bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Anesthesia Practice Patterns for Endovascular Therapy for Acute Ischemic Stroke: A Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Member Survey
Authors: Rusy Deborah A. , Hofer Adam , Rasmussen Mads , Paisansathan Chanannait , Sharma Deepak 
Published: November 2019

Background:
The choice of general anesthesia (GA) or conscious sedation (CS) may impact neurological outcomes of patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS). The aim of this survey was to describe the practice patterns of members of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) for anesthetic management of AIS.

Methods:
Following institutional review board approval, a 16-question online survey assessing anesthetic management of patients with AIS undergoing EVT was circulated to members of SNACC.

Results:
A total of 76 SNACC members from 52 institutions and 11 countries completed the survey (12.5% response rate). Overall, 33% of institutions reported dedicated neuroanesthesia teams for EVT. Patients treated with GA ranged from 5% to 100% between centers. In total 51% and 49% of centers in the United States reported preferentially providing GA and CS, respectively, compared with 34% and 66%, respectively, in European centers. Reported anesthetic induction agents are propofol (64%), etomidate (4%) and either medication (33%). For maintenance of GA, volatile anesthetic is used more often (54%) than propofol (16%). There was wide variation in medications used for CS. Arterial catheter placement was reported by 75% and 43% of respondents for patients undergoing GA and CS, respectively. Systolic blood pressure >140 mm Hg was targeted by 35.7% of respondents, with others targeting mean arterial pressure within 10%, 20% or 30% of baseline values. Phenylephrine and norepinephrine were the most commonly used vasopressors.

Conclusions:
There is wide variation in anesthesia technique and hemodynamic management during EVT for AIS, and no consensus on the choice of, or preferred medications for, GA or CS, or target blood pressure and management of hypotension during the procedure.
Evidence of a Vestibular Origin for Crossed-Sternocleidomastoid Muscle Responses to Air-Conducted Sound
Authors: Taylor Rachael L. , Winton Roger W. , Rosengren Sally M. , Argaet Emma C. , Welgampola Miriam S. 
Published: November 2019

Objectives:
Small, excitatory surface potentials can sometimes be recorded from the contralateral sternocleidomastoid muscle (SCM) following monaural acoustic stimulation. Little is known about the physiological properties of these crossed reflexes. In this study, we sought the properties of crossed SCM responses and through comparison with other cochlear and vestibular myogenic potentials, their likely receptor origin.

Design:
Surface potentials were recorded from the ipsilateral and contralateral SCM and postauricular (PAM) muscles of 11 healthy volunteers, 4 patients with superior canal dehiscence and 1 with profound hearing loss. Air-conducted clicks of 105 dB nHL and tone bursts (250 to 4000 Hz) of 100 dB nHL were presented monaurally through TDH 49 headphones during head elevation. Click-evoked responses were recorded under two conditions of gaze in random order: gaze straight ahead and rotated hard toward the contralateral recording electrodes. Amplitudes (corrected and uncorrected) and latencies for crossed SCM responses were compared with vestibular (ipsilateral SCM) and cochlear (PAM) responses between groups and across the different recording conditions.

Results:
Surface waveforms were biphasic; positive-negative for the ipsilateral SCM, and negative-positive for the contralateral SCM and PAM. There were significant differences in the amplitudes and latencies (p = 0.004) for click responses of healthy controls across recording sites. PAM responses had the largest mean-corrected amplitudes (2.3 ± 2.8) and longest latencies (13.0 ± 1.2 msec), compared with ipsilateral (1.6 ± 0.5; 12.0 ± 0.7 msec) and contralateral (0.8 ± 0.3; 10.4 ± 1.0 msec) SCM responses. Uncorrected amplitudes and muscle activation for PAM increased by 104.4% and 46.8% with lateral gaze respectively, whereas SCM responses were not significantly affected. Click responses of patients with superior canal dehiscence followed a similar latency, amplitude, and gaze modulation trend as controls. SCM responses were preserved in the patient with profound hearing loss, yet all PAM were absent. There were significant differences in the frequency tuning of the three reflexes (p < 0.001). Tuning curves of healthy controls were flat for PAM and down sloping for ipsilateral and contralateral SCM responses. For superior canal dehiscence, they were rising for PAM and slightly down sloping for SCM responses.

