bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up
Authors: Mun Frederick , Vankara Ashish , Suresh Krishna V. , Margalit Adam , Kebaish Khaled M. , Sponseller Paul D. 
Published: May 2022

Introduction:
Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up.

Methods:
We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections.

Results:
Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications.

Conclusions:
SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time.

Level of Evidence:
Level IV.
On-Hours Compared to Off-Hours Pediatric Extracorporeal Life Support Initiation in the United States Between 2009 and 2018—An Analysis of the Extracorporeal Life Support Organization Registry
Authors: Steurer Martina A. , Tonna Joseph E. , Coyan Garrett N. , Burki Sarah , Sciortino Christopher M. , Oishi Peter E. 
Published: May 2022

OBJECTIVES:
We aimed to investigate whether there are differences in outcome for pediatric patients when extracorporeal life support (ECLS) is initiated on-hours compared with off-hours.

DESIGN:
Retrospective cohort study.

SETTING:
Ten-year period (2009–2018) in United States centers, from the Extracorporeal Life Support Organization registry.

PATIENTS:
Pediatric (>30 d and <18 yr old) patients undergoing venovenous and venoarterial ECLS.

INTERVENTIONS:
The primary predictor was on versus off-hours cannulation. On-hours were defined as 0700–1859 from Monday to Friday. Off-hours were defined as 1900–0659 from Monday to Thursday or 1900 Friday to 0659 Monday or any time during a United States national holiday. The primary outcome was inhospital mortality. The secondary outcomes were complications related to ECLS and length of hospital stay.

MEASUREMENTS AND MAIN RESULTS:
In a cohort of 9,400 patients, 4,331 (46.1%) were cannulated on-hours and 5,069 (53.9%) off-hours. In the off-hours group, 2,220/5,069 patients died (44.0%) versus 1,894/4,331 (44.1%) in the on-hours group (p = 0.93). Hemorrhagic complications were lower in the off-hours group versus the on-hours group (hemorrhagic 18.4% vs 21.0%; p = 0.002). After adjusting for patient complexity and other confounders, there were no differences between the groups in mortality (odds ratio [OR], 0.95; 95% CI, 0.85–1.07; p = 0.41) or any complications (OR, 1.02; 95% CI, 0.89–1.17; p = 0.75).

CONCLUSIONS:
Survival and complication rates are similar for pediatric patients when ECLS is initiated on-hours compared with off-hours. This finding suggests that, in aggregate, the current pediatric ECLS infrastructure in the United States provides adequate capabilities for the initiation of ECLS across all hours of the day.
Viability and Cosmesis of Right Angle and Vertical Paramedian Forehead Flaps Are Equivalent: A Retrospective Quantitative Study
Authors: Mukovozov Ilya M. , Laroche Alexandre , Wong Aaron , Zloty David 
Published: May 2022

BACKGROUND
Paramedian forehead flaps (PMFFs) are commonly used for reconstruction of nasal defects. The classic PMFF is vertically oriented while the modified PMFF is designed with a 90-degree angle. No study has compared outcomes between these PMFF designs.

OBJECTIVE
To compare and quantify viability and cosmesis of 90-degree and vertical PMFF.

METHODS
Retrospective chart review of 70 consecutive patients with a vertical or 90-degree PMFF design for nasal repairs after Mohs micrographic surgery (MMS). Cosmetic outcome was assessed on a 10-cm, 100-point, visual analog scale (VAS) by an independent observer using standardized 3-month postoperative photographs. Flap viability was assessed using standardized 3-week postoperative photographs. Descriptive statistics, t-test, and Mann–Whitney test were used for statistical analysis.

RESULTS
Forty-eight patients were repaired with a vertical PMFF and 22 using the 90-degree PMFF. The mean defect area of vertical and 90-degree designs was equivalent (7.7 ± 4.0 cm2 vs 8.1 ± 4.0 cm2, p = .70). There was no significant difference in cosmetic outcome (75.9 ± 9.4 vs 72.9 ± 6.8, p = .19) or flap viability (3.8% ± 11.6 vs 2.6% ± 7.9, p = .67) between vertical and 90-degree designs.

