Tag: nevin manimala

Neurospine. 2021 Mar;18(1):188-196. doi: 10.14245/ns.2040552.276. Epub 2021 Mar 31.

ABSTRACT

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation.

METHODS: Nondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2-7 cadaveric specimens intact and after discectomy (C3-6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance.

RESULTS: All instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3-6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p < 0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion.

CONCLUSION: All instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.

PMID:33819945 | DOI:10.14245/ns.2040552.276

Neurospine. 2021 Mar;18(1):217-225. doi: 10.14245/ns.2040610.305. Epub 2021 Mar 31.

ABSTRACT

OBJECTIVE: There is a scarcity of research evaluating gender differences in depressive symptoms among patients undergoing cervical surgery. This study investigated gender differences with regard to depressive symptom severity, measured by Patient Health Questionnaire-9 (PHQ-9), in patients following anterior cervical discectomy and fusion (ACDF) or artificial disc replacement (ADR).

METHODS: A prospectively maintained surgical registry was retrospectively reviewed for eligible spine surgeries. Depressive symptom severity was evaluated by PHQ-9 at both preand postoperative timepoints (e.g. , 6 weeks, 12 weeks, 6 months, 1 year, and 2 years). A chi-square test and Student t-test evaluated differences between the gender for demographic and operative variables where appropriate. Differences between the gender subgroup mean PHQ-9 scores were assessed using a t-test pre- and postoperatively (e.g. , 6 weeks, 12 weeks, 6 months, and 1 year) and a paired t-test was used to assess differences from preoperative scores at each postoperative time point.

RESULTS: A total of 170 subjects underwent 125 ACDFs and 45 ADRs. Both pre- and postoperative timepoints demonstrated no significant differences between mean PHQ-9 scores by gender. Female patients demonstrated statistically significant improvement in PHQ-9 scores at 6 weeks, and 12 weeks, but not through 2 years. Male patients demonstrated statistically significant improvement in PHQ-9 scores at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years.

CONCLUSION: Although there were no significant differences between mean PHQ-9 score between the genders, there was a difference in magnitude of improvement. Females had a significant improvement in depressive symptom severity over baseline at the 6- and 12-week timepoints only, whereas males had significant improvement through 2 years postoperatively.

PMID:33819948 | DOI:10.14245/ns.2040610.305

Stat Med. 2021 Apr 5. doi: 10.1002/sim.8973. Online ahead of print.

ABSTRACT

It is not always clear how to adjust for control data in causal inference, balancing the goals of reducing bias and variance. We show how, in a setting with repeated experiments, Bayesian hierarchical modeling yields an adaptive procedure that uses the data to determine how much adjustment to perform. The result is a novel analysis with increased statistical efficiency compared with the default analysis based on difference estimates. We demonstrate this procedure on two real examples, as well as on a series of simulated datasets. We show that the increased efficiency can have real-world consequences in terms of the conclusions that can be drawn from the experiments. We also discuss the relevance of this work to causal inference and statistical design and analysis more generally.

PMID:33819927 | DOI:10.1002/sim.8973

Neurospine. 2021 Mar;18(1):45-54. doi: 10.14245/ns.2040520.260. Epub 2021 Mar 31.

ABSTRACT

OBJECTIVE: Cervical spondylotic myelopathy (CSM) is a degenerative disorder leading to progressive decline in spinal cord function. Cervical laminoplasty (CLP) and cervical laminectomy with fusion (CLF) are standard treatments for multilevel CSM. However, it is still unclear whether one procedure over the other provides better outcomes. Here, we performed a comprehensive review of published articles that compare the clinical outcomes and costs between CLP and CLF for CSM.

METHODS: A literature search was performed using PubMed, Web of Science, and Cochrane databases. Strict exclusion criteria were applied, and included articles were then assessed for publication year, study design, and significant differences in outcome variables.

