Out of these, 10 patients revealed facet joint effusion at C3-C4 (4 patients) and C4-C5 (6 patients) levels. The mean age of patients was 65.8 years (49–79) and M:F was 2.2:1. Amount of facet joint effusion varied and ranged from 1.6 mm to 4.7 mm on the axial images. Ten patients (58.82%) demonstrated facet joint effusion associated with mobile CDS. Seven patients (41.17%) with CDS and without facet effusion did not demonstrate mobility of more than 0.5 mm in flexion-extension radiographs.

Conclusion:
The current study acknowledges the association of “cervical facet effusion” and CDS. Clinically measurable facet joint effusion on MRI suggests the need for further attempts to diagnose CDS.
Complications of adult spinal deformity surgery
Authors: Akıntürk Nevhis , Zileli Mehmet , Yaman Onur 
Published: March 2022

Purpose:
Adult spinal deformity incidence increases accordingly as the population ages. Even though surgery is the best option for the treatment, the complications due to surgery are pretty challenging. This study aims to review the complication rates of adult spinal deformity surgery.

Methods:
A literature review of the last decade was performed searching for the query “Adult spine deformity and complication.” This search yielded 2781 results, where 79 articles were chosen to investigate the complications of adult spinal deformity surgery. In addition, the demographic data, surgical interventions, and complications were extracted from the publications.

Results:
A total of 26,207 patients were analyzed, and 9138 complications were found (34.5%). Implant failure, including screw loosening, breakage, distal and proximal junctional kyphosis, were the most common complications. The neurologic complications were about 10.8%, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%.

Discussion:
Age, body mass index, smoking, osteoporosis, and other comorbidities are the significant risk factors affecting adult spinal deformity surgery. Presurgical planning and preoperative risk factor assessment must be done to avoid complications. Furthermore, intra and postoperative complications affect the patients’ quality of life and length of stay, and hospital readmissions. Revision surgery also increases the risk of complications.

Conclusion:
Good patient evaluation before surgery and careful planning of the surgery are essential in avoiding complications of adult spinal deformity.
Epidemiology of atlas fractures in the United States
Authors: Lyons Joseph Gabriel , Mian Humza Moghis 
Published: March 2022

Introduction:
Fractures of the atlas represent a large portion of cervical spine trauma in the geriatric population. With an aging and more active population, it is expected that the number of patients sustaining atlas fractures is increasing. However, epidemiologic data regarding the incidence of atlas fractures in large populations are scarce. The aim of this study was to investigate the incidence and demographic characteristics of patients with fractures of the atlas in the United States (US) over the last 20 years.

Materials and Methods:
This descriptive epidemiology study retrospectively analyzed the National Electronic Injury Surveillance System database to identify cases of atlas fractures presenting to US Emergency Departments (EDs) from 2001 to 2020. Annual and overall numbers of fractures and fracture incidence rates, patient demographics (age, gender, race), and injury characteristics (mechanism, associated injuries) were analyzed. Incidence rates are expressed as the number of fractures per million at-risk person-years. Patients were split into four different age groups for comparisons (<18, 18–64, 65–79, 80+ years).

Results:
An estimated 38,092 cases of acute atlas fractures were identified, representing 11.1% of all cervical fractures and corresponding to an overall incidence rate of 6.2. Slightly more than half (54%) occurred in females and the mean age was 71 years. Overall, a majority (64%) of cases occurred in patients > 70 years old. There was substantial increase in incidence rate with age (<18 years: 0.7; 18–64 years: 2.6; 65–79 years: 17.1; 80 + years: 71.8). The most common injury mechanism was a low-energy fall (74%). Overall, only 42% of atlas fractures were isolated injuries, with 58% of patients sustaining at least one concomitant injury and 48% sustaining at least one additional fracture. Accounting for population growth yielded a significantly increasing incidence over the study period from 1.7 in 2001 to 13.4 in 2020 (annual percent increase = 11, P < 0.00001). Disproportionately large increases in incidence rates were observed in the oldest patient groups.

Conclusions:
Atlas fractures occur in older patients and are often associated with concomitant injuries to the head and spine. These types of fractures are increasing in the US, especially among the elderly. The annual incidence increased nearly 700% over the course of the study period and in 2020 was over 13 per million overall. In elderly patients >80 years old, the most recent annual incidence rate was over 157 per million.
Vertebral artery dissection in acute cervical spine trauma
Authors: Gupta Rahul , Siroya Hardik Lalit , Bhat Dhananjaya Ishwar , Shukla Dhaval P , Pruthi Nupur , Devi Bhagavatula Indira 
Published: March 2022

Objective:
The aim of this study was to study mechanism, risk factors, and prognosis of patients with vertebral artery dissection (VAD) from acute cervical spine trauma (CST).

