bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic evaluation of guideline implementation in primary care: a systematic review
Authors: Kovacs Eva , Wang Xiaoting , Strobl Ralf , Grill Eva
Published: July 2019

Purpose

To review the economic evaluation of the guideline implementation in primary care.

Data sources

Medline and Embase.

Study selection

Electronic search was conducted on April 1, 2019, focusing on studies published in the previous ten years in developed countries about guidelines of non-communicable diseases of adult (≥18 years) population, the interventions targeting the primary care provider. Data extraction was performed by two independent researchers using a Microsoft Access based form.

Results of data synthesis

Among the 1338 studies assessed by title or abstract, 212 qualified for full text reading. From the final 39 clinically eligible studies, 14 reported economic evaluation. Cost consequences analysis, presented in four studies, provided limited information. Cost-benefit analysis was reported in five studies. Patient mediated intervention, and outreach visit applied in two studies showed no saving. Audit resulted significant savings in lipid lowering medication. Audit plus financial intervention was estimated to reduce referrals into secondary care. Analysis of incremental cost-effectiveness ratios was applied in four studies. Educational meeting evaluated in a simulated practice was cost-effective. Educational meeting extended with motivational interview showed no improvement; likewise two studies of multifaceted intervention. Cost-utility analysis of educational meeting supported with other educational materials showed unfavourable outcome.

Conclusion

Only a minor proportion of studies reporting clinical effectiveness of guideline implementation interventions included any type of economic evaluation. Rigorous and standardized cost-effectiveness analysis would be required, supporting decision-making between simple and multifaceted interventions through comparability.
Implications of a Dating Analysis of Hippoboscoidea (Diptera) for the Origins of Phoresis in Feather Lice (Psocodea: Phthiraptera: Philopteridae)
Authors: de Moya Robert S
Published: July 2019

Hippoboscidae (Samouelle 1819) is a family of blood feeding Diptera, which can be phoretic vectors for parasitic feather lice (Philopteridae Burmeister 1838). Hippoboscid flies are understood to provide opportunities for increased instances of dispersal and host-switching for feather lice. This intimate relationship between hippoboscid fly and feather louse may have hypothetically existed since the origin of avian-specialized Hippoboscidae. Thus, phoretic dispersal may have affected patterns of diversification in feather lice over millions of years. To test this, a dating analysis of a previously published Hippoboscoidea data set was performed using known fossil calibrations. The results of the dating analysis suggest Hippoboscoidea diversified shortly after the K-Pg boundary, similar to their modern vertebrate hosts. A maximum age of the avian feeding Ornithomyini is estimated to have occurred around the origin of parasitic feather lice. This maximum divergence date suggest this phoretic relationship could have existed for much of the diversification of avian feather lice and had the potential to influence patterns of diversification due to dispersal and host-switching among avian hosts.
Implications of early-life indicators for survival rate, subsequent growth performance, and carcass characteristics of commercial pigs1
Authors: Zeng Zhikai K , Urriola Pedro E , Dunkelberger Jenelle R , Eggert John M , Vogelzang Roos , Shurson Gerald C , Johnston Lee J
Published: July 2019

As a result of genetic selection for increased litter size, modern, highly prolific sows often produce large litters with an increased percentage of light birth weight (BiW) piglets compared with less prolific females. However, there is limited information elucidating what proportion of light BiW piglets that express compensatory growth and how these pigs might be identified at a young age. The objective of this study was to analyze the effect of birth weight and early phase growth on preweaning mortality, subsequent growth performance, and carcass characteristics of pigs. Individual records collected on 7,654 commercial crossbred pigs were used for analyses. A segmented regression model was used to analyze the effect of birth weight on preweaning survival and a series of mixed models were used to analyze the effect of birth weight (n = 7,654) group on weights recorded at: weaning (n = 6,777), nursery exit (n = 4,805), and finishing exit (n = 1,417); hot carcass weight (HCW), and lean percentage (n = 4,572). The effect of growth rate group was defined during suckling (< 225 or ≥ 225 g/d) or the nursery phase (< 424 or ≥ 424 g/d). Preweaning mortality, growth rate, BW, and carcass traits were adjusted to a standard age, and ADG and lean percentage were calculated. Results of segmented regression analysis showed that the slope of preweaning mortality on birth weights below 0.99 kg differed (P < 0.05) from the slope of preweaning mortality regressed on birth weights above 0.99 kg. The mixed model analyses showed a positive linear effect (P < 0.05) of BiW and quadratic effect (P < 0.05) of sow parity on age-adjusted finishing weight (FiW), HCW, and lean percentage. The positive influences of increasing BiW were greater (P < 0.05) in age-adjusted FiW and HCW for pigs with slow suckling growth rate compared with those with fast suckling growth rate. Pigs with fast nursery growth rate had greater (P < 0.05) age-adjusted FiW and HCW compared with the slow growing nursery contemporaries. In conclusion, piglets born weighing less than 1 kg were at a higher risk of preweaning mortality than piglets born weighing 1 kg or greater. Light BiW pigs, but not heavy BiW pigs, may lose compensatory growth capability if growth rate during the suckling phase is below the average level.
Transmission of Citrus leprosis virus C by the Mite, Brevipalpus yothersi (Acari: Tenuipalpidae), on Four Species of Citrus
Authors: Rodríguez-Ramírez Renata , Santillán-Galicia Ma Teresa , Guzmán-Franco Ariel W , Ortega-Arenas Laura Delia , Teliz-Ortiz Daniel , Sánchez-Soto Saul , Robles-García Pedro L
Published: July 2019

