bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elastic Lumbar Support Versus Rigid Thoracolumbar Orthosis for Acute Pediatric Spondylolysis: A Prospective Controlled Study
Authors: Virkki Ella , Holstila Milja , Kolari Terhi , Lastikka Markus , Mattila Kimmo , Malmi Sari , Pajulo Olli , Helenius Ilkka 
Published: July 2022

Study Design.
A prospective study on clinical, radiographic, and health-related quality of life (HRQoL) outcomes in children with acute spondylolysis treated with a rigid thoracolumbar orthosis or with an elastic lumbar support.

Objective.
To compare outcomes of pediatric spondylosysis treated with a hard brace or an elastic lumbar support.

Summary of Background Data.
The benefits of the use of a rigid orthosis in treatment of spondylolysis are not clear.

Materials and Methods.
Fifty-seven consecutive children with acute spondylolysis (mean age: 14.1 yr, range: 9–17 yr) were prospectively enrolled. Patients were treated with a rigid thoracolumbar orthosis (Boston brace) or with a low-profile, elastic lumbar support. First 14 patients were randomized the remaining 43 chose brace type themselves. Treatment period was four months. Treatment outcomes included bony union of the spondylolysis assessed with a computed tomography at four months and HRQoL using the Scoliosis Research Society-24 outcome questionnaire filled out before and after the treatment.

Results.
Of the 57 patients, 54 completed the treatment protocol. Twenty-nine patients were treated using the Boston brace and 25 patients the elastic lumbar support. Bony union was obtained in 69.0% (20/29) of the Boston brace and in 60.0% (15/25) of the elastic lumbar support group patients. Difference in union rates was not significant (relative risk=1.14, 95% confidence interval: 0.44–2.98, P=0.785). There was no difference in the Scoliosis Research Society-24 total or domain scores at the end of follow-up between the treatment groups (P>0.159 for all comparisons). In the whole cohort, the bony union did not predict better HRQoL in the end of the treatment (P=0.869), although the pain domain improved significantly in the whole cohort (P<0.001).

Conclusions.
A rigid thoracolumbar orthosis did not provide any benefits over an elastic lumbar support in terms of bony union or HRQoL outcomes in children with acute spondylolysis.

Level of Eviden:
2
Failure in Adult Spinal Deformity Surgery
Authors: Burke John F. , Scheer Justin K. , Lau Darryl , Safaee Michael M. , Lui Austin , Jha Sonya , Jedwood Chloe , Thapar Isabelle , Belfield Bethany , Nobahar Nami , Wang Albert J. , Wang Elaina J. , Catalan Tony , Chang Diana , Fury Marissa , Maloney Patrick , Aryan Henry E. , Smith Justin S. , Clark Aaron J. , Ames Christopher P. 
Published: July 2022

Study Design.
Literature review.

Objective.
The aim of this review is to summarize recent literature on adult spinal deformity (ASD) treatment failure as well as prevention strategies for these failure modes.

Summary of Background Data.
There is substantial evidence that ASD surgery can provide significant clinical benefits to patients. The volume of ASD surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities. Although there is potential for significant improvements in pain and disability with ASD surgery, these procedures continue to be associated with major complications and even outright failure.

Methods.
A systematic search of the PubMed database was performed for articles relevant to failure after ASD surgery. Institutional review board approval was not needed.

Results.
Failure and the potential need for revision surgery generally fall into 1 of 4 well-defined phenotypes: clinical failure, radiographic failure, the need for reoperation, and lack of cost-effectiveness. Revision surgery rates remain relatively high, challenging the overall cost-effectiveness of these procedures.

Conclusion.
By consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of ASD surgery.
Comparison of Disease-Specific, Generic, and Hearing-Specific Instruments Assessing Health-Related Quality of Life in Patients Undergoing Middle Ear Surgery for Chronic Otitis Media: A Prospective Correlational Study
Authors: Tailor Bhavesh V. , Phillips John S. , Nunney Ian , Yung Matthew W. 
Published: July 2022

Objective
This study aimed to determine the responsiveness of three instruments (disease-specific, generic, and hearing-specific) assessing health-related quality of life (HRQoL) in adult patients undergoing surgery for chronic otitis media (COM).