CONCLUSION
Vertical and 90-degree PMFF designs for nasal repairs after MMS are equivalent in cosmetic outcome and viability.
Combined Internal Limiting Membrane Peeling and Subretinal Balanced Salt Solution Injection: A Novel Technique to Unfold Congenital Falciform Folds
Authors: Boral Subhendu K. , Dan Shouvick , Mitra Santanu 
Published: May 2022

Purpose:
To describe a novel surgical technique to unfold congenital falciform folds.

Method:
A retrospective, interventional case series was performed where a novel technique was applied to treat five cases of congenital falciform folds. Twenty-five–gauge vitrectomy was performed along with the removal of all vitreous adhesions. The internal limiting membrane was peeled from the macula and around the macular fold area. A Tano diamond-dusted membrane scraper was used to stretch the folded retina mechanically. Then, subretinal balanced salt solution was injected using a 38-gauge subretinal needle to create multiple blebs around the folded retina. Finally, 20% sulfur hexafluoride gas was used for tamponade. Follow-up was conducted for a minimum of 6 months.

Results:
Vision improved from preoperative mean best-corrected visual acuity logMAR 1.44 (20/550) ± 0.32 to postoperative mean best-corrected visual acuity logMAR 0.75 (20/112) ± 0.17 (P value = 0.0208) after intervention. There was a reduction in the macular fold. Postoperatively, a macular hole with retinal detachment developed in one of five (20%) eyes.

Conclusion:
The novel technique of vitrectomy with combined internal limiting membrane peeling and subretinal balanced salt solution injection is visually rewarding in treating congenital falciform folds.
Tumour microenvironment and focal therapy for prostate cancer
Authors: Borges Rafael Castilho , Tourinho-Barbosa Rafael Rocha , de la Rosette Jean 
Published: May 2022

Purpose of review
Although most studies focus on the tumour component of prostate cancer (PCa), increasing attention is being paid to the prostatic tumour microenvironment (TME) and its role in diagnosis, prognosis, and therapy development. Herein, we review the prognostic capability of tumour and nontumour derived biomarkers, the immunomodulatory effects of focal therapy (FT) on TME, and its potential as part of a multidisciplinary approach to PCa treatment.

Recent Findings
Tumour cells have always been the natural candidates to explore new biomarkers, but recent evidence highlights the prognostic contribution of TME cell markers. TME plays a critical role in PCa progression and tumours may escape from the immune system by establishing a microenvironment that suppresses effective antitumour immunity. It has been demonstrated that FT has an immunomodulatory effect and may elicit an immune response that can either favour or inhibit tumorigenesis. TME shows to be an additional target to enhance oncological control.

Summary
A better understanding of TME has the potential to reliably elucidate PCa heterogeneity and assign a prognostic profile in accordance with prostate tumour foci. The joint contribution of biomarkers derived from both tumour and TME compartments may improve patient selection for FT by accurately stratifying disease aggressivity according to the characteristics of tumour foci. Preclinical studies have suggested that FT may act as a TME modulator, highlighting its promising role in multimodal therapeutic management.
Is the Early Diagnosis of Pediatric Stroke Possible in the Emergency Department?
Authors: Yaradılmış Raziye Merve , Öztürk Betül , Göktuğ Aytaç , Güngör Ali , Bodur İlknur , Güneylioğlu Muhammed Mustafa , Atasoy Ergin , Aksoy Erhan , Karacan Can Demir , Tuygun Nilden 
Published: May 2022

Background and Purpose
Pediatric stroke is a neurological emergency. Knowing the predictive clinical markers for childhood stroke will help in early diagnosis and patient management. This study aims to (1) evaluate patients admitted to the pediatric emergency department (PED) with acute neurological signs and/or symptoms who underwent neuroimaging and (2) determine the clinical warning signs for the early recognition of stroke.

Methods
One hundred one patients aged 1 month to 18 years who were admitted with stroke-related neurological signs and symptoms and underwent neuroimaging in the PED were retrospectively analyzed using the file record system. As a result of these imaging tests, the characteristics of patients with stroke and nonstroke were compared.

