bluuebunny/crossref_metadata_2025_split huggingface dataset:
Baseline and 1-year longitudinal data from the National Restless Legs Syndrome Opioid Registry
Authors: Winkelman John W , Purks Julia , Wipper Benjamin 
Published: September 2020

Abstract

Study Objectives
Restless legs syndrome (RLS) is a sensory-motor neurological disorder. Low dose opioid medications are prescribed for treatment-refractory RLS. We describe baseline and 1-year longitudinal dosing and symptom outcomes for the National RLS Opioid Registry.

Methods
Individuals currently taking a prescribed opioid for diagnosed RLS are included in the registry. Information on initial and current opioid dosages, side effects, past and current concomitant RLS treatments, RLS severity, psychiatric history, and opioid abuse risk factors were collected at baseline. Follow-up online surveys were performed at 6 months and 1-year.

Results
Participants (n = 500) are primarily white, elderly, educated, and retired. Half of all subjects are on opioid monotherapy. Nearly 50% of all subjects are taking methadone, and one-quarter are taking oxycodone formulations. The median total daily opioid dose is 30.0 morphine milligram equivalents (MME). At baseline, three-quarters of registry participants had been taking a prescribed opioid for RLS for more than 1 year and one-third for more than 5 years, and had mild-moderate RLS symptoms. At 1-year follow-up, 31.2% increased dose (median = 10 MME) and 16.0% decreased dose of their opioid. An MME increase ≥25 was associated with: opioid use for non-RLS pain, &lt;1 year of opioid use, opioid switch to methadone, and discontinuation of non-opioid RLS medications which, combined, accounted for 91.7% of those with 1-year follow-up increases ≥25 MME.

Conclusions
In refractory RLS, prescribed opioids are generally used at low doses with good efficacy. Longitudinally over 1 year, roughly one-third of participants increased their prescribed opioid dose, though generally by small amounts, with larger dose increases accounted for by predictable features.
Growth performance and gut health of Escherichia coli-challenged weaned pigs fed diets supplemented with a Bacillus subtilis direct-fed microbial
Authors: Park Sangwoo , Lee Jung Wook , Jerez Bogota Kevin , Francis David , González-Vega Jolie Caroline , Htoo John K , Woyengo Tofuko Awori 
Published: September 2020

AbstractThis study was conducted to investigate the effects of a direct-fed microbial (DFM) product (Bacillus subtilis strain DSM 32540) in weaned pigs challenged with K88 strain of Escherichia coli on growth performance and indicators of gut health. A total of 21 weaned pigs [initial body weight (BW) = 8.19 kg] were housed individually in pens and fed three diets (seven replicates per diet) for 21 d in a completely randomized design. The three diets were a corn-soybean meal-based basal diet without feed additives, a basal diet with 0.25% antibiotics (neo-Oxy 10-10; neomycin + oxytetracycline), or a basal diet with 0.05% DFM. All pigs were orally challenged with a subclinical dose (6.7 × 108 CFU/mL) of K88 strain of E. coli on day 3 of the study (3 d after weaning). Feed intake and BW data were collected on days 0, 3, 7, 14, and 21. Fecal scores were recorded daily. On day 21, pigs were sacrificed to determine various indicators of gut health. Supplementation of the basal diet with antibiotics or DFM did not affect the overall (days 0–21) growth performance of pigs. However, antibiotics or DFM supplementation increased (P = 0.010) gain:feed (G:F) of pigs during the post-E. coli challenge period (days 3–21) by 23% and 24%, respectively. The G:F for the DFM-supplemented diet did not differ from that for the antibiotics-supplemented diet. The frequency of diarrhea for pigs fed a diet with antibiotics or DFM tended to be lower (P = 0.071) than that of pigs fed the basal diet. The jejunal villous height (VH) and the VH to crypt depth ratio (VH:CD) were increased (P &lt; 0.001) by 33% and 35%, respectively, due to the inclusion of antibiotics in the basal diet and by 43% and 41%, respectively due to the inclusion of DFM in the basal diet. The VH and VH:CD for the DFM-supplemented diet were greater (P &lt; 0.05) than those for the antibiotics-supplemented diet. Ileal VH was increased (P &lt; 0.05) by 46% due to the inclusion of DFM in the basal diet. The empty weight of small intestine, cecum, or colon relative to live BW was unaffected by dietary antibiotics or DFM supplementation. In conclusion, the addition of DFM to the basal diet improved the feed efficiency of E. coli-challenged weaned pigs to a value similar to that of the antibiotics-supplemented diet and increased jejunal VH and VH:CD ratio to values greater than those for the antibiotics-supplemented diet. Thus, under E. coli challenge, the test DFM product may replace the use of antibiotics as a growth promoter in diets for weaned pigs to improve feed efficiency and gut integrity.
Changing the landscape of South Asian migrant health research by advancing second-generation immigrant health needs
Authors: Ali Shahmir H , DiClemente Ralph J , Parekh Niyati 
Published: September 2020

