bluuebunny/crossref_metadata_2025 huggingface dataset:
Breakthrough spikes in rapid eye movement sleep from the epilepsy monitoring unit are associated with peak seizure frequency
Authors: McKenzie Marna B , Jones Michelle-Lee , O’Carroll Aoife , Serletis Demitre , Shafer Leigh Anne , Ng Marcus C
Published: November 2019

Study Objectives

Rapid eye movement sleep (REM) usually suppresses interictal epileptiform discharges (IED) and seizures. However, breakthrough IEDs in REM sometimes continue. We aimed to determine if the amount of IED and seizures in REM, or REM duration, is associated with clinical trajectories.

Methods

Continuous electroencephalogram (EEG) recordings from the epilepsy monitoring unit (EMU) were clipped to at least 3 h of concatenated salient findings per day including all identified REM. Concatenated EEG files were analyzed for nightly REM duration and the “REM spike burden” (RSB), defined as the proportion of REM occupied by IED or seizures. Patient charts were reviewed for clinical data, including patient-reported peak seizure frequency. Logistic and linear regressions were performed, as appropriate, to explore associations between two explanatory measures (duration of REM and RSB) and six indicators of seizure activity (clinical trajectory outcomes).

Results

The median duration of REM sleep was 43.3 (IQR 20.9–73.2) min per patient per night. 59/63 (93.7%) patients achieved REM during EMU admission. 39/59 (66.1%) patients had breakthrough IEDs or seizures in REM with the median RSB at 0.7% (IQR 0%–8.4%). Every 1% increase in RSB was associated with 1.69 (95% CI = 0.47–2.92) more seizures per month during the peak seizure period of one’s epilepsy (p = 0.007).

Conclusions

Increased epileptiform activity during REM is associated with increased peak seizure frequency, suggesting an overall poorer epilepsy trajectory. Our findings suggest that RSB in the EMU is a useful biomarker to help guide about what to expect over the course of one’s epilepsy.
Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis
Authors: Zheng Chao , Lin Xisheng , Liu He , Lu Weiguang , Xu Xiaolong , Wang Di , Gao Bo , Wang Cheng , Zhou Jinru , Fan Jing , Hu Yaqian , Jie Qiang , Chen Di , Yang Liu , Luo Zhuojing
Published: November 2019

Confusion persists over pathogenesis of spondylolysis. To confirm pathogenicity of the previously identified causative mutation of spondylolysis and investigate the genetic etiology, we generate a new mouse line harboring D673V mutation in the Slc26a2 gene. D673V mutation induces delayed endochondral ossification characterized by transiently reduced chondrocyte proliferation in mice at the early postnatal stage. Adult D673V homozygotes exhibit dysplastic isthmus and reduced bone volume of the dorsal vertebra resembling the detached vertebral bony structure when spondylolysis occurs, including the postzygopophysis, vertebral arch, and spinous process, which causes biomechanical alterations around the isthmic region of L4‐5 vertebrae indicated by finite element analysis. Consistently, partial ablation of Slc26a2 in vertebral skeletal cells using Col1a1‐Cre; Slc26a2 fl/fl mouse line recapitulates a similar but worsened vertebral phenotype featured by lamellar isthmus. In addition, when reaching late adulthood, D673V homozygotes develop an evident bone‐loss phenotype and show impaired osteogenesis. These findings support a multifactorial etiology, involving congenitally predisposed isthmic conditions, altered biomechanics, and age‐dependent bone loss, which leads to SLC26A2‐related spondylolysis.
Insulin receptor preserves mitochondrial function by binding VDAC1 in insulin insensitive mucosal epithelial cells
Authors: Titone Rossella , Robertson Danielle M.
Published: November 2019

Unlike many epithelial tissues, the corneal epithelium is insulin insensitive, meaning it does not require insulin for glucose uptake. In this study, we show that insulin differentially regulates mitochondrial respiration in two human mucosal epithelial cell types: insulin‐insensitive corneal epithelial cells and insulin‐sensitive bronchial epithelial cells. In both cell types, insulin blocks glycogen synthase kinase beta (GSK3β) activity. In the corneal epithelium however, insulin selectively regulates PTEN‐induced kinase 1 (PINK‐1)‐mediated mitophagy and mitochondrial accumulation of insulin receptor (INSR). While insulin blocked basal levels of PINK‐1‐mediated mitophagy in bronchial epithelial cells, mitochondrial trafficking of INSR was not detectable. We further show that in corneal epithelia, INSR interacts with the voltage‐dependent anion channel‐1 (VDAC1) in mitochondria and that INSR knockdown triggers robust mitochondrial fragmentation, alterations in mitochondrial polarization, and blocks the induction of PINK‐1‐mediated mitophagy. Collectively, these data demonstrate that INSR interacts with VDAC1 to mediate mitochondrial stability. We also demonstrate unique interactions between VDAC1 and other receptor tyrosine kinases, indicating a novel role for this family of receptors in mitochondria.
Deceptive and Nondeceptive Placebos to Reduce Pain
Authors: Kube Tobias , Rief Winfried , Vivell Maj-Britt , Schäfer N. Leonora , Vermillion Teresa , Körfer Karoline , Glombiewski Julia A.
Published: November 2019

Objectives:

Recent research has shown that placebos can be effective even if they are openly prescribed to participants. Yet, it is unclear how such “open-label placebos” (OLPs) compare to deceptive placebo (DP) and what the mechanisms of actions are. In this study, we therefore compared 2 versions of OLP to DP and no treatment (NT).