RESULTS: From 519 studies identified with search terms, 38 studies were included for the qualitative analysis. Statistically significant differences in the clinical outcomes and costs were found in 18 studies. Eleven studies were prospective or retrospective, and 8 studies were meta-analyses. For the outcome variables of interest, results were reported by classifying into prospective studies, retrospective studies, and meta-analyses.

CONCLUSION: CLP and CLF are 2 of the most commonly performed surgical procedures for the treatment of CSM. Although CLP and CLF each provide satisfactory clinical outcomes for patients with CMS, CLP may result in better cervical range of motion and less cost, length of stay, operation time, blood loss, paraspinal muscular atrophy, and rate of nerve palsies as compared to CLF. The major limitation of CLP versus CLF comparison studies includes the heterogeneity in techniques and preoperative criteria. Thus, further validation and investigations in larger cohorts will be required.

PMID:33819935 | DOI:10.14245/ns.2040520.260

Neurospine. 2021 Mar;18(1):139-146. doi: 10.14245/ns.2040440.220. Epub 2021 Mar 31.

ABSTRACT

OBJECTIVE: Posterior endoscopic cervical foraminotomy (PECF) is a well-established, minimally invasive surgery for cervical radiculopathy, but have the more chances of neural structure damage due to the limited visibility and steeper learning curve. So, the anatomical understanding of the nerve associated with the bony structure will be an essential surgical guideline.

METHODS: We measured the distance between the bilateral dura lateral edge and bilateral V-point on axial cuts of cervical magnetic resonance imaging and 3-dimensional spine computed tomography imaging, respectively, from 80 patients. We then calculate the distance and position between the dura lateral edge and the V-point as surgically critical width (SCW). Transverse interdural distance (TIDW), transverse inter-V-point distance, and anatomical facet joint width were measured.

RESULTS: The mean TIDW decreased as the levels down in the 40s-60s but increased at the C4-5, C5-6, and C6-7 levels in the 70s. Statistically significant difference was shown at the C6-7 level between the 40s and the 70s. The mean anatomical inter-V-point distance markedly decreased at C5-6 and continued till the C7-Tl level at all age groups. Moreover, a statistically significant difference was shown at the C3-4 and C4-5 level between the 40s and the 70s. The mean negative values of SCW increased from the 40s to 70s at the C5-6 and C6-7 levels (C5-6: -0.60 ± 1.10 mm to -1.63 ± 1.56 mm; C6-7: -0.90 ± 0.74 mm to -2.18 ± 1.25 mm). There were statistically significant differences between the 2 aged groups at the C3-4, C4-5, C5-6, and C6-7 levels.

CONCLUSION: A prediction of the correlated position between the lateral dura edge and the V-point is essential for the PECF not to injure the neural structure. In the case of a performing the PECF at the C5-6 and C6-7 level in the old-aged patient, it should be considered the laterally moved dura edge, and more extended bony remove is needed for less neural structure damage.

PMID:33819940 | DOI:10.14245/ns.2040440.220

Surg Oncol. 2021 Mar 31;37:101557. doi: 10.1016/j.suronc.2021.101557. Online ahead of print.

ABSTRACT

INTRODUCTION: Ductal carcinoma in situ with microinvasion (DCISM); arguably a more aggressive subtype of DCIS, currently has variable recommendations governing its staging and management in the UK. As a result, there is ongoing controversy surrounding the most appropriate management of DCISM, in particular the need of axillary staging.

METHOD: A search was conducted on the databases MEDLINE and Embase using the keywords: breast, DCISM, microinvasion, “ductal carcinoma in situ with microinvasion”, sentinel lymph node biopsy, SLNB, axillary staging was performed. 23 studies were selected for analysis. Primary outcome was the positivity of metastasis of lymph node; secondary outcome looked at characteristics of DCISM that may affect node positivity.

RESULTS: A total of 2959 patients were included. Significant heterogeneity was observed amongst the studies with regards to metastases (I² = 61%; P < 0.01). Lymph node macrometastases was estimated to be 2%. Significant subgroup difference was not observed between SLNB technique and lymph node macrometastases (Q = 0.74; p = 0.69). Statistical significance was observed between the focality of the DCISM and lymph node macrometastases (Q = 8.71; p = 0.033).

