Publications by authors named "Aidin Abedi"

30 Publications

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Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019.

JAMA Oncol 2021 Dec 30. Epub 2021 Dec 30.

Department of Computer Science and Engineering, University of Kurdistan Hewler, Erbil, Iraq.

Importance: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden.

Objective: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019.

Evidence Review: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs).

Findings: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles.

Conclusions And Relevance: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.
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http://dx.doi.org/10.1001/jamaoncol.2021.6987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719276PMC
December 2021

Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: a systematic review and meta-analysis.

Spine J 2021 Dec 9. Epub 2021 Dec 9.

Department of Orthopedics, Emory Spine Center, Emory University, Atlanta, GA, USA.

Background Context: Adjacent segment disease (ASD) is a potential complication following lumbar spinal fusion.

Purpose: This study aimed to demonstrate the demographic, clinical, and operative risk factors associated with ASD development following lumbar fusion.

Study Design/setting: Systematic review and meta-analysis.

Patient Sample: We identified 35 studies that reported risk factors for ASD, with a total number of 7,374 patients who had lumbar spine fusion.

Outcome Measures: We investigated the demographic, clinical, and operative risk factors for ASD after lumbar fusion.

Methods: A literature search was done using PubMed, Embase, Medline, Scopus, and the Cochrane library databases from inception to December 2019. The methodological index for non-randomized studies (MINORS) criteria was used to assess the methodological quality of the included studies. A meta-analysis was done to calculate the odds ratio (OR) with the 95% confidence interval (CI) for dichotomous data and mean difference (MD) with 95% CI for continuous data.

Results: Thirty-five studies were included in the qualitative analysis, and 22 studies were included in the meta-analyses. The mean quality score based on the MINORS criteria was 12.4±1.9 (range, 8-16) points. Significant risk factors included higher preoperative body mass index (BMI) (mean difference [MD]=1.97 kg/m; 95% confidence interval [CI]=1.49-2.45; p<.001), floating fusion (Odds ratio [OR]=1.78; 95% CI=1.32-2.41; p<.001), superior facet joint violation (OR=10.43; 95% CI=6.4-17.01; p<.001), and decompression outside fusion construct (OR=1.72; 95% CI=1.25-2.37; p<.001).

Conclusions: The overall level of evidence was low to very low. Higher preoperative BMI, floating fusion, superior facet joint violation, and decompression outside fusion construct are significant risk factors of development of ASD following lumbar fusion surgeries.
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http://dx.doi.org/10.1016/j.spinee.2021.12.002DOI Listing
December 2021

COVID-19 Vaccination Dynamics in the US: Coverage Velocity and Carrying Capacity Based on Socio-demographic Vulnerability Indices in California.

J Immigr Minor Health 2022 Feb 19;24(1):18-30. Epub 2021 Nov 19.

Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, 2025 Zonal Ave., Los Angeles, CA, 90033, USA.

Coronavirus disease 2019 (COVID-19) disparities among vulnerable populations are of paramount concern that extend to vaccine administration. With recent uptick in infection rates, dominance of the delta variant, and authorization of a third booster shot, understanding the population-level vaccine coverage dynamics and underlying sociodemographic factors is critical for achieving equity in public health outcomes. This study aimed to characterize the scope of vaccine inequity in California counties through modeling the trends of vaccination using the Social Vulnerability Index (SVI). Overall SVI, its four themes, and 9228 data points of daily vaccination numbers from December 15, 2020, to May 23, 2021, across all 58 California counties were used to model the growth velocity and anticipated maximum proportion of population vaccinated, defined as having received at least one dose of vaccine. Based on the overall SVI, the vaccination coverage velocity was lower in counties in the high vulnerability category (v = 0.0346, 95% CI 0.0334, 0.0358) compared to moderate (v = 0.0396, 95% CI 0.0385, 0.0408) and low (v = 0.0414, 95% CI 0.0403, 0.0425) vulnerability categories. SVI Theme 3 (minority status and language) yielded the largest disparity in coverage velocity between low and high-vulnerable counties (v = 0.0423 versus v = 0.035, P < 0.001). Based on the current trajectory, while counties in low-vulnerability category of overall SVI are estimated to achieve a higher proportion of vaccinated individuals, our models yielded a higher asymptotic maximum for highly vulnerable counties of Theme 3 (K = 0.544, 95% CI 0.527, 0.561) compared to low-vulnerability counterparts (K = 0.441, 95% CI 0.432, 0.450). The largest disparity in asymptotic proportion vaccinated between the low and high-vulnerability categories was observed in Theme 2 describing the household composition and disability (K = 0.602, 95% CI 0.592, 0.612; versus K = 0.425, 95% CI 0.413, 0.436). Overall, the large initial disparities in vaccination rates by SVI status attenuated over time, particularly based on Theme 3 status which yielded a large decrease in cumulative vaccination rate ratio of low to high-vulnerability categories from 1.42 to 0.95 (P = 0.002). This study provides insight into the problem of COVID-19 vaccine disparity across California which can help promote equity during the current pandemic and guide the allocation of future vaccines such as COVID-19 booster shots.
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http://dx.doi.org/10.1007/s10903-021-01308-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8603654PMC
February 2022

The impact of data quality assurance and control solutions on the completeness, accuracy, and consistency of data in a national spinal cord injury registry of Iran (NSCIR-IR).

Spinal Cord Ser Cases 2021 06 10;7(1):51. Epub 2021 Jun 10.

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Study Design: Descriptive study.

Objective: This study aimed to develop and evaluate a systematic arrangement for improvement and monitoring of data quality of the National Spinal Cord (and Column) Injury Registry of Iran (NSCIR-IR)-a multicenter hospital-based registry.