Materials and Methods:

Using a standard heat pain paradigm, 117 healthy volunteers underwent a baseline and a posttreatment pain assessment. With the exception of NT, all groups received an inert placebo cream after the first assessment. OLP was administered by either evoking positive expectancies or by raising hope for placebo analgesia, thus distinguishing for the first time conceptually between expectancy and hope in experimental pain research. The primary outcome was pre-post change in pain tolerance.

Results:

Increase in pain tolerance was larger in the 3 treatment groups compared with NT, whereas the treatment groups did not differ from each other. Further results showed that participants receiving DP reported a large reduction of subjective pain intensity and unpleasantness, whereas no such reduction was found for the 2 OLP groups. The 2 OLP versions did not differ in terms of their analgesic effects.

Discussion:

The study provided evidence for traditional placebo analgesia on the basis of deception. For OLP, we found that OLP indeed increased pain tolerance; however, participants receiving OLP were reluctant to report any subjective analgesic effects. Combined with previous studies, the present findings suggest that the effects of OLP are weaker in healthy volunteers than in clinical samples.
Chronic Spinal Pain and Financial Worries in the US Adult Population
Authors: Yang Haiou , Haldeman Scott
Published: November 2019

Study Design.

Epidemiological study based on cross-sectional data of a representative sample.

Objective.

To determine whether financial worries are associated with chronic spinal pain in the US adult population.

Summary of Background Data.

This study used data from the US 2015 National Health Interview Survey. The sample size was 33,672 and the study population is defined as aged 18 to 85 years.

Methods.

To account for the complex sampling design, the Taylor linearized variance estimation method was used. Spinal pain was defined in two ways: chronic low back pain and neck pain, chronic low back pain and/or neck pain. Eight types of financial worries were assessed: paying monthly bills, maintaining standard of living, credit card payments, paying rent/mortgage/housing costs, medical costs for healthcare, money for retirement, medical costs of illness/accident, and paying for children's college.

Results.

Different types of financial worries were significantly associated with chronic spinal pain, controlling for demographic characteristics and socioeconomic status. These worries included paying monthly bills (odds ratio [OR] 2.5), maintaining standard of living (OR 2.5), credit card payments (OR 2.2), paying rent/mortgage/housing costs (OR 2.2), medical costs for healthcare (OR 2.2), money for retirement, (OR 2.3), medical costs of illness/accident (OR 2.2), and paying for children's college (OR 1.4).

Conclusion.

This study shows that financial worries were significantly associated with chronic spinal pain. Financial worries may be important to be taken into consideration by clinicians managing patients with spinal pain. More future research is needed to explore the association between financial worries and spinal pain.

Level of Evidence: 3
Multimodal Pain Management and Postoperative Outcomes in Lumbar Spine Fusion Surgery
Authors: Cozowicz Crispiana , Bekeris Janis , Poeran Jashvant , Zubizarreta Nicole , Schwenk Eric , Girardi Federico , Memtsoudis Stavros G.
Published: November 2019

Study Design.

Retrospective population-based cohort analysis.

Objective.

Given the lack of large-scale data on the use and efficacy of multimodal analgesia in spine fusion surgery, we conducted a population-based analysis utilizing the nationwide claims-based Premier Healthcare database.

Summary of Background Data.

Multimodal analgesia, combining different pain signaling pathways to achieve additive and synergistic effects, is increasingly emerging as the standard of care.

Methods.

Cases of posterior lumbar fusion surgery were extracted (2006–2016). Opioid-only analgesia was compared to multimodal analgesia, that is, systemic opioid analgesia + either acetaminophen, steroids, gabapentinoids, ketamine, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, or neuraxial anesthesia (categorized into 1, 2, or >2 additional analgesic modes). Mixed-effects models measured associations between multimodal analgesia categories and outcomes, including opioid prescription dose, cost/length of hospitalization, and opioid-related complications. Odds ratios (ORs, or % change) and 95% confidence intervals (CIs) are reported.

Results.

Among 265,538 patients the incidence of multimodal analgesia was 61.1% (162,156); multimodal pain management—specifically when adding NSAIDs/COX-2 inhibitors to opioids—was associated with reduced opioid prescription (−13.3% CI −16.7 to −9.7%), cost (−2.9% CI −3.9 to −1.8%) and length of hospitalization (−7.3% CI −8.5 to −6.1%). Multimodal analgesia in general was associated with stepwise decreased odds for gastrointestinal complications (OR 0.95, 95% CI 0.88–1.04; OR 0.84, CI 0.75–0.95; OR 0.78, 95% CI 0.64–0.96), whereas odds were increased for postoperative delirium (OR 1.14, 95% CI 1.00–1.32; OR 1.33, 95% CI 1.11–1.59; OR 1.31, 95% CI 0.99–1.74), and counterintuitively- naloxone administration (OR 1.25, 95% CI 1.13–1.38; OR 1.56, 95% CI 1.37–1.77; OR 1.84, 95% CI 1.52–2.23) with increasing analgesic modes used: one, two, or more additional analgesic modes, respectively. Post-hoc analysis revealed that specifically gabapentinoid use increased odds of naloxone requirement by about 50%, regardless of concurrent opioid dose (P < 0.001).

Conclusion.

Although multimodal analgesia was not consistently implemented in spine fusion surgery, particularly NSAIDs and COX-2 inhibitors demonstrated opioid sparing effects. Moreover, results suggest a synergistic interaction between gabapentinoids and opioids, the former potentiating opioid effects resulting in greater naloxone requirement.