Transmission of the virus, Citrus leprosis virus C (CiLV-C) (Cilevirus) by Brevipalpus yothersi Baker, on different citrus species was evaluated under greenhouse conditions. First, the relationship between acquisition access periods (AAPs; 1, 12, 24, 36, and 48 h) and virus concentration in mites was determined. Second, the ability of B. yothersi to transmit CiLV-C to orange, mandarin, grapefruit, and lime trees was measured. We then assessed the establishment of mites on the different citrus species as measured by their population increase on each species. We found no relationship between AAPs and virus load in mites. The virus was found in all mites tested but there was no difference in virus quantities among the treatments. We selected an AAP of 24 h for the transmission experiment. Brevipalpus yothersi transmitted the virus to all citrus species evaluated, but susceptibility was different. The number of infected leaves was greater on orange and mandarin compared with grapefruit and lime. Furthermore, populations of B. yothersi successfully established on orange and mandarin, but not on grapefruit and lime trees. The implications of our results in the virus–mite–citrus plant relationship are discussed.
Student and Instructor Generated Open Educational Resources Compare Favorably to a Traditional Textbook
Authors: Stovall Jeremy P , Laird Shelby G , Welford Lana , Williams Allison
Published: July 2019

Open Educational Resources (OER) are freely available materials that can be used in courses and modified by instructors. We developed an online OER silviculture textbook (OT). Some sections of OT were developed by the instructor, whereas others were developed by students enrolled in a silviculture course and subsequently edited by the instructor. As a preliminary examination of the effectiveness and student preference of OT, we administered a knowledge assessment and survey to both freshman and junior-level forestry students. We compared OT to a highly respected textbook in the field, The Practice of Silviculture, 9th Edition (Smith et al. 1997). Based on this study, both resources performed similarly and were similarly preferred by students. Although there are a number of limitations to this preliminary study (small sample size, only conducted at a single university, formatting both sources as paper copies) and to OER (time-consuming to create, lack of funding, lack of peer review), our results support further exploration of OER for use in forestry courses.
Impacts of nitrogen deposition on terrestrial plant diversity: a meta-analysis in China
Authors: Han Wen-Juan , Cao Jia-Yu , Liu Jin-Liang , Jiang Jia , Ni Jian
Published: July 2019

Aims

With the global atmospheric nitrogen (N) deposition increasing, the effect of N deposition on terrestrial plant diversity has been widely studied. Some studies have reviewed the effects of N deposition on plant species diversity; however, all studies addressed the effects of N deposition on plant community focused on species richness in specific ecosystem. There is a need for a systematic meta-analysis covering multiple dimensions of plant diversity in multiple climate zones and ecosystems types. Our goal was to quantify changes in species richness, evenness and uncertainty in plant communities in response to N addition across different environmental and experimental contexts.

Methods

We performed a meta-analysis of 623 experimental records published in English and Chinese journals to evaluate the response of terrestrial plant diversity to the experimental N addition in China. Three metrics were used to quantify the change in plant diversity: species richness (SR), evenness (Pielou index) uncertainty (Shannon index).

Important Findings

Results showed that (i) N addition negatively affected SR in temperate, Plateau zones and subtropical zone, but had no significant effect on Shannon index in subtropical zones; (ii) N addition decreased SR, Shannon index and Pielou index in grassland, and the negative effect of N addition on SR was stronger in forest than in grassland; (iii) N addition negatively affected plant diversity (SR, Shannon index and Pielou index) in the long term, whereas it did not affect plant diversity in the short term. Furthermore, the increase in N addition levels strengthened the negative effect of N deposition on plant diversity with long experiment duration; and (iv) the negative effect of ammonium nitrate (NH4NO3) addition on SR was stronger than that of urea (CO(NH2)2) addition, but the negative effect of NH4NO3 addition on Pielou index was weaker than that of CO(NH2)2 addition. Our results indicated that the effects of N addition on plant diversity varied depending on climate zones, ecosystem types, N addition levels, N type and experiment duration. This underlines the importance of integrating multiple dimensions of plant diversity and multiple factors into assessments of plant diversity to global environmental change.
Ultra-diffuse galaxies without dark matter
Authors: Silk Joseph
Published: July 2019

I develop a high-velocity galaxy collision model to explain a rare but puzzling phenomenon, namely the apparent existence of ultra-diffuse galaxies with little dark matter. Predictions include simultaneous triggering of overpressured dense clouds to form luminous old globular clusters, a protogroup environment to generate high relative velocities of the initially gas-rich galaxies in the early universe, and spatially separated dark haloes, possibly detectable via gravitational lensing and containing relic low-metallicity stars with enhanced α/Fe at ultra-low surface brightness.
Minimal-Access Endoscopic Endonasal Management of Dysthyroid Optic Neuropathy: The Dysthone Study
Authors: Zah-Bi Gilles , Abeillon-du Payrat Juliette , Vie Anne Laure , Bournaud-Salinas Claire , Jouanneau Emmanuel , Berhouma Moncef
Published: July 2019

BACKGROUND

Dysthyroid optic neuropathy (DON) is a devastating complication of thyroid eye disease. Corticosteroids are the primary medical treatment for DON, but some refractory patients may require surgical management.