Conclusions:
Properties of crossed SCM responses were similar, though not identical, to those of ipsilateral SCM responses and are likely to be predominantly vestibular in origin. They are unlikely to represent volume conduction from the PAM as they were unaffected by lateral gaze, were shorter in latency, and had different tuning properties. The influence of crossed vestibulo-collic pathways should be considered when interpreting cervical vestibular-evoked myogenic potentials recorded under conditions of binaural stimulation.
Transcutaneous Hemoglobin Screening in an Adult Orthopaedic Trauma Population
Authors: Rascoe Alexander S. , Kavanagh Michael D. , Breslin Mary A. , Hu Emily , Vallier Heather A. 
Published: November 2019

Objectives:
To evaluate a noninvasive hemoglobin measurement device in an orthopaedic trauma population.

Design:
Prospective.

Setting:
Level 1 trauma center.

Patients/Participants:
One hundred five patients consecutively admitted to the orthopaedic trauma service after surgical treatment of fracture.

Intervention:
Transcutaneous hemoglobin (TcHgb) monitoring using the Masimo Pronto Pulse CO-Oximeter model with Rainbow SET Technology for spot TcHgb measurement.

Main Outcome Measurements:
TcHgb measurements and standard venipuncture hemoglobin (vHgb) were obtained. Patient preferences for each were recorded.

Results:
TcHgb measurements were obtained in 100 patients and compared with their corresponding vHgb measurements. The mean vHgb and TcHgb were 10.2 ± 1.9 g/dL and 11.2 ± 2.1 g/dL, respectively, and the mean difference was 1.1 ± 1.6 g/dL, which was statistically different from 0 (P < 0.001). In 76% of cases, the TcHgb device overestimated vHgb. In a subgroup of patients undergoing procedures with minimal expected blood loss (external fixators of knee or ankle, irrigation and debridement, or open reduction and internal fixation of ankle or calcaneal fractures), the mean difference between vHgb and TcHgb was 0.68 ± 1.6 g/dL (P = 0.06).

Conclusions:
A preliminary study of TcHgb monitoring with the tested device as a potential screening mechanism to limit unnecessary blood draws showed statistical difference from vHgb; however, the mean bias 1.1 g/dL of hemoglobin was notably small. In a subgroup of patients undergoing procedures with minimal expected blood loss, the device may have merit. Larger studies are required to determine the clinical relevance of differences in measurements between the 2 methods.

Level of Evidence:
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
A Reimbursement System Based on a 48-Hour Target Time for Surgery Shortens the Waiting Time for Hip Fracture Fixation in Elderly Patients
Authors: Uri Ofir , Folman Yoram , Laufer Gil , Behrbalk Eyal 
Published: November 2019

Objectives:
To evaluate whether a pay-for-performance reimbursement system, aimed at expediting surgical fixation of hip fractures in elderly patients, has, in fact, succeeded in shortening the waiting time for surgery.

Design:
Retrospective analysis of prospectively collected data.

Setting:
Academic Level II trauma center.

Patients/Participants:
One hundred fifty patients older than 70 years with femoral neck fractures (OTA/AO 31 A1–A3).

Intervention:
Implementation of a reimbursement system which incentivizes meeting a 48-hour target time for surgical fixation of hip fractures in elderly patients.

Methods:
Medical records of 75 consecutive patients operated on 1 year before the implementation of the reimbursement system were compared with records of 75 consecutive patients operated on 1 year after the implementation of the reimbursement system. The collected data included age, sex, American Society of Anesthesiologist score, time from injury to hospital admission, time from admission to surgery, reason for surgical delay beyond 48 hours, perioperative complication rate, and length of postoperative hospitalization.

Results:
Patients' mean age, sex distribution, American Society of Anesthesiologist score, and time from injury to hospital admission were similar in both groups. The average waiting time for surgery shortened from a mean of 77 hours before implementing the reimbursement system to 28 hours after the implementation (P < 0.001). Before the reimbursement system implementation, 41% of the surgeries were delayed beyond 48 hours due to medical causes, compared with 20% only after the implementation (P < 0.001). Fewer patients developed perioperative complications in the postimplementation group in comparison with the preimplementation group (9% vs. 13%, respectively); however, because the study was not powered to examine differences in complication rate, the significance of this difference remains unclear.

Conclusions:
A reimbursement system which incentivizes meeting a 48-hour target time for surgery has led to a substantial shortening in the waiting time for surgical fixation of hip fractures in elderly patients in our institution.
Comparison of the Results of Primary Versus Repeat Hamstring Surgical Lengthening in Cerebral Palsy
Authors: Morais Filho Mauro C. , Blumetti Francesco C. , Kawamura Cátia M. , Fujino Marcelo H. , Matias Marcelo S. , Lopes José A.F. 
Published: November 2019

Background:
Hamstring surgical lengthening (HSL) has been frequently performed for the correction of knee flexion deformity in cerebral palsy (CP), although recurrence is described in long-term follow-up. Repeat hamstring surgical lengthening (RHSL) can be an option for recurrent knee flexion deformity; however, the results of this approach are still controversial. The purpose of this study was to compare the results of primary HSL and RHSL in CP.