Level of Evidence: 3
Osteoporosis-related Vertebral Fragility Fractures
Authors: Robinson William A. , Carlson Bayard C. , Poppendeck Heidi , Wanderman Nathan R. , Bunta Andrew D. , Murphy Sarah , Sietsema Debra L. , Daffner Scott D. , Edwards Beatrice J. , Watts Nelson B. , Tosi Laura L. , Anderson Paul A. , Freedman Brett A.
Published: November 2019

Study Design.

Retrospective cohort study of the Own the Bone database which is a fracture liaison service designed to improve recognition and treatment of osteoporosis.

Objective.

To use the Own the Bone (OTB) database to 1) examine the specific demographics of patients presenting with a low-energy clinical vertebral fracture (VFX) and 2) compare demographic and fracture-specific risk factors between patients with clinical VFX versus patients with nonvertebral low-energy fracture (NVFX).

Summary of Background Data.

Large database studies have described risk factors for developing VFX. It is well described that a history of previous VFX portends an increased risk of future VFX. Few studies have reported cohorts from a fracture liaison service such as the OTB initiative.

Methods.

35,039 unique cases of fragility fracture occurred between 2009 and 2016 and were included in analysis. VFX accounted for 3395 (9.9%) of the presenting fractures at OTB enrollment. The demographics, lifestyle factors, medication use, and fracture-specific data for patients in the OTB registry with vertebral fractures were summarized and then statistically compared to those with nonvertebral fragility fractures.

Results.

The majority of VFX patients were Caucasian, postmenopausal women (74.4%). There was an increased likelihood of presenting with a vertebral fracture in patients who sustained a previous VFX after the age of 50, while patients who sustained a prior nonvertebral fracture (NVFX) were more likely to present with a subsequent NVFX. After controlling for patients with a history of fracture after the age of 50, VFX patients (vs. NVFX) were more likely to be age 70–79, class 1 obesity, with a history of taking anti-osteoporotic prescription medications.

Conclusions.

Multiple factors were associated with a significantly increased risk of VFX compared with NVFX. Understanding the risk factors unique to fragility VFX is a critical component for targeting “at-risk” patients and preventing future osteoporosis-related fractures and their consequences.

Level of Evidence: 4
Superior-segment Bilateral Facet Violation in Lumbar Transpedicular Fixation, Part III
Authors: Xu Yunfeng , Le Xiaofeng , Zhang Qi , Kuai Shengzheng , Leng Huijie , Duan Fangfang , Shi Zhan , Liu Bo , He Da , Lang Zhao , Wu Jingye , Wang Ling , Tian Wei
Published: November 2019

Mini

In controls, adjacent-level range of motion (ROM) did not change relative to noninstrumented spine at each moment. In severe violation, flexion-extension and rotation ROM of adjacent vertebrae decreased at each moment (7.5, 6.0, 4.5 Nm); lateral bending ROM decreased at 4.5 Nm. Significant differences in movements were found except lateral bending (7.5 Nm).

Study Design.

This is an in vitro biomechanical study.

Objectives.

This study aimed to investigate the biomechanical variations of lumbar spine motor units after bilateral facet joint severe violation in cadaver specimens and analyze the biomechanics under different moments.

Summary of Background Data.

The incidence of facet joint violation (FJV) is highly variable, and one of the most important factors is the lack of awareness of protection. Until now, the biomechanical effects of FJV remain unclear.

Methods.

Biomechanical testing was performed on 12 human cadaveric spines under flexion-extension, lateral bending, and axial rotation loading. After intact analysis, pedicle screws were inserted at L5, and the biomechanical testing was repeated. Full range of motion (ROM) at the proximal adjacent levels under different moments was recorded and normalized to the intact (100%) noninstrumented spine. The relative ROM changes were compared between the control and severe violation groups.

Results.

The adjacent-level ROM (flexion-extension, lateral bending, axial rotation) did not change significantly in the control group at each moment (7.5, 6.0, 4.5 Nm) compared with the intact noninstrumented spine. In the severe violation group, the supradjacent-level ROM decreased significantly under all moments relative to the intact noninstrumented spine (P < 0.05) except for the ROM of lateral bending at moments of 7.5 and 6.0 Nm. When comparing the ROM between the two groups, there were significant differences in all movements except lateral bending at 7.5 Nm.

Conclusion.

When superior-segment bilateral facet joints are severely violated by screws, the flexion-extension and axial rotation ROM of adjacent vertebrae decreases at each moment (7.5, 6.0, 4.5 Nm), and the lateral bending ROM decreases at 4.5 Nm.

Level of Evidence: N/A
Validation of the Korean Version of the Body Image Disturbance Questionnaire-Scoliosis
Authors: Bae Seong Ho , Son Seung Min , Shin Won Chul , Goh Tae Sik , Lee Jung Sub
Published: November 2019

Study Design.

Cross-cultural adaptation and validation of the Body Image Disturbance Questionnaire-Scoliosis

Objective.

The purpose of this study was to evaluate the reliability and validity of an adapted Korean version of the Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S).

Summary of Background Data.

A modified version of the BIDQ instrument has been validated in adolescent idiopathic scoliosis (AIS) to assess the perception of spinal appearance and psychological disturbance. However, there is no culturally adapted, reliable, and validated BIDQ-S for the Korean population.

Methods.