Study Design
Prospective correlational study.

Setting
Two otology referral centers in England, United Kingdom.

Patients
Consecutive adult patients undergoing middle ear surgery for COM.

Main Outcome Measure(s)
HRQoL assessment and audiometry were performed preoperatively and 12 months after surgery. HRQoL was assessed using disease-specific (Chronic Otitis Media Questionnaire-12 [COMQ-12]), generic (Euro-Qol-5D-5L), and hearing-specific (Hearing Handicap Inventory for Adults [HHIA]) instruments.

Results
A total of 52 patients (mean [standard deviation {SD}] age, 47.3 [18.3] yr) were included, with 42 patients completing both preoperative and postoperative COMQ-12 forms. COMQ-12 and HHIA total scores significantly improved after surgery (COMQ-12: mean [SD], 28.3 [11.6] versus 14.8 [10.6]; p < 0.001; HHIA: 42.9 (28.4) versus 32.6 (27.5); p = 0.012). General HRQoL measured with the Euro-Qol-5D-5L was unaffected by surgery (p > 0.05). The standardized response means for the COMQ-12 and HHIA total scores were 1.21 and 0.44, respectively. Postoperative air conduction thresholds were moderately correlated with the postoperative COMQ-12 (r = 0.46, p = 0.005) and HHIA (r = 0.41, p = 0.012) total scores.

Conclusions
Middle ear surgery significantly improved both disease-specific and hearing-specific HRQoL, whereas general HRQoL did not change. Only the COMQ-12 is highly responsive to surgical intervention. This study supports the use of the COMQ-12 to monitor patient-reported outcomes in both research and routine clinical settings.
Adoption of Patient Engagement Strategies by Physician Practices in the United States
Authors: Miller-Rosales Chris , Lewis Valerie A. , Shortell Stephen M. , Rodriguez Hector P. 
Published: July 2022

Background:
Patient engagement strategies can equip patients with tools to navigate treatment decisions and improve patient-centered outcomes. Despite increased recognition about the importance of patient engagement, little is known about the extent of physician practice adoption of patient engagement strategies nationally.

Methods:
We analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. Stratified-cluster sampling was used to select physician practices operating under different organizational structures. Multivariable linear regression models estimated the association of practice ownership, health information technology functionality, use of screening activities, patient responsiveness, chronic care management processes, and the adoption of patient engagement strategies, including shared decision-making, motivational interviewing, and shared medical appointments. All regression models controlled for participation in payment reforms, practice size, Medicaid revenue percentage, and geographic region.

Results:
We found modest and varied adoption of patient engagement strategies by practices of different ownership types, with health system-owned practices having the lowest adoption of ownership types. Practice capabilities, including chronic care management processes, routine screening of medical and social risks, and patient care dissemination strategies were associated with greater practice-level adoption of patient engagement strategies.

Conclusions:
This national study is the first to characterize the adoption of patient engagement strategies by US physician practices. We found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. Risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
Indeterminate skeletal and lymph node lesion on 18F PSMA 1007 PET/CT scanning: lessons from a review at 12 months with PSMA-RADS
Authors: Bhoil Amit , Seshadri Nagabhushan , Vinjamuri Sobhan 
Published: July 2022

Aims of the study
The study utilizes the prostate-specific membrane antigen-reporting and data system (PSMA-RADS) version 1.0 in a real-world patient scenario in the evaluation of equivocal lesions using the PSMA-RADS categorization for patient management and communication in multidisciplinary team (MDT) meetings.

Methods
A retrospective analysis of 203 patients who had 18F PSMA PET/CT for either restaging or staging over 12 months was undertaken. The scans were evaluated for local disease, lymph node involvement and distant metastases. The scan findings were classified as suspicious for metastases, and equivocal and benign lesions. Experience with PSMA ligand imaging was considered while classifying the lesions, equivocal lesions were assessed with PSMA-RADS and followed up with complementary imaging and/or clinical follow-up assessment or MDT for further patient management.