CONCLUSION: Although histologically more advanced than DCIS, DCISM is not linked with higher rates of clinically significant metastasis to axillary lymph nodes. Survival rates are very similar to those seen in cases of DCIS. Current evidence suggests that axillary staging in cases of DCISM will not change their overall management, thus may only be an unnecessary and inconvenient additional intervention considering the majority of DCISM diagnoses are made from post-operative pathology samples. A multidisciplinary team approach evaluating pre-operative clinical and histological information to tailor the management specific to individual cases of DCISM would be a preferred approach than routine axillary staging.

PMID:33819852 | DOI:10.1016/j.suronc.2021.101557

Placenta. 2021 Mar 22;108:47-54. doi: 10.1016/j.placenta.2021.03.011. Online ahead of print.

ABSTRACT

The objective of this study was to investigate the accuracy of universal third trimester umbilical artery (UA) Doppler to predict adverse pregnancy outcome at term. We searched Medline, EMBASE, the Cochrane library and ClinicalTrials.gov from inception to October 2020 and we also analyzed previously unpublished data from a prospective cohort study of nulliparous women, the Pregnancy Outcome Prediction (POP) study. We included studies that performed a third-trimester ultrasound scan in unselected, low or mixed risk populations, excluding studies which only included high risk pregnancies. Meta-analysis was performed using the hierarchal summary receiver operating characteristic curve (HSROC) analysis and bivariate logit-normal models. We identified 13 studies (including the POP study) involving 67,764 pregnancies which met our inclusion criteria. The overall quality was variable and only six studies (N = 5777 patients) blinded clinicians to the UA Doppler result. The summary sensitivity and positive likelihood ratio (LR) for small for gestational age (SGA; birthweight <10th centile) were 21.7% (95% CI 13.2-33.6%) and 2.65 (95% CI 1.89-3.72) respectively. The summary positive LR for NICU admission and metabolic acidosis were 1.35 (95% CI 0.93-1.97) and 1.34 (95% CI 0.86-2.08) respectively. The results were similar in the POP study: associations with SGA (positive LR 2.66 [95% CI 2.11-3.36]) and severe SGA (birthweight <3rd centile; positive LR 3.27 [95% CI 2.29-4.68]) but no statistically significant association with neonatal morbidity. We conclude that third trimester UA Doppler has moderate predictive accuracy for small for gestational age but not for indicators of neonatal morbidity in unselected and low risk pregnancies.

PMID:33819861 | DOI:10.1016/j.placenta.2021.03.011

Int J Pediatr Otorhinolaryngol. 2021 Mar 21;144:110685. doi: 10.1016/j.ijporl.2021.110685. Online ahead of print.

ABSTRACT

BACKGROUND: Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts.

OBJECTIVE: To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics.

METHODS: A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0-19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention’s WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP’s recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses.

RESULTS: From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005-2010 and 2011-2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians.

CONCLUSIONS: Overall rate of nonfatal choking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0-4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities.

PMID:33819896 | DOI:10.1016/j.ijporl.2021.110685

J Med Internet Res. 2021 Apr 2. doi: 10.2196/26296. Online ahead of print.

ABSTRACT

BACKGROUND: In the United States, racial and ethnic minorities are disproportionately affected by COVID-19, with persistent social and structural factors contributing to these disparities. At the intersection of race/ethnicity and gender, women of color may be disadvantaged in terms of COVID-19 outcomes due to their role as essential workers, higher prevalence of pre-existing conditions, increased stress and anxiety from loss of wages and caregiving, and domestic violence.

OBJECTIVE: The purpose of this study was to examine racial and ethnic differences in the prevalence of COVID-19 outcomes, stressors, fear, and prevention behaviors among adult women residing in the United States.