Results
The mean age of the 92 included patients was 10.7 (SD, 4.5) years. Among the admission symptoms of the patients, a significant difference was observed only in terms of speech disorder, whereas a significant difference was found in the examination results for altered consciousness and dysarthria. The incidences of hemiplegia and hemiparesis were higher in the stroke group, but they were not statistically significant. The median duration of time from symptom onset to PED admission was 240 minutes (interquartile range, 30–1440 minutes). The mean time from PED admission to magnetic resonance imaging in the stroke group was 2.3 (SD, 0.7) hours, which was significantly shorter than for the nonstroke group (4.9 [SD, 1.2] hours, P = 0.002).

Conclusions
Childhood stroke is a neurological emergency that requires a multidisciplinary approach. Early stroke diagnosis is vital for treatment and prognosis. With respect to sudden neurological deficits, particularly dysarthria, altered consciousness, hemiplegia, and hemiparesis, should alert clinicians to stroke. In addition, interdepartmental cooperation is essential both in the rapid recognition of stroke and the treatment and follow-up processes.
Conjoined Twin Separation: Review of 30-Year Case Experience and Lessons Learned
Authors: Shafarenko Mark S. , Zuker Ronald M. 
Published: May 2022

Background:
Conjoined twinning is a rare medical phenomenon, and numerous challenges remain with respect to surgical separation and reconstruction. The purpose of this study is to present a detailed discussion of the authors’ institutional experience with eight conjoined twin separations over the past three decades, focusing on challenges and lessons gleaned from these cases.

Methods:
The records of all patients who underwent conjoined twin separation at The Hospital for Sick Children in Toronto, Ontario, Canada, from 1984 to 2018 were retrospectively reviewed.

Results:
Eight sets of conjoined twins were analyzed. Half of the sets [n = 4 (50 percent)] were female. There were four sets (50 percent) of ischiopagus twins, three sets (37.5 percent) of omphalopagus twins, and one set (12.5 percent) of craniopagus twins. The median age at separation was 6.75 months. The mean durations of intensive care unit and hospital stay were 14.1 ± 12.9 days and 4.9 ± 4.8 months, respectively. Mean length of follow-up was 6.7 ± 4.4 years. Three deaths occurred in our series, with an overall survival rate of 81 percent. Two sets of twins experienced expander-related complications such as infection and bowel perforation. Three twins required reoperation because of flap necrosis or dehiscence after separation.

Conclusions:
The authors’ results highlight the unique nature of each operation and the great ingenuity required in managing the particular considerations of each case and also adhering to a systematic approach of evaluation and planning. A number of novel strategies were used at the authors’ center and have now become commonplace. The lessons learned from such procedures may improve care for future generations of patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Brief Report: Evaluation of Inflammation and Atherogenesis Biomarkers Through 148 Weeks Postswitch to Dolutegravir and Rilpivirine in SWORD-1/SWORD-2
Authors: Llibre Josep M. , López Cortés Luis Fernando , Aylott Alicia , Wynne Brian , Matthews Jessica , Van Solingen-Ristea Rodica , Vandermeulen Kati , van Wyk Jean , Kahl Lesley P. 
Published: May 2022

Background:
Switching to the 2-drug regimen dolutegravir + rilpivirine demonstrated noninferiority vs continuing a 3-drug or 4-drug current antiretroviral regimen (CAR) at week 48 and maintained high levels of virologic suppression to week 148 in the SWORD studies. We report inflammation and atherogenesis biomarkers postswitch to dolutegravir + rilpivirine.

Setting:
SWORD-1: 65 centers, 13 countries; SWORD-2: 60 centers, 11 countries.

Methods:
Virologically suppressed adults were randomized to switch to dolutegravir + rilpivirine (early-switch group; n = 513) or continue CAR (n = 511). Participants continuing CAR switched to dolutegravir + rilpivirine at week 52 (late-switch group; n = 477). Biomarkers were evaluated from Baseline to week 48 for dolutegravir + rilpivirine and CAR and noncomparatively for dolutegravir + rilpivirine postswitch through 148 weeks (early-switch) and 96 weeks (late-switch).