OBJECTIVE

To evaluate the efficacy of endoscopic endonasal decompression of the orbital apex in refractory DON.

METHODS

This study included patients with refractory DON who underwent endoscopic endonasal decompression of the orbital apex from February 2015 to October 2016. A total of 23 orbital apices were decompressed across 17 patients. Visual acuity, ophthalmometry, tonometry, and visual field were evaluated at the preoperative, early and delayed postoperative stages. Statistical analyses were performed using RStudio software. A Wilcoxon test for matched data was performed to determine if there was a statistically significant difference between pre- and postsurgical treatment for the following items: visual acuity, proptosis, visual field, and intraocular pressure.

RESULTS

Visual acuity improved in 69.5% of the cases with a mean gain of 2.5 points ± 1.6 (P < .05). Additionally, there was an 18.3% reduction in mean proptosis across all cases (P < .05) and a 13.7% decrease in intraocular pressure (P < .05) for all patients. Finally, visual field improved in 82.6% (P < .05) of the cases. The mean time for follow-up was of 6.28 ± 3.7 mo. There were 3 cases of transient postoperative rhinitis and 2 cases of transient diplopia. Two patients experienced recurrence at 4 and 8 mo, respectively.

CONCLUSION

Endoscopic endonasal decompression of the orbital apex significantly improves visual parameters. As a result, multidisciplinary screening for patients is crucial to ensure prompt surgical decompression.
Tungiasis: a highly neglected disease among neglected diseases. Case series from Nduta refugee camp (Tanzania)
Authors: Nájera Villagrana Sandra Montserrat , García Naranjo Santisteban Alejandra
Published: July 2019

Tungiasis is a highly prevalent yet neglected disease of populations affected by extreme poverty. It causes great discomfort and pain, leads to social stigmatization and, when left untreated, can cause serious complications. Although natural repellents have been shown to be effective, too little is being done in terms of systematic prevention and treatment. In addition, self-treatment (usually extraction of fleas with non-sterile sharp instruments) comports high risks of infection, notably with viral hepatitis and human immunodeficiency virus. In this article, we report seven severe cases of tungiasis in children living in a refugee camp in Tanzania, all of whom were treated with surgical extraction of the fleas because the topical treatment (dimethicone) was not available. Refugee camps—particularly in sub-Saharan Africa where tungiasis is endemic—should be considered high-risk areas for the condition. Aid organizations should engage in active case searching, and health promotion should be systematically carried out.
Overcoming Parochialism in American Public Administration
Authors: Beagles Jonathan E , Schnell Sabina , Gerard Catherine
Published: July 2019

For decades, there have been complaints about the parochialism of American public administration. Too often, scholars and practitioners assume the American experience is exceptional. It is time to change this mindset. There is much to be learned from the experience of other countries, and some major problems unavoidably span national borders. There are three ways to overcome parochialism: by raising our sights to the macro-level of analysis, by engaging more broadly with other regions and fields of inquiry, and by institutionalizing diversity in our research methods, conferences, journals, and curriculum.
Female genital cutting in the Gambia: can education of women bring change?
Authors: Mboge Baturu , Knapp Kenneth , Tantsyura Vadim , Jagne Siga Fatima , Alamgir Hasanat
Published: July 2019

Background

In the Gambia, three out of four women of reproductive age have undergone Female Genital Cutting (FGC). Many studies and policy advocates suggest that for such a practice that is deeply rooted in culture, a more holistic approach focusing on educating the population will have sustainable impact. This research examined whether educational level of women has an association with their attitude towards the practice of FGC.

Methods

Data from the 2013 Gambia Demographic Health Survey (GDHS) were analyzed. The sample included 6217 households: 10,233 females aged between 15 to 49 years and 3831 males between 15–59 years. This study focused only on women participants. The outcome variable was the attitude of women toward the practice of FGC.

Results

In multivariate regression model, women who were circumcised are found to have 80 times higher odds of supporting FGC [Odds Ratio = 80 (95% CI 50.93–124.4)] compared to uncircumcised women. Women with primary and secondary level education have lower odds of supporting FGC [OR = 0.73 (95% CI 0.915–0.007)) and those with higher education had the lowest odds [OR = 0.28 (95% CI 0.147–0.543)) of supporting FGC relative to women with no education at all.