Translation/retranslation of the English version of the BIDQ-S was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the BIDQ-S (K-BIDQ-S) and the previously validated appearance domain of the Korean version of the Scoliosis Research Society-22 Outcomes questionnaire (K-SRS-22) and Spinal Appearance Questionnaire (K-SAQ) were mailed to 152 patients with AIS. Reliability assessments were conducted using κ statistics to assess item agreements, and intraclass correlation coefficients (ICCs) and Cronbach α values were calculated. Convergent validity was evaluated by comparing the scores of the K-BIDQ-S, K-SAQ, and K-SRS-22 appearance domain and discriminant validity by analyzing relationships between K-BIDQ-S score and patient characteristics.

Results.

All items of the K-BIDQ-S had κ values of agreement >0.6. The K-BIDQ-S showed excellent test/retest reliability with an ICC of 0.912. Internal consistency of the K-BIDQ-S was found to be very good (α = 0.880). Convergent validity testing demonstrated good correlations between the K-BIDQ-S and K-SAQ (r = 0.617), and between the K-BIDQ-S and K-SRS-22 (r = −651). The correlation between the K-BIDQ-S and major curve magnitude was significant (r = 0.688). Discriminant validity was confirmed by significant differences in K-BIDQ-S scores among patients requiring observation, bracing, or surgery.

Conclusion.

The K-BIDQ-S showed satisfactory reliability and validity, and thus, is considered suitable for the evaluation of spinal deformity appearance in Korean-speaking patients with AIS.

Level of Evidence: 3
A 10-Year Radiographic Study Comparing Anterior Versus Posterior Instrumented Spinal Fusion in Patients With Lenke Type 5 Adolescent Idiopathic Scoliosis
Authors: Lim Joel Louis , Hey Hwee Weng Dennis , Kumar Nishant , Teo Alex Quok An , Lau Leok Lim , Hee Hwan Tak , Ruiz John Nathaniel , Kumar Naresh Satyanarayan , Thambiah Joseph Shanthakumar , Liu Gabriel Ka-Po , Wong Hee-Kit
Published: November 2019

Mini

This is a long-term prospective cohort study comparing the radiographic outcomes of anterior versus posterior instrumentation for Lenke 5 adolescent idiopathic scoliosis. Both approaches were comparable in terms of radiographic outcomes up to 10 years. The posterior approach is more prone to developing proximal junctional kyphosis.

Study Design.

Prospective cohort study.

Objective.

To compare the long-term, radiographic coronal and sagittal outcomes of these two approaches at 10-year follow-up.

Summary of Background Data.

Both anterior and posterior instrumented fusions have been found to be safe and effective treatments for Lenke 5 adolescent idiopathic scoliosis with up to 2 to 5 years of follow-up. Few studies follow patients beyond this duration.

Methods.

36 patients who underwent anterior (n = 25) or posterior instrumented spinal fusion (n = 11) for Lenke 5 adolescent idiopathic scoliosis over a 4-year period were recruited and followed for 10 years. Preoperative clinical data include patient's age and age of menarche. Operative data included instrumented levels, duration of surgery, and surgical blood loss. Postoperative data included duration of hospital stay, duration of intensive care unit stay, and complications. Pre- and postoperative radiographic data collected include coronal Cobb angles for structural thoracolumbar/lumbar curves, and sagittal angles—sagittal vertical axis, thoracic kyphosis, global lumbar angle, pelvic incidence, pelvic tilt, sacral slope, and upper and lower end vertebrae.

Results.

Posterior surgery had a shorter operative time (P < 0.010) and hospital stay (P < 0.010). Coronal plane deformity improved by a mean of 74% in the anterior group and 71% in the posterior group. There was no significant change at 10 years in both groups (anterior P = 0.455 and posterior P = 0.325). Sagittal parameters remained unchanged. There was a higher incidence of proximal junctional kyphosis in the posterior (45%) compared to the anterior (16%) group (P < 0.010).

Conclusion.

Both anterior and posterior instrumentation and fusion are successful surgeries after 10 years of follow-up. They are comparable with regards to their ability to achieve and maintain good correction of scoliotic deformities and have a low rate of pseudoarthrosis and instrument failure. Ideal sagittal parameters are maintained up to 10 years of follow-up.

Level of Evidence: 3
Vascular Endothelial Growth Factor-Transfected Bone Marrow Mesenchymal Stem Cells Improve the Recovery of Motor and Sensory Functions of Rats With Spinal Cord Injury
Authors: Liu Xiao , Xu Wenqi , Zhang Zhengzheng , Liu He , Lv Lanxin , Han Dong , Liu Lin , Yao Aimin , Xu Tie
Published: November 2019

Study Design.

Basic science.

Objective.

The aim of this study was to examine the effect of vascular endothelial growth factor (VEGF)-transfected bone marrow mesenchymal stem cells (BMSCs) on the recovery of motor and sensory functions of rats with spinal cord injury (SCI).

Summary of Background Data.

There is no effective treatment to protect against SCI. BMSCs have been widely applied to the treatment of nervous system damage due to the function of prompt neurite growth and inhibition of demyelination following injury.

Methods.

VEGF-transfected BMSCs were injected to rats with SCI and the recovery of motor and sensory functions was observed. The Basso, Beattie, and Bresnahan, mechanical withdrawal threshold and thermal withdraw latency grading was conducted to assess the recovery status of motor and sensory functions of the SCI rats. The expression of VEGF, CD31, and NF200 was detected by immunofluorescence.