Methods:
A total of 149 consecutive patients were chosen from 2014 to 2019 from our institute data base, and their records were retrospectively studied. Morphology of fracture and subluxation were studied in detail with respect to the presence or absence of VAD.

Results:
Patients were divided in subsets of axial spine injury and subaxial spine injury. Subgroup and group analysis was performed and computerized tomography angiogram, MR angiogram and T1/T2 axial scans were studied to identify VAD, an incidence of 14.1% was found. Patients having infarcts in posterior circulation were also identified.

Conclusion:
There is a significant contribution of biomechanics of CST and evolution of VAD. This is an important consideration to prevent significant morbidity and mortality. Hence, a diagnostic algorithm which can be applied in any hospital setup is the need of the hour.
Do the newly proposed realignment targets bridge the gap between radiographic and clinical success in adult cervical deformity corrective surgery
Authors: Pierce Katherine E. , Krol Oscar , Lebovic Jordan , Kummer Nicholas , Passfall Lara , Ahmad Waleed , Naessig Sara , Diebo Bassel , Passias Peter Gust 
Published: March 2022

Hypothesis:
The myelopathy-based cervical deformity (CD) thresholds will associate with patient-reported outcomes and complications.

Materials and Methods:
This study include CD patients (C2-C7 Cobb > 10°, CL > 10°, cervical sagittal vertical axis > 4 cm, or CBVA > 25°) with BL and 1-year (1Y) data. Modifiers assessed low (L), moderate (M), and severe (S) deformity: CL (L: >3°; M:-21° to 3°; S: <[FIGURE DASH]21°), TS-CL (L: <26°; M: 26° to 45°; S: >45°), C2-T3 angle (L: >[FIGURE DASH]25°; M:-35° to-25°; S: <[FIGURE DASH]35°), C2 slope (L: <33°; M: 33° to 49°; S: >49°), MGS (L: >[FIGURE DASH]9° and < 0°; M: [FIGURE DASH]12° to [FIGURE DASH]9° or 0° to 19°; S: < [FIGURE DASH]12° or > 19°), and frailty (L: <0.18; M: 0.18–0.27, S: >0.27). Means comparison and ANOVA assessed outcomes in the severity groups at BL at 1Y. Correlations found between modifiers assessed the internal relationship.

Results:
One hundred and four patients were included in the study (57.1 years, 50%, 29.3 kg/m2). Baseline S TS-CL, C2-T3, and C2S modifiers were associated with increased reoperations (P < 0.01), while S MGS, CL, and C2-T3 had increased estimated blood lost (>1000ccs, P < 0.001). S MGS and C2-T3 had more postop DJK (60%, P = 0.018). Improvement in TS-CL, C2S, C2-T3, and CL patients had better numeric rating scale (NRS) back (<5) and EuroQOL 5-Dimension questionnaire (EQ5D) at 1 year (P < 0.05). Improving the modifiers correlated strongly with each other (0.213–0.785, P < 0.001). Worsened TS-CL had increased NRS back scores at 1 year (9, P = 0.042). Worsened CL had increased 1-year modified Japanese Orthopedic Association (mJOA) (7, P = 0.001). Worsened C2-T3 had worse NRS neck scores at 1 year (P = 0.048). Improvement in all six modifiers (8.7%) had significantly better health-related quality of life (HRQL) scores at follow-up (EQ5D, NRS, and Neck Disability Index).

Conclusions:
Newly proposed CD modifiers based on mJOA were closely associated with outcomes. Improvement and deterioration in the modifiers significantly impacted the HRQL.
Saradhi’s single stage, anterior sequential reduction utilizing C3 for type III hangman’s fracture
Authors: Mudumba Vijaya Saradhi , Pavan S. , Alugolu Rajesh 
Published: March 2022

Background:
Levine Edward's Type III Hangman's fractures are highly unstable and in absence of level 1 evidence, the treatment is individualized. A longer cantilever beam can achieve not just reduction of highly displaced fragments but can also provide a stable construct without the need of global instrumentation.

Objective:
We extrapolated the surgical techniques of the long cantilever beam to this rare group of cohorts for anterior alone, sequential reduction utilizing C3 rather than sacrificing in a single sitting and single approach.