Conclusions

Education and awareness programs targeting women who are married and older, those with less education and those who are already circumcised can help change attitudes towards the practice of FGC.
The therapeutic efficacy of intravenous immunoglobulin in anti-neutrophilic cytoplasmic antibody-associated vasculitis: a meta-analysis
Authors: Shimizu Takashi , Morita Takayoshi , Kumanogoh Atsushi
Published: July 2019

Objectives

The therapeutic effects of IVIG in patients with ANCA-associated vasculitis (AAV) have not been established so far. This study aims to estimate the effects of IVIG on AAV by conducting a systematic review and meta-analysis.

Methods

A comprehensive systematic review was conducted in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews And Meta-analyses). PubMed and Google Scholar were used to search for original studies on AAV and collect clinical data before and after IVIG treatment. A meta-analysis of each clinical parameter was performed, and standardized mean difference (SMD) and 95% CI were calculated using the random effects model.

Results

A total of 220 studies were identified, and nine met the selection criteria for the meta-analysis. IVIG was administered to active AAV patients as an immunomodulatory therapy in the nine studies selected. Significant reductions in BVAS (SMD –1.7; 95% CI [–2.66, –0.73]; P = 0.0006), ANCA (SMD –0.72; 95% CI [–1.13, –0.31]; P = 0.0006) and CRP (SMD –0.92; 95% CI [–1.49, –0.35]; P = 0.002) were noted within 6 months after administration of IVIG. Subgroup analysis in the unmodified immunotherapy population showed reductions in BVAS (SMD –1.39; 95% CI [–2.31, –0.48]; P = 0.003) and CRP (SMD –0.56; 95% CI [–0.93, –0.19]; P = 0.002) within half a month after IVIG treatment.

Conclusion

IVIG was associated with rapid improvements in disease activity and the related biomarkers in patients with active AAV.
Mental Health among Older Adults with Caregiving Needs: The Role of Social Networks
Authors: Tang Fengyan , Jang Heejung , Mulvaney Elizabeth A , Lee Jane Seoyoon , Musa Donald , Beach Scott
Published: July 2019

A major challenge facing an aging society is the increased caregiving needs among community-dwelling older adults with chronic conditions. Reliance on social relations may help address caregiving needs and maintain older adults’ mental well-being. This study examines the roles of different aspects of social relations—social network size, social support, and service use—in the association between caregiving needs and mental health status (MHS). Using a sample of adults age 55 and over in an urban setting, authors tested the direct, mediation, and moderation effects models of social relations. Structural equation modeling was applied and latent variables of caregiving needs, MHS, and social network size were identified. Results showed that caregiving needs and informal social support (that is, network size, positive support, and negative strain) were directly related to MHS and that informal social support partially mediated the negative effect of caregiving needs on MHS; by contrast, service use moderated the association, indicating that those with caregiving needs who used more services were in better MHS than their counterparts with less service use. Findings point to the importance of social work interventions aimed at improving social relations and enhancing awareness and access to social services.
The extent and uptake of mathematics support in higher education: results from the 2018 survey
Authors: Grove Michael , Croft Tony , Lawson Duncan
Published: July 2019

In response to the well-documented challenges associated with the ‘mathematics problem’ in UK higher education, many institutions have implemented a programme of mathematics support. Previous surveys within the UK, undertaken in 2001, 2004 and, most recently, 2012, have shown growth in the number of institutions offering such support and indicate that the dominant form of provision is through a drop-in model. Here we report on a 2018 survey of higher education providers in England and Wales undertaken to establish not only the extent of current provision but also understand the scale of its delivery. We find that overall the proportion of higher education institutions offering mathematics support remains broadly the same, but there is considerable variation in how this support is delivered within institutions. While the drop-in model remains most common, we see evidence that the methods used to provide mathematics support are expanding and that the range of levels and subjects studied of targeted student cohorts is widening. For the first time we are able to report on the volume of use of mathematics support by students across England and Wales, and although dependent upon the institutional context, we see clear evidence of the extensive use being made of it by learners.
Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium
Authors: Rood Paul J. T. , Zegers Marieke , Slooter Arjen J. C. , Beishuizen Albert , Simons Koen S. , van der Voort Peter H. J. , van der Woude Meta C. E. , Spronk Peter E. , van der Hoeven Johannes G. , Pickkers Peter , van den Boogaard Mark
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life.

Methods

A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed.

Results

Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 ± 11 and 39 ± 11, respectively, and P = 0.350; and mental component summary score of 50 ± 10 and 51 ± 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life.

Conclusions

Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.
Blood Purification and Mortality in Sepsis and Septic Shock
Authors: Putzu Alessandro , Schorer Raoul , Lopez-Delgado Juan Carlos , Cassina Tiziano , Landoni Giovanni
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting.

Methods

Electronic databases were searched for pertinent studies up to January 2019. We included randomized controlled trials on the use of hemoperfusion, hemofiltration without a renal replacement purpose, and plasmapheresis as a blood purification technique in comparison to conventional therapy in adult patients with sepsis and septic shock. The primary outcome was mortality at the longest follow-up available. We calculated relative risks and 95% CIs. The grading of recommendations assessment, development and evaluation methodology for the certainty of evidence was used.