Results.

The recovery of the rat motor and sensory functions in the VEGF-transfected BMSC (BMSC-VEGF) group was higher than those of the other groups with the exception of the Sham group (P < 0.05). The expression of the CD31 and NF200 proteins in the rat SCI regions was the highest in the BMSC-VEGF group, whereas the survival of BMSC in the BMSC-VEGF group was increased compared with that in the BMSC-Ad group. In addition, the injection of VEGF-transfected BMSCs can improve the angiogenesis of the injured area and retain the survival of injected cells and neurons.

Conclusion.

The injection of BMSC-VEGF improved the recovery of motor function in SCI rats.

Level of Evidence: N/A
Can the American College of Surgeons Risk Calculator Predict 30-day Complications After Spine Surgery?
Authors: McCarthy Michael H. , Singh Partik , Nayak Rusheel , Maslak Joseph P. , Jenkins Tyler J. , Patel Alpesh A. , Hsu Wellington K.
Published: November 2019

Mini

It is unclear whether the ACS NSQIP Surgical Risk Calculator can predict 30-day complications after lumbar and cervical spinal fusions. This study shows that the Risk Calculator is only of marginal benefit in predicting outcomes in cervical fusion and unlikely to be of benefit in lumbar fusions.

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to assess the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Risk Calculator's ability to predict 30-day complications after spine surgery.

Summary of Background Data.

Surgical risk calculators may identify patients at increased risk for complications, improve outcomes, enhance the informed consent process, and help modify risk factors. The ACS NSQIP Risk Calculator was developed from a cohort of >1.4 million patients, using 2805 unique CPT codes. It uses 21 patient predictors and the planned procedure to predict the risk of 12 different outcomes within 30 days following surgery.

Methods.

A retrospective chart review was performed on patients who underwent primary lumbar and cervical fusions with at least 30-day postoperative follow-up between 2009 and 2015 at a single-institution. Descriptive statistics were calculated for the overall sample, anterior versus posterior fusion (cervical only), and single versus multilevel fusion. Logistic regression models were fit with actual complication occurrence as the dependent variable in each model and ACS estimated risk as the independent variable. The c-statistic was used as the measure of concordance for each model. Receiver-operating charateristic curves depicted the predictive ability of the estimated risks. Acceptable concordance was set at c >0.80.

Results.

A total of 237 lumbar and 404 cervical patients were included in the study. The Risk Calculator risk estimates significantly predicted (P < 0.001) “any complication” and “discharge to skilled nursing facility” among the cervical cohort and demonstrated no significant outcome prediction the lumbar cohort.

Conclusion.

The ACS Risk-Calculator accurately predicted complications in the categories of “any complication” and “discharge to skilled nursing facility” for our cervical cohort and failed to demonstrate benefit for our lumbar cohort. Although the ACS Risk-Calculator may be useful in general surgery, our findings demonstrate that it does not necessarily provide accurate information for patients undergoing spinal surgery.

Level of Evidence: 3
Trends in Leadership at Spine Surgery Fellowships
Authors: Donnally Chester J. , Schiller Nicholas C. , Butler Alexander J. , Sama Andrew J. , Bondar Kevin J. , Goz Vadim , Shenoy Kartik , Vaccaro Alexander R. , Hilibrand Alan S.
Published: November 2019

Study Design.

Cross-sectional study.

Objective.

To illustrate demographic trends among spine fellowship leaders (FLs).

Summary of Background Data.

No previous study in the orthopedic literature has analyzed the demographic characteristics or past surgical training of FL in an orthopedic sub-specialty. We attempt to illustrate demographic trends among spine fellowship leadership including fellowship directors (FDs) and co-fellowship directors (co-FDs). We also highlight the institutions that have trained these leaders at various levels.

Methods.

Our search for FDs was constructed from the 2018 to 2019 North American Spine Surgery (NASS) Fellowship Directory. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index.

Results.

We identified 103 FLs consisting of 67 FDs, 19 co-FDs, and another 16 individuals with a synonymous leadership title. 96.1% (99) of the leadership consisted of males while 3.9% (4) were female. The mean age was 52.9 years old and the mean h-index of the FLs was 23.8. FLs were trained in orthopedic surgery (n = 89), neurosurgery (n = 13), or combined orthopedic surgery and neurosurgery training (n = 1). The top fellowships programs producing future FLs were: Case Western Reserve University, Cleveland (n = 10), Washington University, St. Louis (n = 9), and Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia (n = 7).

Conclusion.

Spine surgery fellowship directors are more likely to have graduated from certain residency and fellowship programs. This finding could be a result of the training provided by these centers or the institution's predilection to select applicants that are more likely to later seek academic leadership roles post-training.

Level of Evidence: 4
Hypnosis Influence on the Perfusion in Perforator Flaps in Early Postoperative Period: A Series of 18 Cases
Authors: Badiul Pavlo O. , Sliesarenko Sergii V. , Saliaiev Mykola G. , Kriachkova Lilia V.
Published: November 2019

Introduction:

In practice worldwide, there are experiences affecting different body functions via central control mechanisms with the help of psychotherapy methods. In plastic and reconstructive surgery, there is the experience of applying hypnosis, with the main goal of eliminating pain. The aim of this research is to study the impact of hypnosis on the perfusion level in perforator flaps in the early postoperative period, which could enhance flap survival.

