bluuebunny/crossref_metadata_2025 huggingface dataset:
Smoking literacy amongst adult Asian asthma patients in primary care
Authors: Ngoh Agnes Soh Heng , Chen Zhao Jin , Tai Bee Choo , Teo Stephanie Swee Hong , Tan Ngiap Chuan
Published: April 2017

Background:

Smoking is a known trigger of asthma exacerbation. Yet some patients with asthma continue to smoke. Little is known about their smoking literacy, which is defined as an individual’s capacity to comprehend and use healthcare information relating to smoking. This study aimed to determine the level of smoking literacy amongst patients with asthma, who were smokers (S) and non-smokers (NS).

Methods:

Standardised questionnaires were administered by trained research assistants to adult multi-ethnic Asian patients with asthma, who were managed in three public primary care clinics (polyclinics) in Singapore. Demographic data and information on a subject’s understanding and effects of smoking on health and complications were collected. The latter were computed into knowledge scores and the mean scores between S and NS were compared using the independent two-sample t-test with adjustment for potential confounders via multiple linear regression.

Results:

A total of 174 S and 183 NS were recruited with a higher proportion of younger male S. Overall, the knowledge score for S was significantly lower than NS (absolute mean difference (AMD) = −0.95, 95% confidence interval (CI) −1.58 to −0.33, p = 0.003). This was particularly for smoking associated specific respiratory disease (AMD = −0.23, 95% CI −0.44 to −0.02, p =0.034) and asthma symptoms (AMD = −0.73, 95% CI −0.98 to −0.47, p < 0.001). The differences persisted after adjusting for other important factors such as gender and education level.

Conclusions:

Compared with NS, S generally reported lower scores in their overall knowledge, and the knowledge in the association between smoking and specific respiratory diseases and asthma symptoms. Smoker patients may require measures to raise their smoking literacy during the counselling to optimise their smoking cessation success rates.
The experience of work stress and the context of time
Authors: Eldor Liat , Fried Yitzhak , Westman Mina , Levi Ariel S. , Shipp Abbie J. , Slowik Linda H.
Published: April 2017

Scholars have generally neglected the importance of the subjective aspects of time in the field of work stress. In this paper we analyze the joint effects of employee perceptions of subjective time and cultural, organizational, individual, and situational factors on employee experiences of stress. By explicitly considering the role of subjective time in stress research, we develop several propositions and discuss recommendations for future research. We discuss implications for organizational practice in reducing stress, revolving around the manipulation and experience of time.
Mucopolysaccharidoses Causing Valvular Heart Disease: Report and Review of Surgical Management
Authors: Encarnacion Carlos O. , Hang Dustin , Earing Michael , Mitchell Michael E.
Published: April 2017

Mucopolysaccharidosis type I is a genetic disorder with impaired glycosaminoglycan degradation. Cardiac pathologic involvement in this subset of patients is predominantly valvular heart disease. Valvular heart disease seen in these patients will most likely require surgical intervention in their lifetime. Only a limited amount of reports are dedicated to the cardiac surgical management of mucopolysaccharidoses. We present the case of a 32-year-old female with Hurler-Scheie syndrome who required multiple valve replacements due to progression of valvular dysfunction and decline in the quality of life. Multidisciplinary evaluation and discussion early are crucial for quality of life optimization in this cohort of patients.
The Economic Might of Earth’s Evolution: The Epic Promise of Knowledge
Authors: Ayala Hana
Published: April 2017