Results

Thirty-seven trials with 2,499 patients were included in the meta-analysis. Hemoperfusion was associated with lower mortality compared to conventional therapy (relative risk = 0.88 [95% CI, 0.78 to 0.98], P = 0.02, very low certainty evidence). Low risk of bias trials on polymyxin B immobilized filter hemoperfusion showed no mortality difference versus control (relative risk = 1.14 [95% CI, 0.96 to 1.36], P = 0.12, moderate certainty evidence), while recent trials found an increased mortality (relative risk = 1.22 [95% CI, 1.03 to 1.45], P = 0.02, low certainty evidence); trials performed in the United States and Europe had no significant difference in mortality (relative risk = 1.13 [95% CI, 0.96 to 1.34], P = 0.15), while trials performed in Asia had a positive treatment effect (relative risk = 0.57 [95% CI, 0.47 to 0.69], P < 0.001). Hemofiltration (relative risk = 0.79 [95% CI, 0.63 to 1.00], P = 0.05, very low certainty evidence) and plasmapheresis (relative risk = 0.63 [95% CI, 0.42 to 0.96], P = 0.03, very low certainty evidence) were associated with a lower mortality.

Conclusions

Very low-quality randomized evidence demonstrates that the use of hemoperfusion, hemofiltration, or plasmapheresis may reduce mortality in sepsis or septic shock. Existing evidence of moderate quality and certainty does not provide any support for a difference in mortality using polymyxin B hemoperfusion. Further high-quality randomized trials are needed before systematic implementation of these therapies in clinical practice.
A Systematic Review of Definitions for Neurological Complications and Disease Progression in Patients Treated Surgically for Degenerative Cervical Myelopathy
Authors: Tetreault Lindsay , Lange Stefan F. , Chotai Silky , Kryshtalskyj Michael T. , Martin Allan R. , Ahuja Christopher S. , Wilson Jefferson R. , Davies Benjamin M. , Nouri Aria , Devin Clinton , Fehlings Michael G.
Published: July 2019

Study Design.

Systematic review.

Objective.

This review aims to (1) outline how neurological complications and disease progression are defined in the literature and (2) evaluate the quality of definitions using a novel four-point rating system.

Summary of Background Data.

Degenerative cervical myelopathy (DCM) is a progressive, degenerative spine disease that is often treated surgically. Although uncommon, surgical decompression can be associated with neurological complications, such as C5 nerve root palsy, perioperative worsening of myelopathy, and longer-term deterioration. Unfortunately, important questions surrounding these complications cannot be fully addressed due to the heterogeneity in definitions used across studies. Given this variability, there is a pressing need to develop guidelines for the reporting of surgical complications in order to accurately evaluate the safety of surgical procedures.

Methods.

An electronic database search was conducted in MEDLINE, MEDLINE in Process, EMBASE and Cochrane Central Register of Controlled Trials for studies that reported on complications related to DCM surgery and included at least 10 surgically treated patients. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A four-point rating scale was developed to assess definition quality for each complication.

Results.

Our search yielded 2673 unique citations, 42 of which met eligibility criteria and were summarized in this review. Defined complications included neurological deterioration, late onset deterioration, perioperative worsening of myelopathy, C5 palsy, nerve root or upper limb palsy or radiculopathy, surgery failure, inadequate decompression and progression of ossified lesions. Reported rates of these complications varied substantially, especially those for neurological deterioration (0.2%–33.3%) and progression of ossified lesions (0.0%–86.7%).

Conclusion.

Reported incidences of various complications vary widely in DCM surgery, especially for neurological deterioration and progression of ossified lesions. This summary serves as a first step for standardizing definitions and developing guidelines for accurately reporting surgical complications.

Level of Evidence: 2
Low Back Pain Among Medical Students
Authors: Amelot Aymeric , Mathon Bertrand , Haddad Rebecca , Renault Marie-Christine , Duguet Alexandre , Steichen Olivier
Published: July 2019

Study Design.

Prospective study.

Objective.

Determine risk factors and consider impact of low back pain for medical students.

Summary of Background Data.

Low back pain (LBP) is one of the most prevalent complaints among students. The vulnerability of medical students due to stress and numerous hours of studying and training makes them at risk of LBP.

Methods.

We submitted an online self-administered modified version of the Standardized Nordic Questionnaire to 1800 medical students from 2nd to 6th year from December 2017 to March 2018.

Results.