Methods:
Patients with spastic diplegic CP, Gross Motor Function Classification System levels I to III, underwent bilateral medial HSL with complete documentation in the gait laboratory before and after the intervention, were included in the study. A total of 229 subjects met the inclusion criteria and were divided into 2 groups: group A was formed by those who received medial HSL for the first time (185 patients), and group B was composed of individuals who underwent RHSL (44 patients). Clinical and kinematic parameters were evaluated before and after the intervention, and the results compared.

Results:
The groups were matched with regard to sex distribution, Gross Motor Function Classification System levels, and follow-up time (>2 y). Popliteal angle was reduced in groups A (60.3 to 51.4 degrees, P<0.001) and B (56.1 to 51.5 degrees, P=0.001) after the intervention. Knee flexion at initial contact was reduced from 40.8 to 28.9 degrees in group A (P<0.001) and from 40.4 to 35.1 degrees in group B (P=0.001). Reduction of minimum knee flexion in the stance phase (24.9 to 17.5 degrees, P<0.001) and improvement of the Gait Deviation Index (52.9 to 60.2, P<0.001) occurred only in group A. Anterior pelvic tilt (APT) increased in groups A (from 17 to 19.5 degrees, P<0.001) and B (from 14.9 to 19.4 degrees, P<0.001) after treatment. Finally, in the comparison between groups, the reduction of knee flexion at initial contact was more significant in group A (P<0.001), whereas the increase of APT was higher in group B.

Conclusions:
In the present study, the improvement of knee extension during the stance phase was observed only after the primary medial HSL. Moreover, the increase of APT was more significant when RHSL was performed.

Level of Evidence:
Level III.
Complex Clubfoot Treatment With Ponseti Method: A Latin American Multicentric Study
Authors: Allende Victoria , Paz Miguel , Sanchez Sergio , Lanfranchi Lucas , Torres-Gomez Armando , Arana Erika , Nogueira Mónica P. , Masquijo J. Javier 
Published: November 2019

Background:
Complex clubfoot is a term used to describe those feet that present after treatment with a short first metatarsal, severe plantar flexion of all metatarsals, rigid equinus, and deep folds through the sole of the foot and above the heel. Ponseti has described a modification of his original technique for the treatment of the deformity. Few series have reported the treatment outcomes of this group of patients. The purpose of this study is to analyze mid-term results and complications of a large multicenter cohort.

Methods:
Patients with complex clubfoot treated at 6 tertiary-care institutions with a minimum of 1-year follow-up were retrospectively analyzed. Demographic data, previous treatment, number of casts, Achilles tenotomy, recurrences, complications, and additional procedures were documented. The patients were clinically evaluated at the time of presentation, after treatment, and at the last follow-up according to the Pirani score. All variables had a nonparametric distribution and are thus described as median (interquartile range (IQR), minimum-maximum). A comparison between the variables was performed using a Mann-Whitney U test, the change within each group was performed with a Wilcoxon-designated range test. A P-value <0.05 was used to indicate statistical significance.

Results:
One hundred twenty-four feet (79 patients) were evaluated. The median age at initial treatment was 7 months (IQR, 15; min-max, 1 to 53 mo). The mean follow-up was 49 months (IQR, 42; min-max, 12 to 132 mo). A median of 5 casts (IQR, 5; min-max, 3 to 13) was required for correction. Percutaneous tenotomy of the Achilles tendon was performed in 96% of the feet. One hundred twenty-two feet (98%) were initially corrected; 2 feet could not be corrected and required a posteromedial release. The Pirani score improved significantly from a pretreatment mean of 6 points (IQR, 1; min-max, 4.5 to 6) to 0.5 (IQR, 0.5; min-max, 0 to 2.5) at the last follow-up (P <0.001). Seven feet (6%) presented minor complications related to casting. Relapses occurred in 29.8% (37/124). In this subgroup, the number of casts required at initial treatment was higher (6; IQR, 5; min-max, 1 to 12 vs. 4 IQR, 4; min-max, 1 to 13; P<0.001), and follow-up was significantly longer (62 mo; IQR, 58; min-max, 28 to 132 vs. 37 mo; IQR, 48, min-max, 7 to 115; P<0.001).