The article presents original economic and business models that, in their interplay, have the capacity to shepherd the sustainability and conservation legacy of the emerging global knowledge economy. These models are framed by an assertion that our planet holds a vast reserve that could define the 21st century as profoundly as oil has shaped the 20th century. They are premised on a comparison: Unlike oil or mineral ores whose global volume is just a sum of their deposits across the world, the 21st-century reserve—the yet-to-be-tapped scientific knowledge embedded in biologically opulent landscapes and seascapes—grows in volume and worth in the context of evolutionary, ecological, and other relationships that transcend regions and political borders. They are grounded in legacy-investment opportunities whose competitiveness and prestige grow along with the geographical footprint of the research they underwrite. While various stages of these models’ conceptualization and validation have been published in scholarly journals and enriched with endorsements by several members and officers of the United States National Academy of Sciences and by heads of state and UNESCO (United Nations Educational, Scientific, and Cultural Organization) leaders, this article is the first comprehensive presentation of both. It pioneers their integration into a catalyst of a new economic geography. It charts a paradigm of “noble wealth,” not intended to replace oil wealth but to outperform it in endurance and lasting benefit to humanity.
Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study
Authors: Hsu Wellington K. , Kannan Abhishek , Mai Harry T. , Fehlings Michael G. , Smith Zachary A. , Traynelis Vincent C. , Gokaslan Ziya L. , Hilibrand Alan S. , Nassr Ahmad , Arnold Paul M. , Mroz Thomas E. , Bydon Mohamad , Massicotte Eric M. , Ray Wilson Z. , Steinmetz Michael P. , Smith Gabriel A. , Pace Jonathan , Corriveau Mark , Lee Sungho , Isaacs Robert E. , Wang Jeffrey C. , Lord Elizabeth L. , Buser Zorica , Riew K. Daniel
Published: April 2017

Study Design:

A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI).

Objective:

To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery.

Methods:

Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36).

Results:

VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery ( P = .20-.94).

Conclusions:

Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits.
A Multicenter Review of Superior Laryngeal Nerve Injury Following Anterior Cervical Spine Surgery
Authors: Tempel Zachary J. , Smith Justin S. , Shaffrey Christopher , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , Riew K. Daniel , Kanter Adam S.
Published: April 2017

Study Design:

A retrospective multicenter case-series study; case report and review of the literature.

Objective:

The anatomy and function of the superior laryngeal nerve (SLN) are well described; however, the consequences of SLN injury remain variable and poorly defined. The prevalence of SLN injury as a consequence of cervical spine surgery is difficult to discern as its clinical manifestations are often inconstant and frequently of a subclinical degree. A multicenter study was performed to better delineate the risk factors, prevalence, and outcomes of SLN injury.

Methods:

A retrospective multicenter case-series study involving 21 high-volume surgical centers from the AO Spine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. A retrospective review of the neurosurgical literature on SLN injury was also performed.

Results:

A total of 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened, and 1 case of SLN palsy was identified. The prevalence ranged from 0% to 1.25% across all centers. The patient identified underwent a C4 corpectomy. The SLN injury was identified after the patient demonstrated difficulty swallowing postoperatively. He underwent placement of a percutaneous gastrostomy tube and his SLN palsy resolved by 6 weeks.

Conclusions:

This multicenter study demonstrates that identification of SLN injury occurs very infrequently. Symptomatic SLN injury is an exceedingly rare complication of anterior cervical spine surgery. The SLN is particularly vulnerable when exposing the more rostral levels of the cervical spine. Careful dissection and retraction of the longus coli may decrease the risk of SLN injury during anterior cervical surgery.
Misplaced Cervical Screws Requiring Reoperation
Authors: Peterson Jeremy C. , Arnold Paul M. , Smith Zachary A. , Hsu Wellington K. , Fehlings Michael G. , Hart Robert A. , Hilibrand Alan S. , Nassr Ahmad , Rahman Ra’Kerry K. , Tannoury Chadi A. , Tannoury Tony , Mroz Thomas E. , Currier Bradford L. , De Giacomo Anthony F. , Fogelson Jeremy L. , Jobse Bruce C. , Massicotte Eric M. , Riew K. Daniel
Published: April 2017

Study Design:

A multicenter, retrospective case series.

Objective:

In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication.

Methods:

A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center.

Results:

A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%).

Conclusions:

This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.
Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature
Authors: Hershman Stuart H. , Kunkle William A. , Kelly Michael P. , Buchowski Jacob M. , Ray Wilson Z. , Bumpass David B. , Gum Jeffrey L. , Peters Colleen M. , Singhatanadgige Weerasak , Kim Jin Young , Smith Zachary A. , Hsu Wellington K. , Nassr Ahmad , Currier Bradford L. , Rahman Ra’Kerry K. , Isaacs Robert E. , Smith Justin S. , Shaffrey Christopher , Thompson Sara E. , Wang Jeffrey C. , Lord Elizabeth L. , Buser Zorica , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , Riew K. Daniel
Published: April 2017

Study Design:

Multicenter retrospective case series and review of the literature.