A total of 1243/1800 (68.9%) students responded to our survey. Mean age was 23.3 ± 2.9 years ranging from 18 to 44 years. 835 (72.1%) students reported suffering from LBP. In multivariate analysis with logistic regression analysis model, the third year of medical studies (odds ratio [OR]: 0.558, 95% confidence interval [CI] 0.387–0.805; P = 0.002) was identified as an independent prognostic factor of LBP. Moreover, exercising weekly (OR: 1.835, 95% CI 0.933–2.5; P = 0.01) and walking at least 30 minutes a day (OR: 1.458, 95% CI 1.129–1.876; P = 0.01) significantly improve LBP. LBP generate higher monthly consumption of an analgesic (OR: 32.8, 95% CI 4.271–252.2; P < 0.001). Finally, LBP had a severe repercussion on student work (OR: 18.89, 95% CI 10.122–35.253; P < 0.0001), on the quality of sleep (OR: 12.162, 95% CI 6.917–21.386; P < 0.0001) and on their personal life (OR: 12.343, 95% CI 5.681–26.8; P < 0.0001).

Conclusion.

Medical students reported high prevalence of LBP with severe consequences. Our educational perspective is to identify the risk factors of LBP, fight them, to improve the medical student’ work, and welfare.

Level of Evidence: 3
The Relationship Between Neuropathic Pain and Spinal Alignment
Authors: Imagama Shiro , Ando Kei , Kobayashi Kazuyoshi , Seki Taisuke , Hamada Takashi , Machino Masaaki , Ota Kyotaro , Tanaka Satoshi , Morozumi Masayoshi , Kanbara Shunsuke , Ito Sadayuki , Ishiguro Naoki , Hasegawa Yukiharu
Published: July 2019

Study Design.

Prospective research in middle-aged and elderly people.

Objective.

To investigate low back pain (LBP) and neuropathic pain (NeP); spinal alignment and range of motion (ROM); spinal degenerative changes in plain radiography; osteoporosis; muscle strength; and physical ability as possible risk factors for poor quality of life (QOL).

Summary of Background Data.

The aging of society has led to an increase in elderly people with chronic pain, including LBP and NeP. However, there has been no analysis of NeP and spinal sagittal alignment as potential risk factors for decreased QOL in the healthy general population.

Methods.

The subjects were 1128 people (male 473, female 655, average age: 64.3 yrs) who attended an annual health checkup in Yakumo study. The prevalence of LBP and sciatica were investigated using a visual analogue scale (VAS), and NeP was defined as more than or equal to 13 points on the painDETECT questionnaire. Sagittal spinal alignment with spinal ROM was also measured. Body mass index, muscle strength, physical ability, osteoporosis, and lumbar degenerative changes were measured, and 36-item short-form health survey (SF-36) was used for QOL analysis.

Results.

NeP was present in 113 people (10%). The NeP (+) subjects had significantly more severe pain, lower gait speed, higher osteoporosis rate, lumbar kyphosis, and larger spinal inclination (P < 0.01) compared with NeP (–) subjects. On SF-36, physical and mental QOL were significantly lower for NeP (+) subjects (P < 0.0001). In multivariate logistic regression analysis adjusted for age and sex, NeP (+) (odds ratio [OR]: 3.01), positive spinal inclination (OR: 1.14), and high VAS for LBP (OR: 1.04) were identified as risk factors for low physical QOL, and NeP (+) (OR: 5.32) was the only significant risk factor for low mental QOL.

Conclusion.

These results suggest that interventions for NeP and other identified risk factors may contribute to improvement of low physical and mental QOL in middle-aged and elderly people.

Level of Evidence: 2
Age-related Changes in Cervical Sagittal Alignment
Authors: Tang Ray , Ye Ivan B. , Cheung Zoe B. , Kim Jun S. , Cho Samuel Kang-Wook
Published: July 2019

Study Design.

Retrospective cohort study.

Objective.

To identify age-related changes in cervical sagittal parameters using standard radiographs.

Summary of Background Data.

Cervical sagittal balance is important for the maintenance of neutral head posture and horizontal gaze. Degenerative changes in the cervical spine that occur with aging may alter cervical sagittal balance, which can lead to chronic neck pain and predispose to various cervical spine pathologies.

Methods.

We performed a retrospective cohort study of 151 patients with lateral cervical spine radiographs taken at our institution between December 2017 and June 2018. Cervical sagittal parameters were measured, including C1 inclination, C2 slope, C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA), cervical tilt, upper and lower C7 slopes, T1 slope, and T1 slope minus cervical lordosis (TS-CL). The association between age and cervical sagittal parameters was assessed using the Pearson correlation coefficient and a linear regression analysis. An analysis of variance (ANOVA) with Tukey adjustments was then performed to identify differences in cervical sagittal parameters among patients aged 18 to 39 years, 40 to 64 years, and >64 years of age.

Results.

There were positive correlations between age and C2-C7 Cobb angle (r = 0.231, P = 0.004), upper C7 slope (r = 0.280, P < 0.001), lower C7 slope (r = 0.283, P < 0.001), and T1 slope (r = 0.189, P = 0.020). Upper C7 slope (R2 = 0.079) and lower C7 slope (R2 = 0.074) had the strongest correlation with age in the linear regression analysis. The ANOVA found significant differences among the age subgroups in terms of C2-C7 Cobb angle (P = 0.002), upper C7 slope (P < 0.001), lower C7 slope (P < 0.001), and T1 slope (P = 0.031). Patients >64 years old had significantly higher C2-C7 Cobb angle, upper C7 slope, lower C7 slope, and T1 slope.