Setting: SCI community in Iran.

Methods: Quality assurance and quality control were the primary objectives in improving overall quality of data that were considered in designing a paper-based and computerized case report. To prevent incorrect data entry, we implemented several validation algorithms, including 70 semantic rules, 18 syntactic rules, seven temporal rules, and 13 rules for acceptable value range. Qualified and trained staff members were also employed to review and identify any defect, inaccuracy, or inconsistency in the data to improve data quality. A set of functions were implemented in the software to cross-validate, and feedback on data was provided by reviewers and registrars.

Results: Socio-demographic data items were 100% complete, except for national ID and education level, which were 97% and 92.3% complete, respectively. Completeness of admission data and emergency medical services data were 100% except for arrival and transfer time (99.4%) and oxygen saturation (48.9%). Evaluation of data received from two centers located in Tehran proved to be 100% accurate following validation by quality reviewers. All data was also found to be 100% consistent.

Conclusions: This approach to quality assurance and consistency validation proved to be effective. Our solutions resulted in a significant decrease in the number of missing data.
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http://dx.doi.org/10.1038/s41394-020-00358-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192950PMC
June 2021

Analysis of trends in lumbar disc degeneration using kinematic MRI.

Clin Imaging 2021 Nov 29;79:136-141. Epub 2021 Apr 29.

Department Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Objective: The aim of the current study was to classify and analyze trends in lumbar disc degeneration across age, sex, and disc level using weightbearing kinematic MRI.

Materials And Methods: Between January 2019 and July 2019, 1198 cases were retrospectively analyzed with kinematic MRI. Patients were divided into 5 groups based on age (20-29, 30-39, 40-49, 50-59, and 60+) and evaluated using the Pfirrmann classification to assess for disc degeneration at 5 vertebral levels: L1/2, L2/3, L3/4, L4/5, and L5/S1. Trends in degeneration were analyzed with regression and time series.

Results: The L5/S1 vertebral disc had the highest prevalence of severe degeneration across all age groups. The most common multi-level degeneration combinations were L4/5 and L5/S1 for two levels and L3/4, L4/5, and L5/S1 for three levels. All vertebral levels showed significant difference in mean Pfirrmann grade among the age groups (p < 0.001 at all levels). Statistically significant differences in mean Pfirmmann grade among males and females were found only in ages 20-29 and 30-39, in which males showed more degeneration.

Conclusion: Our findings using kinematic MRI demonstrate that degeneration increases with age and is most severe in the L5/S1 disc. In multi-level degeneration the most prevalent combinations are those that are contiguous and include L5/S1. Young males were more likely to have degeneration than young females, but there was no significant difference from the fifth decade of life on.
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http://dx.doi.org/10.1016/j.clinimag.2021.04.028DOI Listing
November 2021

The Impact of Physical Therapy Following Cervical Spine Surgery for Degenerative Spine Disorders: A Systematic Review.

Clin Spine Surg 2021 10;34(8):291-307

Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA.

Study Design: Systematic review.

Objective: To characterize the effects of postoperative physical therapy (PT) after surgery for cervical spondylosis on patient-reported outcomes and impairments. Secondarily, to identify associated complications, adverse effects, and health care costs with postoperative PT, and to describe the content, timing, and duration of the PT.

Summary Of Background Data: Cervical spine surgery is common; however, it is unclear if the addition of postoperative PT leads to improved patient outcomes and decreased health care costs.

Materials And Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Web of Science were searched until July 2019. All peer-reviewed articles involving cervical spine surgery with postoperative PT for cervical spondylosis were considered for inclusion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Findings were described narratively, and GRADE approach was used to define the quality of evidence.

Results: A total of 10,743 studies were screened. Six studies met inclusion criteria; 2 randomized controlled trials and 4 subsequent follow-up studies containing study arms that included postoperative PT after cervical spine surgery. Meta-analysis was not performed due to study heterogeneity and no study compared PT+surgery to surgery alone. PT treatment included exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation. Included studies indicated PT appeared to have positive effects on patient outcomes, however, there were no treatment control groups and the quality of evidence was very low to low. Timing, duration, and content of PT programs varied. No studies reported complications, adverse effects, or cost-effectiveness relating to PT after surgery.

Conclusions: Current literature prevents a definitive conclusion regarding the impact of postoperative PT, given the lack of treatment control groups. PT treatment was limited to exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation in the included studies. PT treatment varied, limiting consistent recommendations for content, timing, and treatment duration. Controlled trials are needed to determine the effectiveness of the addition of postoperative PT following cervical spine surgery for cervical spondylosis.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1097/BSD.0000000000001108DOI Listing
October 2021

Examination of the Role of Cells in Commercially Available Cellular Allografts in Spine Fusion: An in Vivo Animal Study.

J Bone Joint Surg Am 2020 Dec;102(24):e135

Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.

Background: Despite the extensive use of cellular bone matrices (CBMs) in spine surgery, there is little evidence to support the contribution of cells within CBMs to bone formation. The objective of this study was to determine the contribution of cells to spinal fusion by direct comparisons among viable CBMs, devitalized CBMs, and cell-free demineralized bone matrix (DBM).