Objective:

To determine the rate of esophageal perforations following anterior cervical spine surgery.

Methods:

As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients’ charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis.

Results:

The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired.

Conclusions:

Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.
Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication
Authors: Ghobrial George M. , Harrop James S. , Sasso Rick C. , Tannoury Chadi A. , Tannoury Tony , Smith Zachary A. , Hsu Wellington K. , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , De Giacomo Anthony F. , Jobse Bruce C. , Rahman Ra’Kerry K. , Thompson Sara E. , Riew K. Daniel
Published: April 2017

Study Design:

Retrospective multi-institutional case series.

Objective:

The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.

Methods:

A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections.

Results:

A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities.

Conclusion:

The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to retrospective series.
Prevalence and Outcomes in Patients Undergoing Reintubation After Anterior Cervical Spine Surgery: Results From the AOSpine North America Multicenter Study on 8887 Patients
Authors: Nagoshi Narihito , Fehlings Michael G. , Nakashima Hiroaki , Tetreault Lindsay , Gum Jeffrey L. , Smith Zachary A. , Hsu Wellington K. , Tannoury Chadi A. , Tannoury Tony , Traynelis Vincent C. , Arnold Paul M. , Mroz Thomas E. , Gokaslan Ziya L. , Bydon Mohamad , De Giacomo Anthony F. , Jobse Bruce C. , Massicotte Eric M. , Riew K. Daniel
Published: April 2017

Study Design:

A multicenter, retrospective cohort study.

Objective:

To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery.

Methods:

A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey.

Results:

Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life.

Conclusions:

Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.
Epidural Hematoma Following Cervical Spine Surgery
Authors: Schroeder Gregory D. , Hilibrand Alan S. , Arnold Paul M. , Fish David E. , Wang Jeffrey C. , Gum Jeffrey L. , Smith Zachary A. , Hsu Wellington K. , Gokaslan Ziya L. , Isaacs Robert E. , Kanter Adam S. , Mroz Thomas E. , Nassr Ahmad , Sasso Rick C. , Fehlings Michael G. , Buser Zorica , Bydon Mohamad , Cha Peter I. , Chatterjee Dhananjay , Gee Erica L. , Lord Elizabeth L. , Mayer Erik N. , McBride Owen J. , Nguyen Emily C. , Roe Allison K. , Tortolani P. Justin , Stroh D. Alex , Yanez Marisa Y. , Riew K. Daniel
Published: April 2017

Study Design:

A multicentered retrospective case series.

Objective:

To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine.

Methods:

Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified.

Results:

A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment ( P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation.

Conclusion:

This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.
Rare Complications of Cervical Spine Surgery: Pseudomeningocoele
Authors: Ailon Tamir , Smith Justin S. , Nassr Ahmad , Smith Zachary A. , Hsu Wellington K. , Fehlings Michael G. , Fish David E. , Wang Jeffrey C. , Hilibrand Alan S. , Mummaneni Praveen V. , Chou Dean , Sasso Rick C. , Traynelis Vincent C. , Arnold Paul M. , Mroz Thomas E. , Buser Zorica , Lord Elizabeth L. , Massicotte Eric M. , Sebastian Arjun S. , Than Khoi D. , Steinmetz Michael P. , Smith Gabriel A. , Pace Jonathan , Corriveau Mark , Lee Sungho , Riew K. Daniel , Shaffrey Christopher
Published: April 2017

Study Design:

This study was a retrospective, multicenter cohort study.

Objectives:

Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience.

Methods:

This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC.

Results:

Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects.

Conclusions:

PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.
Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review
Authors: Härtl Roger , Alimi Marjan , Abdelatif Boukebir Mohamed , Berlin Connor D. , Navarro-Ramirez Rodrigo , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , Riew K. Daniel
Published: April 2017

Study Design:

Retrospective study and literature review.

Objective:

To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery.