Results
A total of 91 of 203 patients had equivocal lesions. Follow-up assessment was performed in 47 of 91 patients with imaging (n = 36) or MDT discussion (n = 11).
On follow-up imaging (n = 36), equivocal lesion was seen in skeletal lesions (n = 24), pelvic lymph nodes (n = 6), both skeletal and pelvic nodes (n = 4), hilar and mediastinal lymph nodes (n = 1) and spleen (n = 1). The patients were reclassified as benign, metastatic with few lesion remained equivocal. Overall follow-up assessment impacted clinical management in 47% patients.

Conclusion
18F PSMA PET/CT may show equivocal lesions; many of them in the skeleton, a small proportion of which are ultimately proven metastatic. In contrast, a higher proportion of the equivocal nodes in the pelvis end up being metastatic on follow-up. A structured reporting with PSMA-RADS grading helps in the proper classification of lesions and standardization of reports.
Molecular biomarkers to help select neoadjuvant systemic therapy for urothelial carcinoma of the bladder
Authors: Laukhtina Ekaterina , Pradere Benjamin , Lemberger Ursula , Karakiewicz Pierre I. , Fajkovic Harun , Shariat Shahrokh F. 
Published: July 2022

Purpose of review
In this review, we aimed to summarize the available evidence on pretreatment molecular biomarkers that may help to predict oncologic and pathologic outcomes in patients treated with neoadjuvant systemic therapy (NAST) for urothelial carcinoma of the bladder (UCB).

Recent findings
Several readily available and easily measurable blood-based biomarkers (e.g., neutrophil to lymphocyte or platelet–lymphocyte ratios) seems to help improve the selection of UCB patients who are most likely to benefit from NAST. Recent evidence suggests liquid biopsy including circulating tumor DNA (ctDNA) to be a promising tool to guide the administration of NAST in UCB patients. Pretreatment molecular and genetic characterization of transurethral resection of the bladder tumor samples may also help understand the tumor biology as luminal and basal tumor subtypes seems to be more responsive to NAST, while claudin-low and luminal-infiltrated tumor subtypes are less. In the context of neoadjuvant immunotherapy, programmed death-ligand 1 (PD-L1) status and ctDNA remain the only biomarker with possible value as the clinical utility of tumor mutational burden remains controversial/poor.

Summary
Biomarker approach is a necessary step to usher the age of precision/personalized medicine for muscle-invasive UCB with the overarching good to prevent both over- and under-therapy. The present review may offer a robust framework to compare and assess current and future molecular biomarkers for the selection of NAST in muscle-invasive UCB.
Hospital Trends of Acute Pancreatitis During the Coronavirus Disease 2019 Pandemic
Authors: Ramsey Mitchell L. , Patel Arsheya , Sobotka Lindsay A. , Lim Woobeen , Kirkpatrick Robert B. , Han Samuel , Hart Phil A. , Krishna Somashekar G. , Lara Luis F. , Lee Peter J. , Conwell Darwin L. , Papachristou Georgios I. 
Published: July 2022

Objective
The coronavirus disease 2019 pandemic led to changes in individuals' behaviors and healthcare delivery. We examined the impact of these changes on the rates and clinical course of acute pancreatitis (AP).

Methods
Hospitalizations for AP from March 1 through August 31 in 2019 (baseline group) and the same period in 2020 (pandemic group) were retrospectively reviewed. Univariate and multivariate analyses were used for demographics and outcomes.

Results
Two hundred eighty subjects (315 admissions) were identified in 2019 and 237 subjects (264 admissions) in 2020. Subjects in the pandemic group were more likely to have systemic inflammatory response syndrome (40% vs 25%, P < 0.01), pancreatic necrosis (14% vs 10%, P = 0.03), and persistent organ failure (17% vs 9%, P = 0.01) compared with prepandemic. There was no difference in etiology of AP. A multivariable model indicates that increased comorbidities, prior pancreatitis, pancreatic necrosis, and prescription of opiates at discharge were associated with 30-day readmissions during the pandemic.