METHODS: Between May and June 2020, women were recruited into The COPE Study, a web-based cross-sectional study, using advertisements on Facebook; 491 eligible women completed a self-administered internet-based cross-sectional survey. Descriptive statistics were used to examine racial and ethnic differences (White; Asian; Native Hawaiian or other Pacific Islander; Black; Hispanic, Latina or Spanish Origin; American Indian or Alaskan Native; Multiracial or some other race, ethnicity, or origin) on COVID-19 outcomes, stressors, fear, and prevention behaviors.

RESULTS: Among our sample of women, 16% (73/470) reported COVID-19 symptoms, 22% (18/82) were concerned about possible exposure from the people they knew who tested positive for COVID-19, and 51.4% (227/442) knew where to get tested; yet only 5.8% (27/469) had been tested. Racial/ethnic differences were observed, with racial/ethnic minority women being less likely to know where to get tested. Significant differences in race/ethnicity were observed for select stressors (food insecurity, not enough money, homeschooling children, unable to have a doctor/telemedicine appointment) and prevention behaviors (handwashing with soap, self-isolation if sick, public glove use, not leaving home for any activities). Although no racial/ethnic differences emerged for the fear of COVID-19 scale, significant racial/ethnic differences were observed for some of the individual scale items (e.g., being afraid of getting COVID-19, sleep loss and heart racing due to worrying about COVID-19).

CONCLUSIONS: Low prevalence of COVID-19 testing and knowledge of where to get tested indicate a critical need to expand testing for women in the U.S., particularly among racial/ethnic minority women. Although overall prevalence of engagement in prevention behaviors was high, targeted education and promotion of prevention activities is warranted in communities of color, particularly with consideration for stressors and adverse mental health.

PMID:33819909 | DOI:10.2196/26296

Eur J Radiol. 2021 Mar 26;139:109681. doi: 10.1016/j.ejrad.2021.109681. Online ahead of print.

ABSTRACT

PURPOSE: To determine the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) in the detection of bone marrow edema (BME) in participants with osteonecrosis of the femoral head (ONFH).

METHODS: In this prospective study, 24 consecutive participants (15 men, 9 women; mean age, 44 years, range, 21-72 years) diagnosed with ONFH who underwent DECT and magnetic resonance imaging (MRI) between September 2019 and January 2020 were involved. Two independent readers visually evaluated color-coded VNCa images using a binary classification (0 = normal bone marrow, 1 = BME). MRI served as the reference standard for the presence of BME. Interobserver agreement for the visual evaluation of VNCa DECT images was calculated with κ statistics. We determined computed tomography (CT) numbers on VNCa images and weighted-average CT sets using region-of-interest-based quantitative analysis. The t-test was used to compare the differences of CT values between BME areas and normal bone marrow areas. Receiver operating characteristic (ROC) curve was used to select an optimal CT values of VNCa images for detecting BME. A p value of <0.05 was considered as statistically significant.

RESULTS: The sensitivity, specificity, and accuracy of Reader 1 and Reader 2, respectively, in the identification of BME at DECT were 95 % and 89 % (18 and 17 of 19), 96 % and 96 % (25 and 25 of 26), and 93 % (43 and 42 of 45). Interobserver agreement was excellent (κ = 0.86). The VNCa CT numbers of the BME area and the normal bone marrow area were -28.6 (-17.9–39.4) HU and -97.9 (-91.3–104.4) HU, respectively, with statistical significance (t = -10.6, p < 0.001). The weighted-average CT numbers of the BME area and the normal bone marrow area were 152.4(122.2-182.7) HU and 121.1(103.6-183.6) HU, respectively, with no statistical significance (t = -2.0, p > 0.05). The area under the receiver operating characteristic curve was 0.99 in differentiation of the BME from normal bone marrow. A cut-off value of -57.2 HU yielded overall sensitivity, specificity, and accuracy, respectively, of 95 % (18 of 19), 100 % (26 of 26), and 98 % (44 of 45) detection of BME in participants with ONFH.

CONCLUSION: Visual and quantitative analyses of VNCa images shows excellent diagnostic performance for assessing BME in participants with ONFH.

PMID:33819804 | DOI:10.1016/j.ejrad.2021.109681