Methods:

We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17 625 patients who went through cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were analyzed. Also, we performed a literature review using Medline and PubMed databases. The following terms were used alone, and in combination, to search for relevant articles: cervical, spine, surgery, complication, iatrogenic, carotid artery, injury, cerebrovascular accident, CVA, and carotid stenosis.

Results:

Among 17 625 patients that were analyzed, no cases were reported to experienced CAI or CVA after cervical spine surgery. Nevertheless, in our PubMed search we found 157 articles, but only 5 articles matched our study objective criteria; 2 cases were reported to present CAI and 3 cases presented CVA.

Conclusions:

CAI and CVA related to anterior cervical spine surgeries are extremely rare. We were not able to find neither in our retrospective study nor in our literature research a correlation between the type or length of anterior cervical spine procedure with CVA or CAI complications. However, surgeons should be aware of the possibility of vascular complications and minimize intraoperative direct vascular manipulations or retraction. Preoperative screening for underlying vascular pathology and risk factors is also important.
Thoracic Duct Injury Following Cervical Spine Surgery: A Multicenter Retrospective Review
Authors: Derakhshan Adeeb , Lubelski Daniel , Steinmetz Michael P. , Corriveau Mark , Lee Sungho , Pace Jonathan R. , Smith Gabriel A. , Gokaslan Ziya , Bydon Mohamad , Arnold Paul M. , Fehlings Michael G. , Riew K. Daniel , Mroz Thomas E.
Published: April 2017

Study Design:

Multicenter retrospective case series.

Objective:

To determine the rate of thoracic duct injury during cervical spine operations.

Methods:

A retrospective case series study was conducted among 21 high-volume surgical centers to identify instances of thoracic duct injury during anterior cervical spine surgery. Staff at each center abstracted data for each identified case into case report forms. All case report forms were collected by the AOSpine North America Clinical Research Network Methodological Core for data processing, cleaning, and analysis.

Results:

Of a total of 9591 patients reviewed that underwent cervical spine surgery, 2 (0.02%) incurred iatrogenic injury to the thoracic duct. Both patients underwent a left-sided anterior cervical discectomy and fusion. The interruption of the thoracic duct was addressed intraoperatively in one patient with no residual postoperative effects. The second individual developed a chylous fluid collection approximately 2 months after the operation that required drainage via needle aspiration.

Conclusions:

Damage to the thoracic duct during cervical spine surgery is a relatively rare occurrence. Rapid identification of the disruption of this lymphatic vessel is critical to minimize deleterious effects of this complication.
Evaluation of Adverse Events in Total Disc Replacement: A Meta-Analysis of FDA Summary of Safety and Effectiveness Data
Authors: Anderson Paul A. , Nassr Ahmad , Currier Bradford L. , Sebastian Arjun S. , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , Riew K. Daniel
Published: April 2017

Study Design:

Systematic review and meta-analysis.

Objectives:

The safety of new technology such as cervical total disc replacement (TDR) is of paramount importance and is best evaluated in randomized clinical trials (RCT). We compared complication risks of TDR to fusion using data from Investigational Device Exemptions.

Methods:

A systematic review of FDA Summary of Safety and Effectiveness reports of the 8 approved cervical TDRs was performed. These were all randomized controlled trials comparing anterior cervical discectomy and fusion (ACDF) to TDR. Important outcome variables were dysphagia, wound infection, neurologic injuries, heterotopic ossification, death, and secondary surgeries. A random effects model was selected a priori. Data on adverse events was abstracted and analyzed by calculating relative risk of ACDF to TDR by meta-analysis techniques.

Results:

The study included 3027 patients with 1377 randomized to ACDF and 1652 to TDR. No statistical differences were present between the 2 groups in dysphagia/dysphonia, hardware related, heterotopic ossification, death, and overall neurologic adverse events and incidence of neurologic deterioration. The relative risk of wound-related problems ACDF to TDR was 0.76 (95% confidence interval [CI] = 0.59, 0.98) favoring ACDF, which was statistically significant, but these were minor and never required a second surgical procedure for deep wound infection. The relative risk of ACDF to TDR in surgical-related neurologic events and secondary surgeries was 1.62 (95% CI = 1.04, 2.53) and 1.79 (95% CI = 1.17, 2.74), both favoring TDR.