Patients and Methods:

For studying the impact of hypnosis on blood circulation in perforator flaps, the analysis of a 18 cases has been conducted. All patients had hypnosis sessions on the second day after the reconstruction, and some had additional sessions on the third and fifth days. In the state of trance, the patient was given specially organized instructions aimed at improvement of perforator flap perfusion. Monitoring of microcirculation in the flap during hypnosis sessions was carried out using a Moor VMS-LDF1 Laser Doppler Perfusion and Temperature Monitor.

Results:

When applying hypnosis, the vast majority of patients had significant increases in perfusion as well as flap surface temperature rise. Most of the patients had significant increases in perfusion during the second part of the hypnosis session in synchrony with hypnosis instruction translation aimed at increasing perfusion.

Conclusions:

The results of our research cannot be distributed widely in medical practice, but, despite that, they illustrate the central nervous system influence on perforator flap perfusion. Including hypnosis in a medical protocol can contribute to increasing the effectiveness of flap surgery.
Hepatic Complications in Preeclampsia
Authors: CHANDRASEKARAN SUCHITRA , SIMON REBECCA
Published: November 2019

In cases of preeclampsia with severe features and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, hepatic complications portend significant short-term and long-term maternal health implications. In this section, we will discuss the physiology of normal hepatic function in pregnancy, the pathophysiology of the abnormalities noted in hepatic function during the process of preeclampsia development, the diagnosis and management of preeclampsia, imitators of HELLP syndrome, the utility of various biomarkers in the diagnosis and prognosis of the preeclampsia disease spectrum, possible underlying genetic factors predisposing women to developing hepatic abnormalities with preeclampsia, and finally prognosis and management of a subcapsular hematoma.
The Hepatobiliary System: An Overview of Normal Function and Diagnostic Testing in Pregnancy
Authors: GONZALEZ-BROWN VERONICA , FREY HEATHER A.
Published: November 2019

Pregnancy is associated with physiological adaptions that affect every organ system. Changes in liver function in pregnancy have important effects on nutrient metabolism, protein synthesis, and the biotransformation of substances in preparation for excretion. A clear understanding of the anatomic and functional changes of the hepatobiliary system is necessary for the diagnosis and evaluation of disease, as well as understanding how these changes predispose women to pregnancy-specific hepatic conditions. In this review, the effect of gestational changes in hepatobiliary function on laboratory tests and the role of diagnostic imaging of the liver and gallbladder in pregnancy will be discussed.
Monitoring Radiation Exposure of Saudi Aramco Pilots
Authors: Shhub Abdu Naser
Published: November 2019

A 1 y study to monitor exposure to cosmic radiation of pilots and aircrew in Saudi Aramco flights has been conducted. In many countries, flight attendants, pilots, and other aircrew are considered to be radiation workers. Five pilots participated in the study, and two methods were used for measuring or estimating the radiation doses received by pilots or aircrew during air flights: the computer program CARI-7 and thermoluminescent dosimeters. It has been concluded that although pilots and aircrew are occupationally exposed to ionizing radiation, they do not receive enough radiation to be included in the company radiation dosimetry program. Although it is not possible, in general, for pilots and aircrew to reach the occupational dose limit, they nonetheless should be monitored (using a computer simulation code) to be in line with international practices. In the case of pregnant aircrew, it is particularly important to monitor their radiation doses, because it is possible for them to reach their radiation dose limits.
From Volume- to Value-Based Payment System in Washington State Federally Qualified Health Centers
Authors: Izguttinov Aniyar , Conrad Douglas , Wood Suzanne J. , Andris Lydia
Published: November 2019

The reimbursement system at 16 Federally Qualified Health Centers in Washington State transformed to a per-member-per-month model with a prospective adjustment for quality performance. The results of this qualitative study suggest that 3 to 5 years would be required to achieve significant progress in the Triple Aim goals of the initiative and also demonstrate that Federally Qualified Health Centers are potentially more advanced in their readiness to offer value-based care. By providing positive financial incentives without downside risk, the state is stimulating replicable models of care, and in longer term such reforms may lead to a greater care coordination and a whole person-centered care.
Clinical significance of down-regulated HINT2 in hepatocellular carcinoma
Authors: Zhou Dong-Kai , Qian Xiao-Hui , Cheng Jun , Chen Ling-Hui , Wang Wei-Lin
Published: November 2019

To study the clinical significance of HINT2 expression in patients with HCC.

We investigated HINT2 mRNA expression in tumors and adjacent non-tumor hepatic tissues from 106 HCC patients using quantitative real-time PCR. Appropriate statistical methods were then applied to assess the relationships between the HINT2 mRNA level and clinical parameters.

HINT2 was significantly down-regulated in HCC (P < .0001). No significant correlation was found between HINT2 expression and clinicopathological factors in HCC patients. A Kaplan–Meier survival curve showed that HINT2 expression is related to recurrence-free survival (P < .05). Multivariate analyses revealed that tumor size and HINT2 expression are risk factors for HCC recurrence.