Abstract
South Asian immigrants confront a growing non-communicable disease burden, a significant issue in countries such as the USA. While efforts have slowly begun to address South Asian migrant health, second-generation communities remain underserved and understudied despite facing many of the same non-communicable disease concerns. The aim of this commentary is to highlight unique health disparities contributing to the current South Asian migrant health status and identify pathways for further formative research needed to inform subsequent development, implementation, and evaluation of health interventions targeting this community. Extant peer-reviewed literature addressing second-generation South Asian health issues was used to identify key research pathways needed to address existing gaps. Specifically, we call for (a) enhancing targeted surveillance and recruitment in research and (b) collecting data to help characterize behavioral and cultural patterns that may contribute to disease onset and progression. Expanding research on second-generation South Asian migrant health may help to develop tailored and targeted interventions.
Effective Masking Levels for Bone Conduction Auditory Brainstem Response Stimuli in Infants and Adults with Normal Hearing
Authors: Lau Ricky , Small Susan A. 
Published: September 2020

Objective:
The purpose of the present study was to investigate effective masking levels (EMLs) for bone conduction (BC) auditory brainstem response (ABR) testing in infants and adults. Early hearing detection and intervention programs aim to limit delays in identifying ear-specific type/degree of hearing loss in infants using the ABR. Ear-specific assessment poses challenges as sound delivered to one ear can travel across the skull and activate the contralateral cochlea. Wave V amplitude and latency measures ipsilateral and contralateral to the bone oscillator can be compared to isolate the test cochlea in some cases; however, when these findings are equivocal, clinical masking is required. This study aims to determine EMLs for ABRs elicited to 500- and 2000-Hz BC stimuli for normal-hearing infants (0 to 18 months) and adults.

Design:
Participants were 21 adults (18 to 54 years) and 24 infants (5 to 47 weeks) with normal hearing. BC 500- and 2000-Hz brief tonal stimuli at intensities approximating normal levels were presented via a B-71 oscillator (infants: 20 dB nHL at 500 Hz and 30 dB nHL at 2000 Hz; adults: 500 and 2000 Hz at 20 and 30 dB nHL, respectively). White noise masking was presented binaurally via ER-3A earphones (22 to 82 dB SPL; 10-dB steps). The lowest level of masking to eliminate a BC response was deemed the EML.

Results:
For stimuli presented at 20 dB nHL, adult mean (1 SD) EMLs for 500 and 2000 Hz were 65 (9) and 53 (6) dB SPL, respectively. Mean EMLs for infants were 80 (6) dB SPL for 500 Hz at 20 dB nHL and 64 (9) dB SPL for 2000 Hz at 30 dB nHL. Compared to adults, infants required approximately 13 dB more masking at 500 Hz but a similar amount of masking at 2000 Hz. Infants required 26 dB more masking at 500 versus 2000 Hz, whereas, adults required only 12 dB more masking.

Conclusions:
Maximum binaural EMLs for infant BC responses elicited to 500 Hz at 20 dB nHL are 82 dB SPL, and for 2000 Hz at 30 and 40 dB nHL, respectively, are 72 and 82 dB SPL. Monaural masking levels for the nontest ear (assuming 10 dB of interaural attenuation) recommended clinically are as follows: (1) 500 Hz: 72 and 82 dB SPL at 20 and 30 dB nHL, respectively; and (2) 2000 Hz: 62, 72, and 82 dB SPL at 30, 40, and 50 dB nHL, respectively. Unsafe levels of white noise would be needed to effectively mask at greater stimulus levels.
Health-Related Quality of Life Outcomes of Instrumented Circumferential Spinal Fusion for Pediatric Spondylolisthesis
Authors: Virkki Ella N. , Oksanen Hanna , Diarbakerli Elias , Helenius Linda , Pape Bernd , Pajulo Olli , Gerdhem Paul , Helenius Ilkka 
Published: September 2020

Study Design.
A prospective study on the clinical, radiographic, and the health-related quality of life (HRQOL) outcomes in adolescents with spondylolisthesis undergoing instrumented circumferential spinal fusion compared with age and sex matched controls.

Objective.
To determine the outcomes of pediatric spondylolisthesis patients minimum 2 years after surgery and to compare their HRQOL with age and sex matched controls.