Results:
Through week 48, changes in biomarkers did not significantly differ between dolutegravir + rilpivirine and CAR groups, except for increases in soluble CD14 and decreases in fatty acid–binding protein-2, which favored dolutegravir + rilpivirine. For inflammation biomarkers through week 148, there was no marked change in C-reactive protein, inconsistent changes in soluble CD14 and interleukin-6, and increases in soluble CD163. For atherogenesis biomarkers through week 148, fatty acid–binding protein-2 and soluble vascular cell adhesion molecule-1 showed sustained reductions; D-dimer showed inconsistent increases between early-switch vs late-switch groups.

Conclusions:
No consistent pattern of change in biomarkers postswitch to dolutegravir + rilpivirine was observed through weeks 48 and 148 in SWORD-1/SWORD-2, suggesting no association of increased inflammation or atherogenesis with the 2-drug regimen while maintaining virologic suppression.
Predictive Value of Coronary Artery Calcium in Patients Receiving Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department
Authors: Vakil Parmede , Wen Zhaoying , Lima Ana S. , Weber Ellen J. , Kallianos Kimberly G. , Elicker Brett M. , Naeger David M. , Henry Travis S. , Ordovas Karen G. 
Published: May 2022

Purpose:
Coronary artery calcium (CAC) is a frequent incidental finding on computed tomography pulmonary angiogram (CTPA) in the evaluation of pulmonary embolism (PE) in the emergency department (ED); however, its prognostic value is unclear. In this study, we interrogate the prognostic value of CAC identified on CTPA in predicting adverse outcomes in the evaluation of PE in the ED.

Materials and Methods:
In this retrospective cohort study, we identified 610 patients presenting to the ED in 2013 and evaluated with CTPA for suspected PE. Ordinal CAC scores were evaluated as absent (0), mild (1), moderate (2), or severe (3) in each of the 4 main coronary arteries. Composite CAC scores were subsequently compared against adverse clinical outcomes, defined as intensive care unit admission, hospital stay longer than 72 hours, or death during hospital course or at 6-month follow-up, using univariate and multivariate logistic regression analyses. Relevant exclusion criteria included a history of cardiovascular disease.

Results:
In all, 365 patients met the inclusion criteria (231 women, mean age 56±16 y) with 132 patients (36%) having some degree of CAC and 16 (4%) having severe CAC. Known malignancy was present in 151 (41%) patients and composite adverse clinical outcomes were observed in 98 patients (32%). Age, presence of acute PE, malignancy, and presence of CAC were significant predictors of adverse outcomes on both univariate and multivariate analyses. CAC was not an independent predictor of short-term adverse outcomes on multivariate analysis (P=0.06) when all patients were considered. However, when patients with known malignancy were excluded, CAC was an independent predictor of short-term adverse outcomes (odds ratio=2.5, confidence interval=1.1-5.5, P=0.03) independent of age and presence of PE.

Conclusion:
The presence of CAC on CT PA was predictive of adverse outcomes in patients without known cardiac disease presenting to the ED with suspected PE.
Incremental Value of Noncontrast Chest Computed Tomography-derived Parameters in Predicting Subclinical Carotid Atherosclerosis
Authors: Wang Xi , Xin Ran , Shan Dongkai , Dou Guanhua , Zhang Wei , Jing Jing , He Bai , Chen Yundai , Yang Junjie 
Published: May 2022

Purpose:
To investigate the incremental value of noncontrast chest computed tomography (CT)-derived parameters, such as coronary artery calcium score (CACS) and epicardial adipose tissue volume (EATv), in predicting subclinical carotid atherosclerosis above traditional risk factors in community-based asymptomatic populations of northern China.

Materials and Methods:
A total of 2195 community-based asymptomatic individuals were enrolled from Jidong Oilfield in accordance with the PERSUADE study. CACS and EATv were measured on noncontrast chest CT. Demographics and ideal cardiovascular health score (ICHS) were collected through questionnaires. We recalculated the ideal cardiovascular health risk score (ICHRS) (ICHRS=14−ICHS) and standardized the parameters as log-CACS and body mass index adjusted EATv (i-EATv). Subclinical carotid atherosclerosis was assessed by Doppler sonography and defined as any prevalence of average carotid intima-media thickness ≥1.00 mm, appearance of carotid plaque, and carotid arterial stenosis in the areas of extracranial carotid arteries on both sides.