HINT2 is down-regulated in HCC, and low HINT2 expression predicts earlier tumor recurrence. HINT2 expression may serve as a prognostic indicator of recurrence in HCC.
Right ventricular dysfunction is associated with the development of chronic thromboembolic pulmonary hypertension but not with mortality post-acute pulmonary embolism
Authors: Hsu Chih-Hsin , Lin Chih-Chan , Li Wei-Ting , Chang Hsien-Yuan , Chang Wei-Ting
Published: November 2019

Chronic thromboembolic pulmonary hypertension (CTEPH), a late complication of pulmonary embolism (PE), is associated with high mortality. However, whether the right ventricular (RV) echocardiographic parameters can predict – in the short- and long-term – the development of CTEPH and mortality after PE remains unknown. Herein, we aim to investigate the incidence of CTEPH after acute PE and to evaluate the risk factors of CTEPH. In this retrospective cohort, patients with PE were followed for 10 years for the onset of CTEPH. The screening was initially conducted through echocardiography and confirmed by right heart catheterization. Also, transient and permanent risk factors were identified. Among 358 patients with PE, 8 patients (4%) were subsequently diagnosed with CTEPH at a median time of 36 months and 47 died during the follow-up period. Notably, both short- and long-term RV dilatation, hypertrophy, and increased pulmonary pressure increased the incidence of CTEPH. However, RV echocardiographic parameters failed to differentiate survivors from non-survivors. Instead, malignancy, respiratory, or chronic heart failure was strongly associated with post PE mortality in the multivariable analysis. According to our findings, post PE screening of CTEPH may facilitate early diagnosis and intervention for patients at high risk of developing CTEPH. Also, RV echocardiographic parameters are associated with subsequent CTEPH, but mortality is mainly dependent on underlying comorbidities.
Risk factor for diabetes mellitus in pediatric chronic pancreatitis patients
Authors: Xie Ting , Hao Lu , Liu Yu , Zhang Di , Bi Ya-Wei , Wang Teng , Zeng Xiang-Peng , Xin Lei , Pan Jun , Wang Dan , Ji Jun-Tao , Du Ting-Ting , Lin Jin-Huan , Zou Wen-Bin , Chen Hui , Guo Hong-Lei , Li Bai-Rong , Cong Zhi-Jie , Liao Zhuan , Wan Rong , Li Zhao-Shen , Hu Liang-Hao
Published: November 2019

Pediatric patients suffer from chronic pancreatitis (CP), especially those with diabetes mellitus (DM). This study aimed to identify the incidence of and risk factors for DM in pediatric CP.

CP patients admitted to our center from January 2000 to December 2013 were assigned to the pediatric (<18 years old) and adult group according to their age at onset of CP. Cumulative rates of DM and risk factors for both groups were calculated and identified.

The median follow-up duration for the whole cohort was 7.6 years. In these 2153 patients, 13.5% of them were pediatrics. The mean age at the onset and the diagnosis of CP in pediatrics were 11.622 and 19.727, respectively. DM was detected in 13.1% patients and 31.0% patients in the pediatric group and adult group, respectively. Age at the onset of CP, smoking history, body mass index (BMI), and etiology of CP were identified risk factors for DM in pediatrics.

DM was detected in 13.1% pediatric patients. Age at the onset of CP, smoking history, BMI, and etiology of CP were identified risk factors for the development of DM in pediatric CP patients. The high-risk populations were suggested to be monitored frequently. They could also benefit from a lifestyle modification.
Effectiveness of continuous adductor canal block versus continuous femoral nerve block in patients with total knee arthroplasty
Authors: Zhang Zhen , Wang Yu , Liu Yuanyuan
Published: November 2019

Background:

This study aimed to evaluate the effectiveness of continuous adductor canal block (CACB) versus continuous femoral nerve block (CFNB) in postoperative analgesia and early rehabilitation of patients with total knee arthroplasty (TKA).

Methods:

The Cochrane Library, PubMed, and EMbase were systematically searched to retrieve literature comparing efficacy of CACB versus CFNB on pain relief and functional recovery in knee replacement patients until December 2018, without language limitation. Meta-analysis was performed using RevMan 5.3 software.

Results:

A total of 7 clinical randomized controlled trials and 4 retrospective studies were included, involving 484 cases in the CACB group and 491 in the CFNB group. The results of the meta-analysis showed that the visual analogue scores (VAS) at rest were similar between the CACB group and the CFNB group at 8 hours (standard mean difference(SMD) = -0.26, 95% confidence interval(CI): -0.62, 0.11), 12 hours (SMD = -0.02, 95%CI: -0.50, 0.47), 24 hours (SMD = 0.05, 95%CI: -0.22, 0.33), and 48 hours (SMD = -0.10, 95%CI: -0.29, 0.09) after TKA (P > .05 for all). The muscle strength of patients in the CACB group post-operation was significantly improved than those of the CFNB group (SMD = 0.81; 95% CI: 0.35, 1.26;P = .0005). There were no significant differences in the amount of opioids consumption and the incidence of postoperative fall between CACB and CFNB (P > .05).

Conclusion:

The analgesic effects of CACB versus CFNB are equivalent after TKA. CACB has less effect on the quadriceps muscle strength, which is beneficial to the early postoperative activities and functional rehabilitation.
Acute proximal left anterior descending thrombosis manifested by persistent hiccups
Authors: Gao Hanxiang , Zhang Bo , Song Li , Yao Suyu , Zhang Zheng , Bai Ming
Published: November 2019

Introduction:

Hiccup is usually a benign and self-limited phenomenon. Therefore, if hiccups do not resolve by themselves and even last for a long time, it may be the marker of serious medical conditions.

Patient concerns:

We encountered a case presenting with recurrent abdominal discomfort. Diffuse ST-segment elevation in V2-V6 and elevated Troponin I was identified. He had complained about constipation and incomplete intestinal obstruction was ever suspected. Four days later, he exhibited persistent hiccups.