Conclusions:

Cervical TDR appears to be as safe as or safer than ACDF at 2-year follow-up.
Perioperative Vision Loss in Cervical Spinal Surgery
Authors: Gabel Brandon C. , Lam Arthur , Chapman Jens R. , Oskouian Rod J. , Nassr Ahmad , Currier Bradford L. , Sebastian Arjun S. , Arnold Paul M. , Hamilton Steven R. , Fehlings Michael G. , Mroz Thomas E. , Riew K. Daniel
Published: April 2017

Study Design:

Retrospective multicenter case series.

Objective:

To assess the rate of perioperative vision loss following cervical spinal surgery.

Methods:

Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery.

Results:

Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining 4355 cases were posterior and/or circumferential fusions. There were no cases of blindness or vision loss in the postoperative period reported during the sampling period.

Conclusions:

Perioperative vision loss following cervical spinal surgery is exceedingly rare.
Mindfulness-based Stress Reduction for Executives: Results from a Field Experiment
Authors: Mulla Zubin R. , Govindaraj Kalaiselvan , Polisetti Srinivasa Rao , George Elis , More Nagraj Rao S.
Published: April 2017

Mindfulness-based meditation has been reported to produce positive effects on psychological and physiological well-being, and to reduce stress levels. The present study examined the effects of a 16-week mindfulness-based stress reduction (MBSR) program on stress levels and self-compassion of 22 executives of a large public sector oil company located in the south of India. The study was a pre- and post-test experimental design in which participants were tested for physiological and psychological parameters, both before and after the intervention. Physiological assessment was carried out through the testing of blood cortisol and measurement of systolic and diastolic blood pressure. Participants also reported on variables such as self-compassion, and various stress indicators such as physical indicators, sleep indicators, behavioral indicators, emotional indicators, and personal habits. Results from the present study suggest that a 16-week MBSR intervention not only had a positive impact on various stress indicators (physical, sleep, behavioral, emotional, and personal habits) and self-compassion but also reduced systolic and diastolic blood pressure and blood cortisol levels. The findings suggest that MBSR can be a useful stress management intervention for addressing the issues of high stress for senior executives in Indian organizations.
Association of Autoimmune Hepatitis and Celiac Disease: Role of Gluten-Free Diet in Reversing Liver Dysfunction
Authors: Iqbal Umair , Chaudhary Ahmad , Karim Muhammad Arsalan , Siddiqui Muhammad Arsalan , Anwar Hafsa , Merrell Nancy
Published: April 2017

Autoimmune hepatitis (AIH) is a chronic inflammation of liver with unclear etiology. It is frequently associated other autoimmune diseases, and its association with celiac disease (CD) is well established. In this article, we describe the case of a 50-year-old male with long-standing AIH taking azathioprine for 10 years, evaluated for flares in transaminases. Despite adding high-dose corticosteroids, his transaminases and bilirubin remained high. Serology for CD was ordered, which revealed elevated tissue transglutaminase antibody IgG and endomysial IgA, which was further confirmed by endoscopic biopsy. Strict gluten-free diet was advised and now for over 2 years he is in remission with azathioprine and budesonide. This emphasizes the role of gluten-free diet in reversing liver dysfunction in patients with AIH, and clinicians should consider screening for CD in patients with AIH with persistent elevation of liver enzymes despite immunosuppressant treatment.
Generalized Joint Hypermobility Is Predictive of Hip Capsular Thickness
Authors: Devitt Brian M. , Smith Bjorn N. , Stapf Robert , Tacey Mark , O’Donnell John M.
Published: April 2017

Background:

The pathomechanics of hip microinstability are not clearly defined but are thought to involve anatomical abnormalities, repetitive forces across the hip, and ligamentous laxity.

Purpose/Hypothesis:

The purpose of this study was to explore the relationship between generalized joint hypermobility (GJH) and hip capsular thickness. The hypothesis was that GJH would be predictive of a thin hip capsule.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A prospective study was performed on 100 consecutive patients undergoing primary hip arthroscopy for the treatment of hip pain. A Beighton test score (BTS) was obtained prior to each procedure. The maximum score was 9, and a score of ≥4 was defined as hypermobile. Capsular thickness at the level of the anterior portal, corresponding to the location of the iliofemoral ligament, was measured arthroscopically using a calibrated probe. The presence of ligamentum teres (LT) pathology was also recorded.