Results:
A total of 451 (20.55%) individuals presented subclinical carotid atherosclerosis. CACS and EATv were significantly greater in the subclinical group, while ICHS was lower. In multivariate logistic regression, ICHRS (odds ratio [OR]=1.143, 95% confidence interval [CI]: 1.080-1.210, P<0.001), log-CACS (OR=1.701, 95% CI: 1.480-1.955, P<0.001), and i-EATv (OR=1.254, 95% CI: 1.173-1.341, P<0.001) were found to be independent risk predictors for subclinical carotid atherosclerosis. In receiver-operating characteristic curve analysis, when combined with male sex and age level, the area under the curve of the ICHRS basic model increased from 0.627 (95% CI: 0.599-0.654) to 0.757 (95% CI: 0.732-0.781) (P<0.0001). Further adding log-CACS and i-EATv, the area under the curve demonstrated a statistically significant improvement (0.788 [95% CI: 0.765-0.812] vs. 0.757 [95% CI: 0.732-0.781], P<0.0001).

Conclusion:
Noncontrast chest CT-derived parameters, including CACS and EATv, could provide significant incremental improvement for predicting subclinical carotid atherosclerosis beyond the conventional risk assessment model based on ICHRS.
Percutaneous delivery of self-propelling thrombin-containing powder increases survival from noncompressible truncal hemorrhage in a swine model of coagulopathy and hypothermia
Authors: Cau Massimo F. , Ali-Mohamad Nabil , Yeh Han , Baylis James R. , Peng Henry , Gao Han Zhang , Rezende-Neto Joao , Grecov Dana , White Nathan J. , Tenn Catherine , Semple Hugh A. , Beckett Andrew , Kastrup Christian J. 
Published: May 2022

BACKGROUND
Noncompressible truncal hemorrhage (NCTH) remains a leading cause of preventable death on the battlefield. Definitively managing severe NCTH requires surgery within the first hour after injury, which is difficult when evacuating casualties from remote and austere environments. During delays to surgery, hemostatic interventions that are performed prehospital can prevent coagulopathy and hemorrhagic shock and increase the likelihood that casualties survive to receive definitive care. We previously reported that a self-propelling thrombin-containing powder (SPTP) can be delivered percutaneously into the abdomen as a minimally invasive intervention and can self-disperse through pooled blood to deliver the hemostatic agents thrombin and tranexamic acid locally to noncompressible intracavitary wounds. We hypothesized that, in swine with massive NCTH, dilutional coagulopathy, and hypothermia, delivering SPTP could extend survival times.

METHODS
Ten swine (n = 5 per group) underwent NCTH from a Grade V liver injury following a midline laparotomy. The laparotomy was closed with sutures afterwards, creating a hemoperitoneum, and animals were managed with crystalloid fluid resuscitation, or crystalloid resuscitation and SPTP. Self-propelling thrombin-containing powder was delivered into the closed abdomen using a CO2-powered spray device and a catheter placed into the hemoperitoneum, entering through the upper right quadrant using the Seldinger technique. Survival to 1 and 3 hours was recorded. In an additional animal, hemorrhage was created laparoscopically, and SPTP was imaged in situ within the abdomen to visually track dispersion of the particles.

RESULTS
Self-propelling thrombin-containing powder dispersed as far as 35 ± 5.0 cm within the abdomen. It increased survival to 1 and 3 hours (Kaplan-Meier p = 0.007 for both). The median survival time was 61 minutes with SPTP and 31 minutes without (p = 0.016).

CONCLUSION
Self-propelling thrombin-containing powder effectively disperses medications throughout a hemoperitoneum and increases survival in a model of NCTH. It is a promising strategy for nonsurgical management of NCTH, warranting further testing of its safety and efficacy.