Methods: Three commercially available grafts were tested: a CBM containing particulate DBM (CBM-particulate), a CBM containing DBM fibers (CBM-fiber), and a cell-free product with DBM fibers only (DBM-fiber). CBMs were used in viable states (CBM-particulatev and CBM-fiberv) and devitalized (lyophilized) states (CBM-particulated and CBM-fiberd), resulting in 5 groups. Viable cell counts and bone morphogenetic protein-2 (BMP-2) content on enzyme-linked immunosorbent assay (ELISA) within each graft material were measured. A single-level posterolateral lumbar fusion was performed on 45 athymic rats with 3 lots of each product implanted into 9 animals per group. After 6 weeks, fusion was assessed using manual palpation, micro-computed tomography (μ-CT), and histological analysis.

Results: The 2 groups with viable cells were comparable with respect to cell counts, and pairwise comparisons showed no significant differences in BMP-2 content across the 5 groups. Manual palpation demonstrated fusion rates of 9 of 9 in the DBM-fiber specimens, 9 of 9 in the CBM-fiberd specimens, 8 of 9 in the CBM-fiberv specimens, and 0 of 9 in both CBM-particulate groups. The μ-CT maturity grade was significantly higher in the DBM-fiber group (2.78 ± 0.55) compared with the other groups (p < 0.0001), while none of the CBM-particulate samples demonstrated intertransverse fusion in qualitative assessments. The viable and devitalized samples in each CBM group were comparable with regard to fusion rates, bone volume fraction, μ-CT maturity grade, and histological features.

Conclusions: The cellular component of 2 commercially available CBMs yielded no additional benefits in terms of spinal fusion. Meanwhile, the groups with a fiber-based DBM demonstrated significantly higher fusion outcomes compared with the CBM groups with particulate DBM, indicating that the DBM component is probably the key determinant of fusion.

Clinical Relevance: Data from the current study demonstrate that cells yielded no additional benefit in spinal fusion and emphasize the need for well-designed clinical studies on cellular graft materials.
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http://dx.doi.org/10.2106/JBJS.20.00330DOI Listing
December 2020

Reliability Statistics: A "Weight-Bearing" View.

Global Spine J 2020 Oct;10(7):943-950

Department of Orthopaedic Surgery, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA.

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http://dx.doi.org/10.1177/2192568220935826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485074PMC
October 2020

Anterior Versus Posterior Decompression for Degenerative Thoracic Spine Diseases: A Comparison of Complications.

Global Spine J 2021 May 21;11(4):442-449. Epub 2020 Feb 21.

5116University of Southern California, Los Angeles, CA, USA.

Study Design: Retrospective database.

Objectives: Although posterior decompression is the most common approach for surgical treatment of degenerative thoracic spine disease, anterior approach is gaining interest due to its advantage in disc visualization. The objective of this study was to compare the intra- and postoperative medical complication rates between anterior and posterior decompression for degenerative thoracic spine pathologies.

Methods: A national US insurance database was queried for patients with degenerative diagnoses who had undergone anterior or posterior thoracic decompression. Incidence of intra- and postoperative complications were evaluated on the day of surgery and within 1 and 3 months. Two subgroups were matched based on age, gender, and comorbidity. The association of decompression approach and complications was assessed using logistic regression.

Results: A total of 1459 patients were included, consisting of 1004 patients in posterior and 455 patients in anterior group. Respiratory complications were the most common complications on the day of surgery (8.57%) and within 30 days (17.75%). Matched analysis showed that anterior approach was associated with organ failure, gastrointestinal, and device-/implant-/graft-related complications in all follow-up periods; and with cardiovascular, deep venous thrombosis/pulmonary embolism, and respiratory complications in at least 1 follow-up period. Among respiratory complications, anterior decompression was significantly associated with noninfectious etiologies on the day of surgery (odds ratio [OR] = 1.72), within 30 days (OR = 2.05), and within 90 days (OR = 1.92).

Conclusions: Anterior approach was associated with increased rates of several complications. High rates of respiratory complications necessitate comprehensive preoperative risk stratification to identify those who may benefit more from posterior approach.
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http://dx.doi.org/10.1177/2192568220907337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119921PMC
May 2021

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Chest Computed Tomography Manifestation of Coronavirus Disease 2019 (COVID-19) in Patients With Cardiothoracic Conditions.

J Thorac Imaging 2020 Jul;35(4):W90-W96

Keck School of Medicine, University of Southern California, Los Angeles, CA.

The coronavirus disease 2019 (COVID-19) pandemic is a serious public health concern, with an exponentially growing number of patients worldwide. Computed tomography (CT) has been suggested as a highly sensitive modality for the diagnosis of pulmonary involvement in the early stages of COVID-19. The typical features of COVID-19 in chest CT include bilateral, peripheral, and multifocal ground-glass opacities with or without superimposed consolidations. Patients with underlying medical conditions are at higher risks of complications and mortality. The diagnosis of COVID-19 on the basis of the imaging features may be more challenging in patients with preexisting cardiothoracic conditions, such as chronic obstructive pulmonary disease, interstitial lung disease, cardiovascular disease, and malignancies with cardiothoracic involvement. The extensive pulmonary involvement in some of these pathologies may obscure the typical manifestation of COVID-19, whereas other preexisting pathologies may resemble the atypical or rare CT manifestations of this viral pneumonia. Thus, understanding the specific CT manifestations in these special subgroups is essential for a prompt diagnosis.
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http://dx.doi.org/10.1097/RTI.0000000000000531DOI Listing
July 2020

Coronavirus disease 2019 (COVID-19) imaging reporting and data system (COVID-RADS) and common lexicon: a proposal based on the imaging data of 37 studies.

Eur Radiol 2020 Sep 28;30(9):4930-4942. Epub 2020 Apr 28.

Keck School of Medicine, University of Sothern California (USC), Los Angeles, CA, USA.