Results:

Fifty-five women and 45 men were included in the study. The mean age was 32 years (range, 18-45 years). The median hip capsule thickness was statistically greater in men than women (12.5 and 7.5 mm, respectively). The median BTS for men was 1 compared with 4 for women ( P < .001). A statistically significant association was found between BTS and capsular thickness; a BTS of <4 is strongly predictive of having a capsular thickness of ≥10 mm, while a BTS ≥4 correlates with a capsular thickness of <10 mm. There was a statistically greater incidence of LT tears in patients with a capsular thickness of ≤7.5 mm and a BTS of ≥4 ( P < .001).

Conclusion:

Measurement of the GJH is highly predictive of hip capsular thickness. A BTS of <4 correlates significantly with a capsular thickness of ≥10 mm, while a BTS ≥4 correlates significantly with a thickness of <10 mm.
Measuring Self-Reported Discrimination: Trends in Question Wording Used in Publicly Accessible Datasets
Authors: Denise Eric Joy , Hagiwara Nao
Published: April 2017

Research on Americans’ self-reported experiences of discrimination or unfair treatment (hereafter collectively referred to as differential treatment) has proliferated since the 1960s. Despite the growth of this research, some health scholars express concern about how to effectively measure self-reported experiences of differential treatment. Specifically, it has been suggested that the term discrimination is emotionally charged and that more neutral terms, such as unfair treatment, should be used instead. This study documents trends in question wording used to capture self-reported differential treatment in publicly accessible U.S. health and social science surveys. Our systematic review of 221 publicly available surveys reveals that there was a slight decline in social scientists’ use of the once dominant term discrimination. Yet, there has been no consensus in question wording in health surveys, as health scholars increasingly use discrimination, unfair treatment, or other (e.g., because you are) or multiple terms ( discrimination or unfair treatment) at nearly equal frequencies. We conclude by discussing the potential implications of these shifts and disciplinary variations in question wording on discrimination research and highlighting several important directions for future research.
GISCOME – Genetics of Ischaemic Stroke Functional Outcome network: A protocol for an international multicentre genetic association study
Authors: Maguire Jane M , Bevan Steve , Stanne Tara M , Lorenzen Erik , Fernandez-Cadenas Israel , Hankey Graeme J , Jimenez-Conde Jordi , Jood Katarina , Lee Jin-Moo , Lemmens Robin , Levi Christopher , Norrving Bo , Rannikmae Kristiina , Rost Natalia , Rosand Jonathan , Rothwell Peter M , Scott Rodney , Strbian Daniel , Sturm Jonathan , Sudlow Cathie , Traylor Matthew , Thijs Vincent , Tatlisumak Turgut , Wieloch Tadeusz , Woo Daniel , Worrall Bradford B , Jern Christina , Lindgren Arne
Published: April 2017

Introduction

Genome-wide association studies have identified several novel genetic loci associated with stroke risk, but how genetic factors influence stroke outcome is less studied. The Genetics of Ischaemic Stroke Functional outcome network aims at performing genetic studies of stroke outcome. We here describe the study protocol and methods basis of Genetics of Ischaemic Stroke Functional outcome.

Methods

The Genetics of Ischaemic Stroke Functional outcome network has assembled patients from 12 ischaemic stroke projects with genome-wide genotypic and outcome data from the International Stroke Genetics Consortium and the National Institute of Neurological Diseases Stroke Genetics Network initiatives. We have assessed the availability of baseline variables, outcome metrics and time-points for collection of outcome data.

Results

We have collected 8831 ischaemic stroke cases with genotypic and outcome data. Modified Rankin score was the outcome metric most readily available. We detected heterogeneity between cohorts for age and initial stroke severity (according to the NIH Stroke Scale), and will take this into account in analyses. We intend to conduct a first phase genome-wide association outcome study on ischaemic stroke cases with data on initial stroke severity and modified Rankin score within 60–190 days. To date, we have assembled 5762 such cases and are currently seeking additional cases meeting these criteria for second phase analyses.