Conclusion.

Changes in cervical sagittal alignment with age are characterized by increased cervical lordosis and increased thoracic kyphosis.

Level of Evidence: 3
Utilization and Outcomes for Spine Surgery in the United States and Canada
Authors: Cram Peter , Landon Bruce E. , Matelski John , Ling Vicki , Perruccio Anthony V. , Paterson J. Michael , Rampersaud Y. Raja
Published: July 2019

Study Design.

A retrospective cohort study.

Objective.

The aim of this study was to examine variation in spine surgery utilization between the province of Ontario and state of New York among all patients and pre-specified patient subgroups.

Summary of Background Data.

Spine surgery is common and costly. Within-country variation in utilization is well studied, but there has been little exploration of variation in spine surgery utilization between countries.

Methods.

We used population-level administrative data from Ontario (years 2011–2015) and New York (2011–2014) to identify all adults who underwent inpatient spinal decompression or fusion surgery using relevant procedure codes. Patients were stratified according to age and surgical urgency (elective vs. emergent). We calculated standardized utilization rates (procedures per-10,000 population per year) for each jurisdiction. We compared Ontario and New York with respect to patient demographics and the percentage of hospitals performing spine surgery. We compared utilization rates of spinal decompression and fusion surgery in Ontario and New York among all patients and after stratifying by surgical urgency and patient age.

Results.

Patients in Ontario were older than patients in New York for both decompression (mean age 58.8 vs. 51.3 years; P < 0.001) and fusion (58.1 vs. 54.9; P < 0.001). A smaller percentage of hospitals in Ontario than New York performed decompression (26.1% vs. 54.9%; P < 0.001) or fusion (15.2% vs. 56.7%; P < 0.001). Overall, utilization of spine surgery (decompression plus fusion) in Ontario was 6.6 procedures per-10,000 population per-year and in New York was 16.5 per-10,000 per-year (P < 0.001). Ontario-New York differences in utilization were smaller for emergent cases (2.0 per 10,000 in Ontario vs. 2.5 in New York; P < 0.001), but larger for elective cases (4.6 vs. 13.9; P < 0.001). The lower utilization in Ontario was particularly large among younger patients (age <60 years).

Conclusion.

We found significantly lower utilization of spine surgery in Ontario than in New York. These differences should inform policy reforms in both jurisdictions.

Level of Evidence: 3
The Impact of Body Mass Index (BMI) on 30-day Outcomes Following Posterior Spinal Fusion in Neuromuscular Scoliosis
Authors: Malik Azeem Tariq , Tamer Robert , Yu Elizabeth , Kim Jeffery , Khan Safdar N.
Published: July 2019

Study Design.

Retrospective.

Objective.

Assess the impact of varying severity of BMI on 30-day outcomes following posterior spinal fusions in neuromuscular scoliosis.

Summary of Background Data.

Obesity in the pediatric population is shown to be associated with adverse outcomes across varying specialties. The weight-outcome relationship in neuromuscular scoliosis has not been thoroughly investigated.

Methods.

The 2012–2016 American College of Surgeons – National Surgical Quality Improvement (ACS-NSQIP) database was queried using Current Procedural Terminology codes 22800, 22802, and 22804 to identify patients undergoing posterior spinal fusion for neuromuscular scoliosis only. BMI was classified into four groups based on the Center for Disease Control (CDC) BMI-for-age percentile chart – Normal weight (BMI ≥5th to <85th percentile), Underweight (<5th percentile), Overweight (≥85th to <95th percentile) and Obese (≥95th percentile). Multivariate regression models were built to understand the impact of varying BMI severity classes on 30-day outcomes.

Results.

A total of 1291 patients underwent posterior spinal fusion for neuromuscular scoliosis. A total of 695 (53.8%) were normal weight, 286 (22.2%) were underweight, 145 (11.2%) were overweight, and 165 (12.8%) were obese. Obese patients versus normal weight patients were at a significantly higher risk of surgical site infections (OR 2.15; P = 0.035), wound dehiscence (OR 1.58; P = 0.037), urinary tract infections (OR 3.41; P = 0.010), and 30-day readmissions (OR 1.94; P = 0.029). Of note, overweight versus normal weight individuals had higher odds of cardiopulmonary complications (OR 8.82; P = 0.024). No significant associations were seen for varying BMI and other 30-day outcomes.

Conclusions.

Obese neuromuscular patients undergoing PSF have higher odds of experiencing adverse outcomes, particularly surgical site infections, urinary tract infections, and readmissions. Providers should promote prevention strategies, such as dietary modification and/or early physical activity in these high-risk patients to minimize the risks of experiencing complications in the acute postoperative period.