Background: In the vast majority of the laboratory-confirmed coronavirus disease 2019 (COVID-19) patients, computed tomography (CT) examinations yield a typical pattern and the sensitivity of this modality has been reported to be 97% in a large-scale study. Structured reporting systems simplify the interpretation and reporting of imaging examinations, serve as a framework for consistent generation of recommendations, and improve the quality of patient care.

Purpose: To compose a comprehensive lexicon for description of the imaging findings and propose a grading system and structured reporting format for CT findings in COVID-19.

Material And Methods: We updated our published systematic review on imaging findings in COVID-19 to include 37 published studies pertaining to diagnostic features of COVID-19 in chest CT. Using the reported imaging findings of 3647 patients, we summarized the typical chest CT findings, atypical features, and temporal changes of COVID-19 in chest CT. Subsequently, we extracted a list of descriptive terms and mapped it to the terminology that is commonly used in imaging literature.

Results: We composed a comprehensive lexicon that can be used for documentation and reporting of typical and atypical CT imaging findings in COVID-19 patients. Using the same data, we propose a grading system with five COVID-RADS categories. Each COVID-RADS grade corresponds to a low, moderate, or high level of suspicion for pulmonary involvement of COVID-19.

Conclusion: The proposed COVID-RADS and common lexicon would improve the communication of findings to other healthcare providers, thus facilitating the diagnosis and management of COVID-19 patients.

Key Points: • Chest CT has high sensitivity in diagnosing the coronavirus disease 2019 (COVID-19). • Structured reporting systems simplify the interpretation and reporting of imaging examinations, serve as a framework for consistent generation of recommendations, and improve the quality of patient care. • The proposed COVID-RADS and common lexicon would improve the communication of findings to other healthcare providers, thus facilitating the diagnosis and management of COVID-19 patients.
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http://dx.doi.org/10.1007/s00330-020-06863-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186323PMC
September 2020

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

Reply to "Vascular Changes Detected With Thoracic CT in Coronavirus Disease (COVID-19) Might Be Significant Determinants for Accurate Diagnosis and Optimal Patient Management".

AJR Am J Roentgenol 2020 07 24;215(1):W16. Epub 2020 Apr 24.

Keck School of Medicine, University of Southern California, Los Angeles, CA

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http://dx.doi.org/10.2214/AJR.20.23339DOI Listing
July 2020

Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients.

AJR Am J Roentgenol 2020 07 14;215(1):87-93. Epub 2020 Mar 14.

Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033.

Available information on CT features of the 2019 novel coronavirus disease (COVID-19) is scattered in different publications, and a cohesive literature review has yet to be compiled. This article includes a systematic literature search of PubMed, Embase (Elsevier), Google Scholar, and the World Health Organization database. Known features of COVID-19 on initial CT include bilateral multilobar ground-glass opacification (GGO) with a peripheral or posterior distribution, mainly in the lower lobes and less frequently within the right middle lobe. Atypical initial imaging presentation of consolidative opacities superimposed on GGO may be found in a smaller number of cases, mainly in the elderly population. Septal thickening, bronchiectasis, pleural thickening, and subpleural involvement are some of the less common findings, mainly in the later stages of the disease. Pleural effusion, pericardial effusion, lymphadenopathy, cavitation, CT halo sign, and pneumothorax are uncommon but may be seen with disease progression. Follow-up CT in the intermediate stage of disease shows an increase in the number and size of GGOs and progressive transformation of GGO into multifocal consolidative opacities, septal thickening, and development of a crazy paving pattern, with the greatest severity of CT findings visible around day 10 after the symptom onset. Acute respiratory distress syndrome is the most common indication for transferring patients with COVID-19 to the ICU and the major cause of death in this patient population. Imaging patterns corresponding to clinical improvement usually occur after week 2 of the disease and include gradual resolution of consolidative opacities and decrease in the number of lesions and involved lobes. This systematic review of current literature on COVID-19 provides insight into the initial and follow-up CT characteristics of the disease.
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http://dx.doi.org/10.2214/AJR.20.23034DOI Listing
July 2020

Reason for Exam Imaging Reporting and Data System: Consensus Reached on Quality Assessment of Radiology Requisitions.

J Patient Saf 2021 06;17(4):e255-e261

From the Departments of Radiology.

Objective: The aim of this study was to reach consensus on quality assessment of clinical information in imaging requisitions using Reason for exam Imaging Reporting and Data System (RI-RADS).

Methods: A Delphi study was conducted in September 2018 with a panel of 87 radiologists with diverse levels of experience from various settings (community hospitals, private hospitals, university hospitals, and clinics), of which 74.7% completed the survey. The agreement was assessed in the following subjects: (a) presumed effect of standardization, (b) the standardized system for information, (c) the scoring system for evaluation of requisitions, and (d) the implementation of RI-RADS. The consensus threshold was set at 51% responding (strongly) agree. The rate of lawsuits preventable with clinical information was also assessed.

Results: Consensus was reached on all objectives of the study with a high level of agreement. Radiologists agreed on the need for standardization of imaging requisitions and attributed it to increased speed and accuracy of interpretations. Three categories of information were determined as key indicators of quality: impression, clinical findings, and clinical question. The scoring system is intended to grade requisitions based on the presence of these categories. Radiologists also agreed that RI-RADS will encourage physicians to improve requisitions. Among radiologists who responded to the survey, 12.6% had experienced at least one lawsuit potentially preventable with sufficient information in requisitions.