Diagnosis:

He was diagnosed with acute anterior wall myocardial infarction. And elective coronary angiography showed that proximal left anterior descending (LAD) was occluded by fresh thrombus with TIMI 1 flow.

Interventions:

The lesion in proximal LAD was dilated with low pressure. Interestingly, the hiccups reduced. And after stent implantation the hiccup disappeared in 24 hours.

Outcomes:

The patient was discharged in good general condition, with maintenance therapy and a follow-up protocol.

Conclusion:

Hiccup is only rarely described in the context of acute proximal LAD thrombosis. However, if this special symptom occurs intractably during disease progression, thrombus is revealed to be the probable cause, prompt opening of the criminal vessel should be performed besides strengthening of anticoagulant and antiplatelet.
Radiological analysis of breast lymphoma
Authors: Zhou Changyu , Lv Kun , Lin Dongya , Yu Yinxing , Xu Maosheng , Bu Yangyang
Published: November 2019

This retrospective study aimed to improve the diagnostic accuracy of breast lymphoma (BL) by analyzing the findings of BL on mammography and magnetic resonance imaging (MRI).

Fifteen patients with breast lymphoma (BL, Primary/Secondary: 13/2) were confirmed by pathology. The imaging findings of those patients were analyzed by 2 senior radiologists.

BL commonly showed significant enhancement with penetrating vessels and septation in masses on dynamic contrast-enhanced MRI (DCE-MRI). Diffusion limitation of BL is more pronounced than breast cancer on diffusion weighted imaging.

The study suggests that the penetrating vessels and diffusion restriction of lesions are helpful for the diagnosis and differential diagnosis of BL.
Development and validation of a rheumatologist satisfaction with practice scale
Authors: Sheth Khushboo , Valenzuela Antonia , Shoor Stanford , Ritter Philip Lloyd , Lorig Kate
Published: November 2019

There is a paucity of succinct measures of physician satisfaction. As part of a Performance Improvement Project, we developed and piloted a simple questionnaire to determine rheumatologists satisfaction.

Thirty 5 rheumatologists in the academic or private setting were sent opened-ended questions to determine the factors that made them satisfied or dissatisfied with respect to their rheumatology practice. From the responses we formed 14 questions 1 to 10 scale centering on satisfaction and dissatisfaction that was piloted in 30 rheumatologists and subsequently validated in 173 rheumatologists within the US and Latin America.

Our combined sample included 173 rheumatologists (55 English and 118 Spanish-speaking respondents). The mean satisfaction for the combined sample was 6.92 (standard deviation=1.1, range 4.08–9.62). The strongest contributors to physician satisfaction were “Seeing interesting and challenging cases” (8.6 ± 1.5) and “The ability to make a difference in patient's life” as well as “Establishing long term relationship with patients” (8.39 ± 1.5). The strongest contributors to physician dissatisfaction were “Getting inappropriate referrals not in the scope of practice” (4.3 ± 2.13) and “Time spent on documentation” (4.5 ± 2.59). The scale had good reliability, relatively normal distribution, and little or no redundancy among items.

A simple and practical questionnaire to measure physician satisfaction, in particular rheumatologists satisfaction, was developed, piloted and successfully validated on a predominately academic sample of rheumatologists within the US and Latin America. This scale will serve as a means to identifying potential barriers to the implementation of performance improvement projects in the practice of Rheumatology.
Gastric mucormycosis complicated by a gastropleural fistula
Authors: Uchida Tomohisa , Okamoto Momoko , Fujikawa Keita , Yoshikawa Daisuke , Mizokami Akinari , Mihara Tomo , Kondo Akira , Ohba Kazuo , Kurohama Kazuhiro , Nakashima Masahiro , Sekine Ichiro , Nakamura Shigeki , Miyazaki Yoshitsugu , Kawakami Atsushi
Published: November 2019

Rationale:

Mucormycosis is a rare opportunistic fungal infection with poor prognosis. The incidence of mucormycosis has been increasing, and it is a threat to immunocompromised hosts. We present a case of gastric mucormycosis complicated by a gastropleural fistula during immunosuppressive treatment for adult-onset Still disease (AOSD).

Patient concerns:

An 82-year-old woman diagnosed with AOSD who developed gastric ulcers during the administration of an immunosuppressive therapy with corticosteroids, cyclosporine, and tocilizumab complained of melena and epigastralgia. Esophagogastroduodenoscopy showed multiple ulcers covered with grayish or greenish exudates.

Diagnoses:

The patient diagnosed with mucormycosis based on culture and biopsy of the ulcers, which showed nonseptate hyphae branching at wide angles. Mucor indicus was identified using polymerase chain reaction.

Interventions and outcomes:

Although liposomal amphotericin B was administered, gastric mucormycosis was found to be complicated by a gastropleural fistula. The patient died because of pneumonia due to cytomegalovirus infection, and autopsy revealed the presence of Mucorales around the fistula connecting the stomach and diaphragm.

Lessons:

Gastric mucormycosis is refractory to treatment and fatal. Surgical resection, if possible, along with antifungal drugs can result in better outcomes.
Crossed-fused renal ectopia with renal calculi
Authors: Cao Yalei , Zhang Yinan , Kang Weiting , Suo Ning , Cui Zilian , Luo Yuanman , Jin Xunbo
Published: November 2019

Rationale:

Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date.

Patient concerns:

Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day.

Diagnoses:

On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys.

Interventions:

Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief.

Outcomes:

Two patients have been followed up and have no stones recurrence.

Lessons:

Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.