Conclusion

Genetics of Ischaemic Stroke Functional outcome is a unique collection of ischaemic stroke cases with detailed genetic and outcome data providing an opportunity for discovery of genetic loci influencing functional outcome. Genetics of Ischaemic Stroke Functional outcome will serve as an exploratory study where the results as well as the methodological observations will provide a basis for future studies on functional outcome. Genetics of Ischaemic Stroke Functional outcome can also be used for candidate gene replication or assessing stroke outcome non-genetic association hypotheses.
Progressive Massive Choroidal Neovascularization
Authors: Cheung Albert Y. , Rao Prethy , Yonekawa Yoshihiro , Thomas Benjamin J. , Shah Aparna , Garretson Bruce R. , Capone Antonio , Hassan Tarek S.
Published: April 2017

Purpose:

A small subset of patients with neovascular age-related macular degeneration (AMD) can have relentless progression of choroidal neovascularization (CNV) and subsequent disciform scarring (DS) with extension beyond the vascular arcades to the equator. We present the clinical courses of this severe phenotype of progressive massive CNV (PM-CNV).

Methods:

Retrospective case series of 14 eyes of 8 patients who presented with (1) massive DS encompassing the posterior pole and extending to the equator and (2) progressive DS expansion despite treatment between 2004 and 2015 at a tertiary referral center. Demographics, clinical and ocular characteristics, fluorescein angiographic findings, and treatment regimens were reviewed.

Results:

Baseline characteristics included a mean age of 73.0 years (range, 65.- 86.9 years) with 7 (87.5%) women. Six (75%) patients had bilateral PM-CNV. Mean follow-up was 10.5 years (range, 0.5-18.2 years). Ten (71.4%) eyes underwent intravitreal anti-vascular endothelial growth factor therapy, 3 (21.4%) intravitreal corticosteroid injections, and 3 photodynamic therapy. Most eyes (92.9%) demonstrated subretinal hemorrhage at the edge of the DS prior to DS expansion during treatment. Of the 6 patients with bilateral PM-CNV, 5 developed DS in 1 eye earlier than the subsequent eye (mean time, 63.6 months). Final visual acuity was ≤20/400 in all eyes (20/400 [n = 1]), count fingers (n = 5), hand motions (n = 5), and no light perception (n = 3).

Conclusion:

Progressive massive CNV is a profound reactivation of DS in some AMD eyes and is associated with severe, often bilateral, vision loss.
Calcium phosphates and silicon: exploring methods of incorporation
Authors: Rodrigues Ana I. , Reis Rui L. , van Blitterswijk Clemens A. , Leonor Isabel B. , Habibović Pamela
Published: April 2017

Background

Bioinorganics have been explored as additives to ceramic bone graft substitutes with the aim to improve their performance in repair and regeneration of large bone defects. Silicon (Si), an essential trace element involved in the processes related to bone formation and remodeling, was shown not only to enhance osteoblasts proliferation but also to stimulate the differentiation of mesenchymal stem cells (MSCs) and preosteoblasts into the osteogenic lineage. In this study, the added value of Si to calcium phosphate (CaP) coatings was evaluated.

Methods

Tissue culture plastic well plates were coated with a thin CaP layer to which traces amounts of Si were added, either by adsorption or by incorporation through coprecipitation. The physicochemical and structural properties of the coatings were characterized and the dissolution behavior was evaluated. The adsorption/incorporation of Si was successfully achieved and incorporated ions were released from the CaP coatings. Human MSCs were cultured on the coatings to examine the effects of Si on cell proliferation and osteogenic differentiation. For the statistical analysis, a one-way ANOVA with Bonferroni post-hoc test was performed.

Results

The results showed that human MSCs ﻿(hMSCs)﻿ responded to the presence of Si in the CaP coatings, in a dose-dependent manner. An increase in the expression of markers of osteogenic differentiation by human MSCs was observed as a result of the increase in Si concentration.