Conclusions: Reason for exam Imaging Reporting and Data System can be used as a standard for quality assessment of requisitions. Its use may improve the quality of patient care and reduce lawsuits against radiologists.
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http://dx.doi.org/10.1097/PTS.0000000000000653DOI Listing
June 2021

Reason for exam Imaging Reporting and Data System (RI-RADS): A grading system to standardize radiology requisitions.

Eur J Radiol 2019 Nov 9;120:108661. Epub 2019 Sep 9.

Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address:

Radiologists often encounter imaging requisitions that lack important information needed for accurate diagnostic studies. Reason for exam Imaging Reporting and Data System (RI-RADS) is proposed as a grading system for evaluation of the quality of clinically pertinent information provided in imaging requisitions. Three categories of information are suggested as key indicators of quality: impression, clinical findings, and the diagnostic question. This scheme is intended to improve the quality of imaging requisitions and overall patient care.
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http://dx.doi.org/10.1016/j.ejrad.2019.108661DOI Listing
November 2019

Performance properties of health-related measurement instruments in whiplash: systematic review protocol.

Syst Rev 2019 08 9;8(1):199. Epub 2019 Aug 9.

Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Mail Code: 9224, Los Angeles, CA, 90033, USA.

Background: Whiplash is a common traumatic cervical injury which is most often a consequence of rear-end motor vehicle accidents. It has been estimated that up to 50% of the whiplash patients suffer from chronic symptoms, resulting in extensive individual and societal burden. Several measurement instruments are used for initial assessment of whiplash and evaluation of response to treatment. However, a comprehensive assessment of the performance of these measures is lacking. Furthermore, there is no consensus on the most relevant outcome domains and their corresponding measurement instruments of choice. This systematic review aims to identify, describe, and critically appraise the performance properties of health-related measurement instruments in whiplash population.

Methods: The following literature databases will be searched from their date of establishment: PubMed, Embase®, MEDLINE, CINAHL Complete, PsycINFO, and HAPI. All original articles evaluating the reliability, validity, responsiveness, and feasibility of health-related measurement instruments in whiplash will be included, without additional restriction on their intended use, source of data, and structure. Risk of bias will be assessed using the COSMIN Risk of Bias checklist. Findings of the studies will be judged against the criteria for good measurement properties, and results from all studies will be qualitatively summarized to generate an overall quality of findings. Overall quality of evidence will be determined using a modified GRADE approach, which will be used in conjunction with the overall quality of results for generation of recommendations. Two reviewers will perform all steps of the review independently. Discrepancies will be discussed between the reviewers, and in case of remaining disagreement, the senior reviewer will make the final decision.

Discussion: This systematic review will summarize the body of literature on health-related measurement instruments in whiplash, aiming to facilitate the selection of high-quality measurement instrument for researchers and physicians. Findings of this study will guide the ongoing efforts for development of a core outcome set.

Systematic Review Registration: PROSPERO reference number CRD42018070901.
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http://dx.doi.org/10.1186/s13643-019-1119-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688369PMC
August 2019

Prayer's fracture: rare cases of knee insufficiency fracture in non-weight-bearing femoral condyle.

Clin Imaging 2019 Nov - Dec;58:80-83. Epub 2019 Jun 22.

Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, USA.

Insufficiency fractures are a relatively common sub-type of stress fractures and occur as a result of decreased bone resistance due to underlying conditions such as osteoporosis. Insufficiency fractures of the knee most commonly occur at the central weight-bearing zone of the medial femoral condyle. We present five unusual cases of insufficiency fractures occurring at the posterior non-weight-bearing zone of condyles. After investigating commonalities between these patients, we discovered that all of these patients performed the daily practice of prayer rituals that include high knee flexion. We have chosen to coin this type of fracture a "Prayer's fracture". Considering the mechanics of high knee flexion, transient changes in the weight-bearing zone of knee explain the unusual location of this fracture. We describe these cases, the characteristic imaging appearance, and the probable biomechanics that we believe predispose patients to this type of injury.
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http://dx.doi.org/10.1016/j.clinimag.2019.06.013DOI Listing
March 2020

Dual-layer spectral computerized tomography for metal artifact reduction: small versus large orthopedic devices.

Skeletal Radiol 2019 Dec 1;48(12):1981-1990. Epub 2019 Jun 1.

University of Texas Southwestern Medical Center, Dallas, TX, USA.

Introduction: Metal artifacts limit the diagnostic utility of computerized tomography (CT) for implant-related complications. Dual-layer spectral detector CT imaging has been suggested for artifact reduction. Our objective was to evaluate the utility of spectral CT in artifact reduction in patients with small and large metal implants.

Methods: In this prospective study, patients with metallic orthopedic implants underwent CT imaging using a prototype spectral detector CT scanner. Conventional images were generated with iterative reconstruction at 120 kVp, and virtual monochromatic images were generated at 20-keV intervals between 40 to 200 keV. Conventional and monochromatic images were compared quantitatively using signal-to-noise ratio (SNR) and artifact improvement. Qualitative analysis was performed independently by two musculoskeletal radiologists and included six image quality indicators.

Results: A total of 12 patients were scanned. In monochromatic images, as the energy level increased, the artifact size decreased progressively (p < 0.01). When conventional and monochromatic images were compared, maximum reduction was seen at 200 keV. Using qualitative assessments, 160 and 180 keV levels had the best overall diagnostic image quality. With increased energy level, there was improvement in qualitative ratings of bone-metal interface conspicuity (p = 0.002), degree of streak artifact (p = 0.010) and trabecular bone definition at 1 cm from implant (p = 0.023), and a trend towards significance for bone definition at 5 cm, soft tissue detail and overall diagnostic quality. Subgroup analysis revealed superior artifact reduction in small implants compared to large hardware.