Level of Evidence: 3
The Amount of Relative Curve Correction Is More Important Than Upper Instrumented Vertebra Selection for Ensuring Postoperative Shoulder Balance in Lenke Type 1 and Type 2 Adolescent Idiopathic Scoliosis
Authors: Sielatycki John Alex , Cerpa Meghan , Beauchamp Eduardo C. , Shimizu Takayoshi , Wei Chao , Pongmanee Suthipas , Wang Hui , Xue Rui , Zhou Rongping , Liu Xinchun , Yang Jun , Suomao Yuan , Lenke Lawrence G.
Published: July 2019

Study Design.

Retrospective review of a prospectively collected multicenter database.

Objective.

To assess how “overcorrection” of the main thoracic curve without control of the proximal curve increases the risk for shoulder imbalance in Lenke type 1 Adolescent Idiopathic Scoliosis (AIS).

Summary of Background Data.

Postop shoulder imbalance is a common complication following AIS surgery. It is thought that a more cephalad upper-instrumented vertebra (UIV) decreases the risk of shoulder imbalance in Lenke type 1 and 2 curves; however, this has not been proven.

Methods.

Thirteen surgeons reviewed preop and 5-year postop clinical photos and PA radiographs of patients from a large multicenter database with Lenke type 1 and 2 AIS curves who were corrected with pedicle screw/rod constructs. Predictors of postop shoulder imbalance were identified by univariate analysis; multivariate analysis was done using the classification and regression tree method to identify independent drivers of shoulder imbalance.

Results.

One hundred forty-five patients were reviewed. The UIV was T3-T5 in 87% of patients, with 8.9% instrumented up to T1 or T2. Fifty-two (36%) had shoulder imbalance at 5 years. On classification and regression tree analysis when the proximal thoracic (PT) Cobb angle was corrected more than 52%, 80% of the patients had balanced shoulders. Similarly, when the PT curve was corrected less than 52% and the main thoracic (MT) curve was corrected less than 54%, 87% were balanced. However, when the PT curve was corrected less than 52%, and the MT curve was corrected more than 54%, only 41% of patients had balanced shoulders (P = 0.05). This relationship was maintained regardless of the UIV level.

Conclusion.

In Lenke type 1 and 2 AIS curves, significant correction of the main thoracic curve (>54%) with simultaneous “under-correction” (<52%) of the upper thoracic curve resulted in shoulder height imbalance in 59% of patients, regardless of the UIV. This suggests the PT curve must be carefully scrutinized in order to optimize shoulder balance, especially when larger correction of the MT curve is performed.

Level of Evidence: 2
Reclassifying endometrial carcinomas with a combined morphological and molecular approach
Authors: Carlson Joseph , McCluggage W. Glenn
Published: July 2019

Purpose of review

Currently, endometrial carcinoma diagnosis is based on morphology, often supplemented by immunohistochemistry. However, especially with high-grade endometrial carcinomas, there is considerable interobserver variability in diagnosis calling into question the value of morphology in stratifying these tumours into different prognostic and therapeutic groups. The purpose of this review is to provide an update on the recently described molecular classification of endometrial carcinoma.

Recent findings

In 2013, the Cancer Genome Atlas (TCGA) published a seminal molecular study of endometrial carcinomas of endometrioid, serous and mixed types. This revealed that endometrial carcinoma consists of four intrinsic molecular subtypes: POLE (ultramutated), microsatellite instabilty (hypermutated), copy-number low (also referred to as microsatellite stable or no specific molecular profile) and copy-number high (serous-like). These four molecular subtypes are of prognostic significance with POLE tumours having the best and copy-number high, the worst prognosis.

It is likely that TCGA classification will become the mainstay of endometrial carcinoma diagnosis in the coming years and various strategies (Proactive Molecular Risk Classifier for Endometrial Cancer and the TransPORTEC classifiers) have been proposed for a combined morphological–molecular classification which can be undertaken in most pathology laboratories. This will necessitate routine undertaking of POLE mutation analysis in some endometrial carcinomas and require an appropriate infrastructure.
Nivolumab and Ipilimumab-induced Acute Inflammatory Demyelinating Polyradiculoneuropathy: A Case Report
Authors: Pomerantz Madison , Lichtenstein Daniel A. , Niesvizky-Kogan Itamar , Sohal Raman , Leibovitch Jennifer , Basnet Alina
Published: July 2019

Immunotherapies such as the cytotoxic T-lymphocyte–associated protein 4 inhibitor ipilimumab and the programmed cell death protein 1 inhibitor nivolumab have become ubiquitous in cancer treatment. Recently, the FDA approved nivolumab with or without ipilimumab for the treatment of refractory small cell lung cancer. Immunotherapies increase the immune response to cancer cells by interfering with inhibitory molecular pathways that prevent tumor cell killing, thus augmenting tumor cell death without many of the cytotoxic side effects associated with chemotherapy. However, this augmented immune response may result in unwanted immune-mediated inflammation of different organs and are therefore associated with immune-related adverse events, unlike traditional chemotherapies or targeted therapies. Here, we describe 1 patient with advanced small cell lung cancer who developed grade III–IV acute inflammatory demyelinating polyradiculoneuropathy after treatment with ipilimumab and nivolumab. The patient was treated with intravenous immunoglobulin alone and showed symptomatic improvement.