Conclusions
Fewer patients were admitted for AP during the pandemic, suggesting that patients with milder symptoms avoided hospital interaction. Practices followed during the pandemic, especially avoidance of hospitalization and improved efficiency of hospital management, may reduce the burden of pancreatitis care in the future.
Development and Evaluation of a Nomogram to Predict the Eventual Severity of the First Episode of Acute Pancreatitis
Authors: Zhong Rui , Xu Jin , Luo Xujuan , Shi Xiaomin , Peng Yan , Xu Huan , Jiang Xin , Yan Yongfeng , Fu Xiangsheng , Tang Xiaowei 
Published: July 2022

Objective
The aim of this research was to establish a nomogram for early prediction of the severity of acute pancreatitis (AP).

Methods
A total of 1860 AP patients from 2013 to 2020 were included in this study. According to the 2012 revised Atlanta classification, patients were divided into nonsevere AP group and severe AP (SAP) group. The baseline characteristics and first laboratory indicators after admission between the 2 groups were analyzed using univariate and multivariate logistic regression analysis in training set. R language was used for establishing a predictive nomogram and further verified in validation set.

Results
Univariate and multivariate logistic regression analysis in the training set showed red blood cell distribution width, d-dimer, apolipoprotein A1, and albumin were independent factors for SAP. A predictive nomogram was accordingly established based on the 4 indicators. Validation on this predictive nomogram showed high internal validation concordance index of 0.940 (95% confidence interval, 0.922–0.958) and high external validation concordance index of 0.943 (95% confidence interval, 0.920–0.966). The calibration curve, receiver operating characteristic curve, and decision curve analysis all showed that the nomogram had good predictive ability.

Conclusions
This nomogram may be an effective clinical tool for predicting the first episode of SAP.
In Patients With Melanoma Brain Metastases, Is Combination Immune Checkpoint Inhibition a Safe and Effective First-Line Treatment? A Critically Appraised Topic
Authors: Gritsch David , Mrugala Maciej M. , Marks Lisa A. , Wingerchuk Dean M. , O’Carroll Cumara B. 
Published: July 2022

Background:
Combined PD-1/PD-L1 and CTLA-4 immune checkpoint inhibition for the has been shown to produce superior results in the treatment of malignant melanoma when compared to monotherapy. However, patients with intracranial disease were excluded from these studies given their poor prognosis.

Objective:
The objective of this study was to critically assess current evidence supporting the co-administration of PD-1/PD-L1 and CTLA-4 inhibitors in the treatment of melanoma brain metastases.

Methods:
The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and a content expert in the field of neuro-oncology.

Results:
A recent, open-label, non-comparative randomized phase II trial was selected for critical appraisal. This trial evaluated the efficacy and safety of nivolumab alone or in combination with ipilimumab in 79 adult patients with untreated, asymptomatic melanoma brain metastases. The rates of the primary outcome (intracranial response at ≥12 wk) in the primary endpoint cohort were 46% for cohort A (combination therapy) and 20% for cohort B (nivolumab monotherapy). No treatment related deaths were observed in the study. Grade 4 adverse events occurred in 9% of patients in cohort A and none in cohort B.

Conclusions:
Co-administration of ipilimumab and nivolumab as first-line therapy is effective in the treatment of asymptomatic melanoma brain metastases, with an acceptable safety profile.
A community-based adapted exercise program to increase quality of life and self-efficacy among adults with physical disabilities: A mixed-method study
Authors: Oh Juntack , Davis Ronald 
Published: July 2022

Background:
Self-efficacy is one of the key constructs that directly influence physical activity, community participation, and mental health while acting as a strong influence on the quality of life (QOL) for adults with physical disabilities (AWPDs). There are relatively few studies focusing on a community-based exercise program in this population.

Objective:
This study aims to quantitatively examine a community-based adapted exercise program on the QOL and self-efficacy of AWPDs. In addition, we explored AWPD's perceived benefits of community-based exercise programming and any factors that may influence those perceived benefits.

Method:
Adults with physical disabilities (N = 50) participated in a 9-week community-based adapted exercise program (90-minute session, twice per week). QOL (WHOQOL-BREF) and self-efficacy were measured at baseline and at the conclusion of the program. A follow-up focus group (n = 22) was conducted at the postprogram. Quantitative data were analyzed by paired t test (α = 0.05). Qualitative data were analyzed by thematic coding and content analysis.