Discussion: Our results support the utility of dual-layer spectral CT in metal artifact reduction. Virtual monochromatic images were diagnostically superior, especially for smaller implants. Virtual monoenergetic images at 160-180 keV are ideal for reducing artifacts.
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http://dx.doi.org/10.1007/s00256-019-03248-3DOI Listing
December 2019

Reliability and Validity of the AOSpine Thoracolumbar Injury Classification System: A Systematic Review.

Global Spine J 2019 Apr 15;9(2):231-242. Epub 2018 Oct 15.

University of Southern California, Los Angeles, CA, USA.

Study Design: Systematic review.

Objectives: The AOSpine thoracolumbar injury classification system (ATLICS) is a relatively simple yet comprehensive classification of spine injuries introduced in 2013. This systematic review summarizes the evidence on measurement properties of this new classification, particularly the reliability and validity of the main morphologic injury types with and without inclusion of the subtypes.

Methods: A literature search was performed using PubMed and Embase in September 2016. A revised version of the COSMIN checklist was used for evaluation of the quality of studies. Two independent reviewers performed all steps of the review.

Results: Nine articles were included in the final review, all of which evaluated the reliability of the ATLICS and had a fair methodological quality. The reliability of the modifiers was unknown. Overall, the quality of evidence for reliability of the morphologic and neurologic classification sections was low. However, there was moderate evidence for poor interobserver reliability of the morphologic classification when all subtypes were included, and moderate evidence for good intraobserver reliability with exclusion of subtypes. The reliability of the morphologic classification was independent of the observer's experience and cultural background.

Conclusions: ATLICS represents the most current system for evaluation of thoracolumbar injuries. Based on this review, further studies with robust methodological quality are needed to evaluate the measurement properties of ATLICS. Shortcomings of the reliability studies are discussed.
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http://dx.doi.org/10.1177/2192568218806847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448204PMC
April 2019

The future of disc surgery and regeneration.

Int Orthop 2019 04 30;43(4):995-1002. Epub 2018 Nov 30.

Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.

Low back and neck pain are among the top contributors for years lived with disability, causing patients to seek substantial non-operative and operative care. Intervertebral disc herniation is one of the most common spinal pathologies leading to low back pain. Patient comorbidities and other risk factors contribute to the onset and magnitude of disc herniation. Spine fusions have been the treatment of choice for disc herniation, due to the conflicting evidence on conservative treatments. However, re-operation and costs have been among the main challenges. Novel technologies including cage surface modifications, biologics, and 3D printing hold a great promise. Artificial disc replacement has demonstrated reduced rates of adjacent segment degeneration, need for additional surgery, and better outcomes. Non-invasive biological approaches are focused on cell-based therapies, with data primarily from preclinical settings. High-quality comparative studies are needed to evaluate the efficacy and safety of novel technologies and biological therapies.
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http://dx.doi.org/10.1007/s00264-018-4254-7DOI Listing
April 2019

Kinematic evaluation of thoracic spinal cord sagittal diameter and the space available for cord using weight-bearing kinematic magnetic resonance imaging.

Spinal Cord 2019 Apr 24;57(4):276-281. Epub 2018 Sep 24.

Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Study Design: Retrospective kinematic MRI (kMRI) study.

Objective: To evaluate the dynamic changes of thoracic anterior and posterior space available for cord (SAC), and thoracic spinal cord in the dural sac in three positions.

Setting: Expert MRI, Bellflower California; and University of Southern California, in Los Angeles, USA.

Methods: A total of 118 patients (66 males and 52 females, mean age ( ± SD) of 45.6 ± 10.6 years) who underwent thoracic spine kMRI were evaluated from T4-5 to T11-12 in flexion, neutral, and extension positions. The anterior SAC, posterior SAC, and mid-sagittal thoracic cord diameter were measured at each level from T4-5 to T11-12. Inter- and intraobserver agreements were analyzed.

Results: The anterior SAC was significantly narrower in flexion position compared with other positions at T8-9 to T11-12 levels (p < 0.01). The T8-9 level had significantly wider posterior SAC in flexion and extension positions compared with the neutral position (p < 0.005). However, the posterior SAC at T9-10 was narrower in extension than the neutral position (p = 0.002). Thoracic spinal cord diameter significantly increased in flexion position when compared with the neutral position at T8-9, T9-10, and T11-12 levels (p < 0.005).

Conclusions: Thoracic spinal cord had dynamic changes with positions. In flexion position, the thoracic cord at T8-9 and below tended to move anteriorly, getting closer to the vertebral body and intervertebral disc. The mid-sagittal diameter of the thoracic cord increased in flexion position at the levels below T8-9. In the presence of lesions in anterior epidural space, the risk of spinal cord compression is higher in flexion position, especially at levels below T8-9.
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http://dx.doi.org/10.1038/s41393-018-0198-4DOI Listing
April 2019

Can C2-6 Cobb Angle Replace C2-7 Cobb Angle?: An Analysis of Cervical Kinetic Magnetic Resonance Images and X-rays.

Spine (Phila Pa 1976) 2019 02;44(4):240-245

Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Study Design: Retrospective study of consecutive 113 cervical kinetic magnetic resonance images (kMRIs) and 57 radiographs.

Objective: To elucidate the relationship between C2-6 or C2-7 Cobb angle and cervical sagittal alignment parameters using kMRI, and evaluate the visibility of C6 and C7 inferior endplates on cervical radiographs.