Conclusions:
Ponseti method is safe and effective for the correction of complex clubfeet. Early diagnosis and strict adherence to the Ponseti principles are key to achieve deformity correction. Patients with complex clubfoot require frequent follow-up because of a higher recurrence rate.

Level of Evidence:
Level III—therapeutic study.
Does Cervical Sagittal Balance Affect the Preoperative Neck Disability Index in Patients With Cervical Myelopathy?
Authors: Lin Taotao , Chen Penghong , Wang Zhenyu , Chen Gang , Liu Wenge 
Published: November 2019

Study Design:
This was a retrospective study.

Objective:
This study aimed to ascertain the relationship between preoperative Neck Disability Index (NDI) scores and cervical sagittal alignment in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data:
Cervical alignment may influence postoperative clinical outcomes. However, the effect of preoperative sagittal balance on the preoperative status in CSM patients remains uncertain.

Materials and Methods:
From 2010 to 2016, 90 patients who underwent cervical surgery for CSM were enrolled. The inclusion criteria for this study included preoperative standing cervical radiographs and a preoperative NDI score. The following radiographic parameters were measured: (1) C0–C2 lordosis, (2) C2–C7 lordosis, (3) C2–C7 sagittal vertical axis (SVA), (4) neck tilt, (5) thoracic inlet angle, (6) T1 slope, and (7) T1 slope minus cervical lordosis (T1S-CL). The Pearson product-moment correlation coefficients were calculated between all radiographic variables and the NDI scores, and multiple regression analysis was performed to determine the independent predictors of high preoperative NDI scores.

Results:
Both C2–C7 SVA and T1S-CL were positively correlated with NDI scores (r=0.732, P<0.001 and r=0.333, P=0.001). Cervical lordosis was negatively correlated with NDI scores (r=−0.267, P=0.011). Significant correlations were found between C2–C7 SVA and the C0–C2 Cobb angle (r=0.244, P=0.020), C2–C7 SVA and the C2–C7 Cobb angle (r=−0.359, P=0.001), the C2–C7 Cobb angle and the C0–C2 Cobb angle (r=−0.457, P<0.001), and the C2–C7 Cobb angle and T1 slope (r=−0.385, P<0.001).

Conclusions:
The disability of the neck increased with increasing C2–C7 SVA and T1S-CL and decreasing cervical lordosis before surgical reconstruction. High C2–C7 SVA, low thoracic inlet angle, and high neck tilt values are independent predictors of high preoperative NDI scores.
Magnesium and Hemorrhage Volume in Patients With Aneurysmal Subarachnoid Hemorrhage
Authors: Liotta Eric M. , Karmarkar Ameeta , Batra Ayush , Kim Minjee , Prabhakaran Shyam , Naidech Andrew M. , Maas Matthew B. 
Published: November 2019

Objectives:
We tested the hypothesis that admission serum magnesium levels are associated with extent of hemorrhage in patients with aneurysmal subarachnoid hemorrhage.

Design:
Single-center prospective observational study.

Setting:
Tertiary hospital neurologic ICU.

Patients:
Patients with aneurysmal subarachnoid hemorrhage.

Interventions:
Clinically indicated CT scans and serum laboratory studies.

Measurements and Main Results:
Demographic, clinical, laboratory, and radiographic data were analyzed. Extent of initial hemorrhage was graded semi-quantitatively on admission CT scans using the modified Fisher scale (grades: 0, no radiographic hemorrhage; 1, thin [< 1 mm in depth] subarachnoid hemorrhage; 2, thin subarachnoid hemorrhage with intraventricular hemorrhage; 3, thick [≥ 1 mm] subarachnoid hemorrhage; 4, thick subarachnoid hemorrhage with intraventricular hemorrhage). We used both ordinal (modified Fisher scale) and dichotomized (thick vs thin subarachnoid hemorrhage) univariate and adjusted logistic regression models to assess associations between serum magnesium and radiographic subarachnoid hemorrhage severity. Data from 354 patients (mean age 55 ± 14 yr, 28.5% male, median admission Glasgow Coma Scale 14 [10–15]) were analyzed. Mean magnesium was lower in patients with thick versus thin subarachnoid hemorrhage (1.92 vs 1.99 mg/dL; p = 0.022). A monotonic trend across categories of modified Fisher scale was found using analysis of variance and Spearman rank correlation (p = 0.015 and p = 0.008, respectively). In adjusted ordinal and binary regression models, lower magnesium levels were associated with higher modified Fisher scale (odds ratio 0.33 per 1 mg/dL increase; 95% CI, 0.14–0.77; p = 0.011) and with thick subarachnoid hemorrhage (odds ratio 0.29 per 1 mg/dL increase; 95% CI, 0.10–0.78; p = 0.015).