Materials and Methods:
This is a prospective observational study from 2015 to 2019, of all consecutive 10 patients diagnosed and treated as Type III Hangman's fracture in the Department of Neurosurgery. Clinical evaluation and pain scores were recorded in the preoperative assessment. Radiological investigations included plain roentgenograms in anterior-posterior and lateral views, magnetic resonance imaging, and computed tomography scan of the cervical spine. Preoperative cervical traction was placed in all cases for the achievement of facetal reduction. The high cervical extra-pharyngeal approach was utilized for discectomy, bone grafting, reduction, and sequential plating.

Results:
Complete reduction was achieved in all the cases and none required additional posterior surgery. There was a significant decrease in axial neck pain with complete fusion of the graft, and healing of fracture site.

Conclusion:
The anterior alone approach with a longer cantilever for primary internal stabilization is a technically safe and suitable option for unstable Type III Hangman's fracture.
Spontaneous spinal epidural hematoma
Authors: Diyora Batuk , Chajjed Rahul , Dhall Gagan 
Published: March 2022

Background:
Spontaneous Spinal Epidural Haematoma (SSEH) is a rare entity that results from spontaneous, non-traumatic haemorrhage in the spinal epidural space. While erring on the side of caution, few significant clues in the history can lead to an earlier differentiation from more frequently seen pathologies like acute disc herniation and spinal tumors. Once diagnosed, the decision of surgical versus conservative management is entirely clinical and situation-based. In ambiguous scenarios, the study of specific parameters can help to choose one over another.

Objective:
We are sharing here our experience of six such patients and review relevant literature, mainly focusing on the variables that can help to determine the best therapeutic plan.

Material and Methods:
We studied the parameters like age, gender, location, number of levels involved, drug history, duration to surgery, American Spinal Injury Association (ASIA) impairment scale grade at presentation, therapeutic plan, and their final ASIA score for six patients of SSEH who presented to our department. We also reviewed the published literature focusing on therapeutic decision-making in SSEH.

Results:
Five patients were managed surgically and one conservatively. Variables considered while opting for surgical treatment. One patient was managed conservatively based on his improving neurology.

Conclusions:
Patients with SSEH need to be cautiously selected for surgical or conservative management for their optimal outcome. The study's various variables highlight a few critical concerns while predicting the outcome and guide one to decide a therapeutic plan for this rare pathology.
Accuracy and safety of free-hand pedicle screw placement in cervical injury patients
Authors: Rijal Sanjeeb , Dhatt Sarvdeep Singh , Kumar Vishal , Neradi Deepak , Prakash Mahesh 
Published: March 2022

Objectives:
The purpose of this study was to describe the free hand method of pedicle screw placement without intraoperative imaging monitors and to evaluate the accuracy of the screw placement in quadriplegics patients.

Methods:
A free hand screw was inserted in the eleven cervical injury patients with quadriplegia. We studied the preoperative pedicle dimension in all the patients and assessed the clinical and radiological outcome and accuracy of the screw placement.

Results:
A total of 44 screws were inserted in the cervical pedicles of eleven patients. The postoperative images showed that 28 of the 44 screws had perforated the pedicles but none of them had breached the spinal canal. Among them 16 screws were grade 2 and 12 screws were grade 3. All the screws had penetrated the lateral wall. There were no neurovascular complications related to any malpositioned screw and there was no screw loosening or instrumentation failure in the patients.

Conclusion:
The free hand screw placement without intraoperative image guidance seems to be safe and effective method of fixation. But this technique requires sound knowledge of the cervical anatomy and experience and is useful in the places where navigation system are not available.
Efficacy of Customized Soft Occlusal Splints in the Management of Temporomandibular Joint Disorders among the Population of Parsa District of Nepal
Authors: Wazir Sartaj Singh , Jaiswal Alok Kumar , Srivastava Rahul 
Published: March 2022

Background:
In recent years, temporomandibular joint disorders (TMDs) have been a highly debated topic. TMD is the collective term of clinical problems that involves the masticatory apparatus, temporomandibular joint (TMJ), and its associated structures or both. It is really a tough challenge for both the dental and the medical specialists and is often difficult to diagnose and treat such a disorder as the presenting symptoms can be variable. A variety of treatment modalities have been described in the literature for its management and the conservative method is most preferred. The objective of the present study was to evaluate the effectiveness of soft occlusal splint therapy among the population of Parsa district of Nepal in the management of TMDs.