Conclusions

The incorporation/adsorption of Si into CaP coatings was successfully achieved and hMSCs responded with an increase in osteogenic genes expression with the increase of Si concentration. Furthermore, hMSCs cultured on CaP-I coatings expressed higher levels of ALP and OP, indicating that this may be the preferred method of incorporation of bioinorganics into CaPs.
Gestational Diabetes Alters Functions in Offspring’s Umbilical Cord Cells With Implications for Cardiovascular Health
Authors: Amrithraj Ajith Isaac , Kodali Anjaneyulu , Nguyen Linh , Teo Adrian Kee Keong , Chang Cheng Wei , Karnani Neerja , Ng Kai Lyn , Gluckman Peter D. , Chong Yap Seng , Stünkel Walter
Published: April 2017

Because noncommunicable diseases such as type 2 diabetes mellitus have their roots in prenatal development and conditions such as maternal gestational diabetes mellitus (GDM), we aimed to test this hypothesis in primary cells derived from the offspring of mothers with GDM compared with control subjects. We have assessed primary umbilical cord–derived cells such as human umbilical vein endothelial cells (HUVECs) and Wharton’s jelly–derived mesenchymal stem cells from the offspring of mothers with and without GDM. We have compared the primary isolates in cell-based assays measuring proliferation, mitochondrial oxygen consumption, and the ability to support blood vessel growth. We conducted gene expression microarray studies with subsequent pathway analysis and candidate gene validation. We observed striking differences between the two groups, such as lower metabolic rates and impairment of endothelial tube formation in cells with GDM background. HUVECs from subjects with maternal GDM have lower expression of the antiapoptotic protein BCL-xL, suggesting compromised angiogenic capabilities. Comparative gene expression analysis revealed blood vessel formation as a major pathway enriched in the GDM-derived HUVECs with the surface marker CD44 as a gene underexpressed in the GDM group. Functional validation of CD44 revealed that it regulates tube formation in HUVECs, thereby providing insights into a pathway imprinted in primary umbilical cord–derived cells from GDM offspring. Our data demonstrate that primary cells isolated from the umbilical cord of offspring born to mothers with GDM maintain metabolic and molecular imprints of maternal hyperglycemia, reflecting an increased risk for cardiovascular disease later in life.
Preconception Low-Dose Aspirin Restores Diminished Pregnancy and Live Birth Rates in Women With Low-Grade Inflammation: A Secondary Analysis of a Randomized Trial
Authors: Sjaarda Lindsey A. , Radin Rose G. , Silver Robert M. , Mitchell Emily , Mumford Sunni L. , Wilcox Brian , Galai Noya , Perkins Neil J. , Wactawski-Wende Jean , Stanford Joseph B. , Schisterman Enrique F.
Published: April 2017

Context:

Inflammation is linked to causes of infertility. Low-dose aspirin (LDA) may improve reproductive success in women with chronic, low-grade inflammation.

Objective:

To investigate the effect of preconception-initiated LDA on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy.

Design:

Stratified secondary analysis of a multicenter, block-randomized, double-blind, placebo-controlled trial.

Setting:

Four US academic medical centers, 2007 to 2012.

Participants:

Healthy women aged 18 to 40 years (N = 1228) with one to two prior pregnancy losses actively attempting to conceive.

Intervention:

Preconception-initiated, daily LDA (81 mg) or matching placebo taken up to six menstrual cycles attempting pregnancy and through 36 weeks’ gestation in women who conceived.

Main Outcome Measures:

Confirmed pregnancy, live birth, and pregnancy loss were compared between LDA and placebo, stratified by tertile of preconception, preintervention serum high-sensitivity C-reactive protein (hsCRP) (low, <0.70 mg/L; middle, 0.70 to <1.95 mg/L; high, ≥1.95 mg/L).

Results:

Live birth occurred in 55% of women overall. The lowest pregnancy and live birth rates occurred among the highest hsCRP tertile receiving placebo (44% live birth). LDA increased live birth among high-hsCRP women to 59% (relative risk, 1.35; 95% confidence interval, 1.08 to 1.67), similar to rates in the lower and mid-CRP tertiles. LDA did not affect clinical pregnancy or live birth in the low (live birth: 59% LDA, 54% placebo) or midlevel hsCRP tertiles (live birth: 59% LDA, 59% placebo).

Conclusions:

In women attempting conception with elevated hsCRP and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates compared with women without inflammation and reduce hsCRP elevation during pregnancy.