Result:
Significant improvement with moderate effect size was found across all variables. Two main themes emerged from the qualitative analysis: 1) perceived benefit of exercise program and 2) factors of an exercise program for AWPD.

Conclusion:
A community-based exercise program and self-efficacy play a large role in the exercise behaviors and QOL of AWPDs. The benefits of exercise and factors identified as promoting exercise may be carefully considered to improve QOL for this population. The finding of this study offers practical recommendations to community-based exercise specialists, which would assist in establishing an appropriate exercise program for AWPDs.
Azygos Vein Enlargement Secondary to Superior Vena Cava Syndrome on 18F-FDG PET/CT
Authors: Filizoglu Nuh , Ozguven Salih , Ones Tunc , Turoglu Halil Turgut , Erdil Tanju Yusuf 
Published: July 2022

Abstract
Obstruction of the blood flow from the superior vena cava (SVC) to the right atrium causes the SVC syndrome. The azygos system is the most important way to overcome SVC obstruction. Azygos vein enlargement can be seen secondary to the SVC syndrome. Although a few cases showing 18F-FDG uptake along the SVC in SVC syndrome were reported before, 18F-FDG PET/CT findings of azygos vein enlargement have not been documented yet. Herein, we presented an intriguing case of azygos vein enlargement secondary to SVC syndrome on 18F-FDG PET/CT.
Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma
Authors: Callegaro Dario , Raut Chandrajit P. , Ajayi Taiwo , Strauss Dirk , Bonvalot Sylvie , Ng Deanna , Stoeckle Eberhard , Fairweather Mark , Rutkowski Piotr , van Houdt Winan J. , Gelderblom Hans , Sangalli Claudia , Hayes Andrew , Honoré Charles , Gladdy Rebecca A. , Fau Magali , Haas Rick , Tzanis Dimitri , Miah Aisha B. , Chung Peter , Baldini Elizabeth H. , Marreaud Sandrine , Litiere Saskia , Swallow Carol J. , Gronchi Alessandro 
Published: July 2022

Objective:
The aim of the present study was to compare the effect of radiotherapy (RT) on abdominal recurrence-free survival (ARFS) in patients with primary retroperitoneal sarcoma treated in the EORTC-STBSG-62092 (STRASS) phase 3 randomized controlled trial (STRASS cohort) and off-trial (STREXIT cohort) and to pool STRASS and STREXIT data to test the hypothesis that RT improves ARFS in patients with liposarcoma.

Background:
The STRASS trial did not show any difference in ARFS between patients treated with preoperative radiotherapy+surgery (RT+S) versus surgery alone (S).

Methods:
All consecutive adult patients not enrolled in STRASS and underwent curative-intent surgery for a primary retroperitoneal sarcoma with or without preoperative RT between 2012 and 2017 (STRASS recruiting period) among ten STRASS-recruiting centres formed the STREXIT cohort. The effect of RT in STREXIT was explored with a propensity score (PS)-matching analysis. Primary endpoint was ARFS defined as macroscopically incomplete resection or abdominal recurrence or death of any cause, whichever occurred first.

Results:
STRASS included 266 patients, STREXIT included 831 patients (727 after excluding patients who received preoperative chemotherapy, 202 after 1:1 PS-matching). The effect of RT on ARFS in STRASS and 1:1 PS-matched STREXIT cohorts, overall and in patients with liposarcoma, was similar. In the pooled cohort analysis, RT administration was associated with better ARFS in patients with liposarcoma [N=321, hazard ratio (HR), 0.61; 95% confidence interval (CI), 0.42–0.89]. In particular, patients with well-differentiated liposarcoma and G1-2 dedifferentiated liposarcoma (G1-2 DDLPS, n=266) treated with RT+S had better ARFS (HR, 0.63; 95% CI, 0.40–0.97) while patients with G3 DDLPS and leiomyosarcoma had not. At the current follow-up, there was no association between RT and overall survival or distant metastases-free survival.

Conclusions:
In this study, preoperative RT was associated with better ARFS in patients with primary well-differentiated liposarcoma and G1-2 DDLPS.