Materials and Methods:
Thirty subjects with signs and symptoms of TMDs were included in the study, out of which 13 (43.3%) subjects were males and 17 (56.7%) were females, with age ranging from 21 to 40 years. Soft occlusal splints were given to the patients for about 3 months and evaluated for reduced mouth opening, tenderness of TMJ (preauricular), TMJ sounds, and mandibular deviation after 1 week of initiation of therapy and every month for 3 consecutive months.

Results:
There was a significant improvement of 3.06 mm (9.7%) in mouth opening, 86.7% of subjects showed significant reduction in preauricular tenderness, 80.0% subjects showed reduction in TMJ sounds, and 76.7% of subjects showed improvement in mandibular deviation after 3 months of the splint therapy. Paired t-test and Chi-square tests were done for comparison.

Conclusions:
Soft occlusal splints can be used effectively as a conservative treatment modality in reducing the signs and symptoms related to TMDs.
Propranolol use in patients with cirrhosis and refractory ascites
Authors: Chen Yen-Chun , Li Yun-Da , Lu Chia-Ming , Huang Wei-Chun , Kao Sung-Shuo , Chen Wen-Chi 
Published: March 2022

Background:
The impact of propranolol on patients with cirrhosis and refractory ascites is controversial. We conducted a nationwide longitudinal cohort study to compare the survival between patients with cirrhosis and refractory ascites, with and without using propranolol.

Methods:
Data of patients with cirrhosis and refractory ascites using propranolol, and controls matched by age and gender, were extracted from The National Health Insurance Research Database of Taiwan. The baseline demographic characteristics were compared between groups. Cox regression analysis was used to examine the predictors of mortality.

Results:
In this study, 1788 patients were enrolled in each group; 1304 patients (72.9%) in the propranolol group and 1445 patients (80.8%) in the control group died (P < 0.001). The mean survival was 34.3 ± 31.2 months in the propranolol group and 20.8 ± 26.6 months in the control group (P < 0.001). Propranolol (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.55–0.64, P < 0.001), statins (HR: 0.43, 95% CI: 0.34–0.56, P < 0.001), age (HR: 1.02, 95% CI: 1.01–1.02, P < 0.001), and diabetes mellitus (HR: 1.14, 95% CI: 1.05–1.24, P = 0.002) were the independent predictors for mortality.

Conclusions:
Use of propanolol was associated with reduced mortality, compared with controls, in this nationwide cohort of patients with cirrhosis and refractory ascites.
Nailfold capillaroscopy changes with disease activity in patients with inflammatory myositis including overlap myositis, pure dermatomyositis, and pure polymyositis
Authors: Shenavandeh Saeedeh , Rashidi Farideh 
Published: March 2022

ObjectivesNailfold capillaroscopy (NFC) is useful in the evaluation of connective tissue diseases. There are few capillaroscopy examinations in patients with idiopathic inflammatory myopathies (IIMs) using the 2017 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification. We evaluated the clinical, laboratory, and NFC in patients with IIMs using 2 classifications.Material and methodsIn this cross-sectional study, 150 patients with IIMs were selected based on the EULAR/ACR classification and the Troyanov and Senécal classification. Nailfold capillaroscopy, laboratory tests, clinical manifestations, and disease activity were evaluated.ResultsThe subgroups were as follows: 81 patient with dermatomyositis (DM), 25 with amyopathic dermatomyositis (ADM), 25 with juvenile dermatomyositis (JDM), 19 with polymyositis (PM),53 with pure DM, 11 with pure PM, and 51 with overlap myositis (OM). Eight (42%) patients with PM and 28 (34.5%) patients with DM were categorized as OM. The scleroderma pattern was the dominant capillaroscopy pattern in the DM (72.8%), JDM (72%), ADM (76%), pure DM (75.4%), and OM (78.4%) subgroups, respectively. In the DM, ADM, JDM, and OM subgroups, scleroderma pattern had an association with high skin Visual Analogue Scale (VAS) score (p < 0.05). In OM patients, the association between scleroderma pattern and high global VAS was also detected (p < 0.05).ConclusionsThe scleroderma pattern was the dominant capillaroscopy pattern in all groups except for PM and pure PM. Some of patients with PM could be categorized as OM. In the DM and pure DM subgroups, there was a significant association between global and skin activity and higher NFC score. Adding the NFC to the classification of IIM is probably helpful in more detailed classifications.