Summary Of Background Data: Several studies have used C2-6 Cobb angle instead of C2-7 Cobb angle as C7 inferior endplate is not always visible because of overlying shadows. However, the relationship between C2-6 or C2-7 Cobb angle and cervical sagittal alignment parameters remains unclear. Moreover, visibility of C6 inferior endplate remains unknown.

Methods: C2-6 Cobb angle, C2-7 Cobb angle, occiput-C2 angle, Atlas-dens interval (ADI), narrowest oropharyngeal airway space (nPAS), cervical sagittal vertical axis (cSVA), cervical tilt, cranial tilt, neck tilt, thoracic inlet angle (TIA), and T1 slope were measured using kMRI, and analyzed for their relationship with C2-6 or C2-7 Cobb angle. Visibility rates of C6 or C7 inferior endplates were evaluated using cervical radiographs.

Results: Linear regression analysis showed high association between C2-6 and C2-7 Cobb angle (R = 0.696, P < 0.01). C2-6 Cobb angle was significantly correlated with occiput-C2 angle, TIA, T1 slope, neck tilt, cSVA, and cervical tilt; but not with nPAS, ADI, and cranial tilt. C2-7 Cobb angle resembled C2-6 Cobb angle regarding the relationships with other parameters. In our study, 94.7% C6 and 50.9% C7 inferior endplate were clearly visible; 1.8% C6 and 24.6% C7 inferior endplate were invisible. Chi-square test and residual analysis showed significant difference between the two groups (P < 0.01).

Conclusion: C2-6 Cobb angle highly resembled C2-7 Cobb angle regarding its relationships with parameters of craniovertebral, cervical and thoracic inlet alignment. C2-6 Cobb angle could be an alternative to C2-7 Cobb angle because of its significantly higher visibility rate.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000002795DOI Listing
February 2019

Corticosteroid Administration to Prevent Complications of Anterior Cervical Spine Fusion: A Systematic Review.

Global Spine J 2018 May 23;8(3):286-302. Epub 2017 Jun 23.

Tehran University of Medical Sciences, Tehran, Iran.

Study Design: Systematic review.

Objectives: Anterior cervical approach is associated with complications such as dysphagia and airway compromise. In this study, we aimed to systematically review the literature on the efficacy and safety of corticosteroid administration as a preventive measure of such complications in anterior cervical spine surgery with fusion.

Methods: Following a systematic literature search of MEDLINE, Embase, and Cochrane databases in July 2016, all comparative human studies that evaluated the effect of steroids for prevention of complications in anterior cervical spine surgery with fusion were included, irrespective of number of levels and language. Risk of bias was assessed using MINORS (Methodological Index for Non-Randomized Studies) checklist and Cochrane Back and Neck group recommendations, for nonrandomized and randomized studies, respectively.

Results: Our search yielded 556 articles, of which 9 studies (7 randomized controlled trials and 2 non-randomized controlled trials) were included in the final review. Dysphagia was the most commonly evaluated complication, and in most studies, its severity or incidence was significantly lower in the steroid group. Although prevertebral soft tissue swelling was less commonly assessed, the results were generally in favor of steroid use. The evidence for airway compromise and length of hospitalization was inconclusive. Steroid-related complications were rare, and in both studies that evaluated the fusion rate, it was comparable between steroid and control groups in long-term follow-up.

Conclusions: Current literature supports the use of steroids for prevention of complications in anterior cervical spine surgery with fusion. However, evidence is limited by substantial risk of bias and small number of studies reporting key outcomes.
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http://dx.doi.org/10.1177/2192568217708776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958478PMC
May 2018

Feasibility and Data Quality of the National Spinal Cord Injury Registry of Iran (NSCIR-IR): A Pilot Study.

Arch Iran Med 2017 Aug;20(8):494-502

Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

Background: Spinal cord injury (SCI) is one of the most disabling consequences of trauma with unparalleled economic, social, and personal burden. Any attempt aimed at improving quality of care should be based on comprehensive and reliable data. This pilot investigation studied the feasibility of implementing the National Spinal Cord and Column Injury Registry of Iran (NSCIR-IR) and scrutinized the quality of the registered data.

Methods: From October 2015 to May 2016, over an 8-month period, 65 eligible trauma patients who were admitted to hospitals in three academic centers in mainland Iran were included in this pilot study. Certified registered nurses and neurosurgeons were in charge of data collection, quality verification, and registration.

Results: Sixty-five patients with vertebral column fracture dislocations were registered in the study, of whom 14 (21.5%) patients had evidence of SCI. Mechanisms of injury included mechanical falls in 30 patients (46.2%) and motor vehicle accidents in 29 (44.6%). The case identification rate i.e. clinical and radiographic confirmation of spine and SCI, ranged from 10.0% to 88.9% in different registry centers. The completion rate of all data items was 100%, except for five data elements in patients who could not provide clinical information because of their medical status. Consistency i.e. identification of the same elements by all the registrars, was 100% and accuracy of identification of the same pathology ranged from 66.6% to 100%.

Conclusions: Our pilot study showed both the feasibility and acceptable data quality of the NSCIR-IR. However, effective and successful implementation of NSCIR-IR data use requires some modifications such as presence of a dedicated registrar in each center, verification of data by a neurosurgeon, and continuous assessment of patients' neurological status and complications.
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August 2017

Clinical Application of Ceramics in Anterior Cervical Discectomy and Fusion: A Review and Update.

Global Spine J 2017 Jun 20;7(4):343-349. Epub 2017 Apr 20.

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Study Design: Narrative review.