Conclusions:
These data support the hypothesis that magnesium influences hemorrhage severity in patients with aneurysmal subarachnoid hemorrhage, potentially through a hemostatic mechanism.
Effects of Hyaluronic Acid on Stability of Bleomycin Foam
Authors: Zhang Hao , Song Yu-Tong , Zhang Han-Shu , Zhang Fan , Liu Shao-Hua 
Published: November 2019

BACKGROUND
Bleomycin (BLM) foam sclerotherapy is effective in the treatment of venous malformations (VMs). Foam stability is influenced by factors such as sclerosant concentration, viscosity, and liquid–gas ratio.

OBJECTIVE
To investigate whether hyaluronic acid (HA) could increase the stability of BLM foam and to evaluate the safety and efficacy of HA—BLM foam.

MATERIALS AND METHODS
Experiment: BLM 6.0 IU + human serum albumin (HSA, 2, 1.95, 1.90, and 1.85 mL, respectively) + 1% HA (0, 0.05, 0.10, and 0.15 mL, respectively) + air 6 mL to create foam using the Tessari method. The foam half-life (FHL) was used to evaluate foam stability. Clinical study: Twenty-eight patients with head and neck VMs were enrolled between June 2018 and August 2019 treated by HA-BLM foam to evaluate the safety and efficacy.

RESULTS
The FHL of the BLM foam was 8.46, 8.95, 10.45, and 14.51 minutes, respectively. All patients achieved significant efficacy, and no obvious side effects were observed.

CONCLUSION
Addition of HA could improve the stability of BLM foam.
Barriers to Performing Soft Tissue Reconstruction Procedures among Orthopedic Surgeons in Low- and Middle-income Countries: Results of a Surgical Skills Training Course
Authors: Holler Jordan T. , Albright Patrick , Challa Sravya , Ali Syed H , Martins Deborah , Keys Kari , Shearer David W. , Terry Michael J. 
Published: November 2019

Background:
Appropriate management of soft tissue injury associated with orthopedic trauma is challenging in low- and middle-income countries (LMICs) due to the lack of available reconstructive surgeons. The Surgical Management and Reconstructive Training (SMART) course teaches orthopedic surgeons reconstructive techniques aimed at improving soft tissue management. This study aims to identify additional barriers to implementing these techniques for surgeons in LMICs who have attended SMART courses.

Methods:
This is a mixed-methods study including a Likert-scale-based survey administered to 150 surgeons from LMICs attending the 2018 SMART courses in Tanzania and San Francisco and key informant interviews with 20 surgeons who perform soft tissue coverage procedures.

Results:
In surveys, respondents reported inadequate local plastic surgeon availability for lower extremity fracture requiring muscle flaps (88%). Surgeons agreed that flap surgeries are important for patients with significant soft tissue injury following open fractures (97%). They reported inadequate access to instruments, such as dermatomes (59%) and Humby knives (32%), and senior-level support (31%). Fewer than half of surgeons with flap experience (n = 85) felt confident in training peers (45%). In interviews, delays in returning patients to operating rooms were frequently cited as a barrier (90%).

Conclusions:
Our study demonstrates that soft tissue procedures are perceived as a high priority among orthopedic surgeons, but there are multiple barriers, including a lack of plastic surgeons, and many modifiable barriers including a lack of surgical equipment, peer training, and senior colleague support.
Nerve Transfer from the Long Head Triceps Nerve to Posterior Interosseous Nerve for Restoration of Wrist, Finger, and Thumb
Authors: Zermeño-Rivera Jesús Jaime , Flores-Moltedo Nicolás Ignacio , Gutiérrez-Amavizca Bianca Ethel 
Published: November 2019

Summary:
In brachial plexus injuries where the radial nerve is damaged, there is loss of wrist, finger, and thumb extension. Surgical options for treating brachial plexus injuries are case dependent. To restore finger and wrist extension, the median nerve is primarily utilized for nerve transfer. We describe a new technique in a young man who suffered a gunshot wound in the left axilla, injuring the radial, median, and ulnar nerves. To restore wrist, finger, and thumb extension, we designed and performed a new technique consisting of nerve transfer, an interposition sural nerve graft from the motor branch of the long triceps portion to the posterior interosseous nerve. Positive outcomes were seen after 18 months with postoperative recovery of the functionality of finger and wrist extension.