Objectives: Anterior cervical discectomy and fusion (ACDF) is a reliable procedure, commonly used for cervical degenerative disc disease. For interbody fusions, autograft was the gold standard for decades; however, limited availability and donor site morbidities have led to a constant search for new materials. Clinically, it has been shown that calcium phosphate ceramics, including hydroxyapatite (HA) and tricalcium phosphate (TCP), are effective as osteoconductive materials and bone grafts. In this review, we present the current findings regarding the use of ceramics in ACDF.

Methods: A review of the relevant literature examining the clinical use of ceramics in anterior cervical discectomy and fusion procedures was conducted using PubMed, OVID and Cochrane.

Result: HA, coralline HA, sandwiched HA, TCP, and biphasic calcium phosphate ceramics were used in combination with osteoinductive materials such as bone marrow aspirate and various cages composed of poly-ether-ether-ketone (PEEK), fiber carbon, and titanium. Stand-alone ceramic spacers have been associated with fracture and cracks. Metallic cages such as titanium endure the risk of subsidence and migration. PEEK cages in combination with ceramics were shown to be a suitable substitute for autograft.

Conclusion: None of the discussed options has demonstrated clear superiority over others, although direct comparisons are often difficult due to discrepancies in data collection and study methodologies. Future randomized clinical trials are warranted before definitive conclusions can be drawn.
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http://dx.doi.org/10.1177/2192568217699201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546682PMC
June 2017

Bone Morphogenetic Proteins in Anterior Cervical Fusion: A Systematic Review and Meta-Analysis.

World Neurosurg 2017 Aug 16;104:752-787. Epub 2017 Mar 16.

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Electronic address:

Objective: Bone morphogenetic proteins (BMPs) have been commonly used as a graft substitute in spinal fusion. Although the U.S. Food and Drug Administration issued a warning on life-threatening complications of recombinant human BMPs (rhBMPs) in cervical spine fusion in 2008, their off-label use has been continued. This investigation aimed to review the evidence for the use of rhBMP-2 and rhBMP-7 in anterior cervical spine fusions.

Methods: A comprehensive search was performed through Ovid (MEDLINE), PubMed, and Embase. The risk of bias assessment was according to the recommended criteria by the Cochrane Back and Neck group and MINORS (Methodological Index for Non-Randomized Studies). A wide array of radiographic and clinical outcomes including the adverse events were collated.

Results: Eighteen articles (1 randomized and 17 nonrandomized) were eligible for inclusion. The fusion rate was higher with use of rhBMP in most studies and our meta-analysis of the pooled data from 4782 patients confirmed this finding (odds ratio, 5.45; P < 0.00001). Altogether, the rhBMP and control groups were comparable in patient-reported outcomes. However, most studies tended to show a significantly higher incidence of overall complication rate, dysphagia/dysphonia, cervical swelling, readmission, wound complications, neurologic complications, and ossification.

Conclusions: Application of rhBMPs in cervical spine fusion yields a significantly higher fusion rate with similar patient-reported outcomes, yet increased risk of life-threatening complications. Thus, we do not recommend the use of rhBMP in anterior cervical fusions.
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http://dx.doi.org/10.1016/j.wneu.2017.02.098DOI Listing
August 2017

Demineralized bone matrix in anterior cervical discectomy and fusion: a systematic review.

Eur Spine J 2017 04 10;26(4):958-974. Epub 2016 Nov 10.

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (TUMS), P.O.Box:11365/3876, Hassan Abad SQ., Imam Khomeini St., Tehran, Iran.

Purpose: Anterior cervical discectomy and fusion (ACDF) is one of the most widely used procedures in cervical spine. Demineralized bone matrix (DBM) is one of the fusion options that has been used in treatment of the bone defects for years. The purpose of this review is to provide an evidence-based analysis on the current evidence for effectiveness of DBM in ACDF.

Methods: A systematic search of the literature was conducted using MEDLINE, Scopus, and CENTRAL. The risk of bias was evaluated with the criteria recommended by the Cochrane Back and Neck group and the Methodological Index for Non-Randomized Studies (MINORS). The patient-reported outcome measures included the visual analog scale (VAS), Odom's criteria, Japanese Orthopaedic Association (JOA), and Neck Disability Index (NDI). Secondary outcome measures were fusion rate, non-union, subsidence, collapse, displacement, spinal alignment, and re-operation.

Results: Twelve studies met the eligibility criteria, of which three were randomized and nine were non-randomized. Patient-reported outcomes were non-inferior for DBM compared with the autograft and other bone substitute materials. The DBM had a fusion rate comparable with other graft materials, particularly in long term (88.8-100%, after 18 months follow-up). The majority of studies reported no collapse, subsidence or displacement with DBM. The revision surgery was mainly due to the symptomatic non-union in 4.1-8.3% of the DBM cases. Preservation of the angle of cervical lordosis was acceptable with DBM fusion.

Conclusions: Most of the studies reported non-inferior results for DBM compared with autograft and other graft substitute materials in terms of patient-reported outcomes, fusion rate, and safety. However, the quantity and quality of evidence is very limited.
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http://dx.doi.org/10.1007/s00586-016-4858-9DOI Listing
April 2017

Pelvic Floor Muscle Exercise for Paediatric Functional Constipation.

J Clin Diagn Res 2015 Jun 1;9(6):SC16-7. Epub 2015 Jun 1.

Faculty, Department of Paediatric, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences , Babol, IR Iran .

Introduction: Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC.

Materials And Methods: In this study which was conducted in Children's Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline.

Results: Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation.

Conclusion: Pelvic floor muscle exercise is an effective non-pharmacologic treatment for Paediatric FC.
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http://dx.doi.org/10.7860/JCDR/2015/12726.6036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525569PMC
June 2015
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