Summary of Background Data.
There is limited evidence of the HRQOL of adolescent spondylolisthesis patients after surgery and no studies comparing it with healthy controls.

Methods.
Twenty-six consecutive adolescents (mean age 14.7 yr, range 10–18 yr) undergoing instrumented reduction with intercorporeal spinal fusion for spondylolisthesis (11 low-grade, 15 high-grade) by a single orthopedic surgeon were included to this study cohort and matched by age and sex with two controls. The HRQOL was measured with Scoliosis Research Society-24 (SRS-24) questionnaire before surgery, 6 months and 2 years after the surgery.

Results.
The mean (SD) vertebral slip in the low-grade patients was 25% (13%) and 67% (15%) in the high-grade patients and 6% (7%) and 21% (25%) postoperatively, respectively (P ≤ 0.041 for both comparisons). Three (12%) patients developed a non-union during follow-up. None of the patients developed a persistent neurologic deficit, but two (8%) patients presented with chronic postsurgical pain persisting 24 months. Seven (27%) of the patients had reoperations for any reason during the follow-up. Pain and activity domains of the SRS-24 improved significantly from preoperative to 2-year follow-up (P ≤ 0.007 for both). SRS pain, self-image, function domains, and total score were significantly worse as compared with the 52 controls (P ≤ 0.020 for all comparisons).

Conclusion.
Risk of non-union is relatively low after instrumented spinal reduction in adolescents with spondylolisthesis. HRQOL improves significantly after instrumented reduction and circumferential spinal fusion in adolescents with spondylolisthesis, but remains at statistically lower level than in the controls.

Level of Evidence: 2
Radiation Exposure in Minimally Invasive Lumbar Fusion Surgery
Authors: Klingler Jan-Helge , Scholz Christoph , Krüger Marie T. , Naseri Yashar , Volz Florian , Hohenhaus Marc , Brönner Johannes , Hoedlmoser Herbert , Sircar Ronen , Hubbe Ulrich 
Published: September 2020

Study Design.
Randomized controlled trial.

Objective.
The aim of this study was to compare the dosemetrically determined radiation exposure of surgeon and patient during minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using conventional 2D fluoroscopy (FLUORO) or 3D fluoroscopy-based navigation (NAV).

Summary of Background Data.
MIS TLIF was shown to exhibit higher radiation exposures compared to open techniques. In particular, the routinely exposed surgeon encounters the risks of increased radiation doses. With the additional use of intraoperative 3D navigation, major steps of the operation can be performed without exposing the operating room staff to ionizing radiation.

Methods.
Forty-four patients undergoing monosegmental MIS TLIF were randomized into the two intraoperative imaging technique groups (FLUORO or NAV). The primary endpoint was the radiation exposure of the surgeon; the secondary endpoints were the radiation exposure of the patient and C-arm readings.

Results.
After exclusion of three patients, 41 patients were analyzed. In general, the average radiation exposure of the surgeon was lower in the NAV group without being statistically significant. The radiation exposure of the patient was significantly higher in the NAV group at all dosemeter sites. The average fluoroscopy time was 63 ± 36 versus 109 ± 31 sec (FLUORO versus NAV group, P < 0.001).

Conclusion.
The additional use of intraoperative 3D fluoroscopy-based navigation compared to conventional 2D fluoroscopy alone showed a nonsignificant reduction of the radiation exposure of the surgeon in monosegmental MIS TLIF, while increasing the radiation exposure of the patient.

Level of Evidence: 1
Cost and Complications of Single-Level Lumbar Decompression in Those Over and Under 75
Authors: Rosas Samuel , Knio Ziyad O. , Gowd Anirudh K. , Luo T. David , Emory Cynthia L. , O’Gara Tadhg J. 
Published: September 2020

Study Design.
Retrospective database analysis.

Objective.
This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and older.

Summary of Background Data.
Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined.

Methods.
The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared.

Results.
The matched cohort included 89,388 total patients (n = 44,694 for each study arm). Compared to the under 75 age group, the 75 and older age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, P = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and older (9.66% vs. 9.28%, P = 0.051), although the 75 and older age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867, respectively, P = 0.013 and <0.001, respectively). The 75 and older age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement.

Conclusion.
Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates.

Level of Evidence: 3
Is There a Relationship Between Bony Fusion After Anterior Cervical Discectomy and Fusion and Heterotopic Ossification After Cervical Disc Arthroplasty in Hybrid Surgery?
Authors: He Junbo , Ding Chen , Liu Hao , Wu Tingkui , Huang Kangkang , Wang Beiyu , Hong Ying , Liu Ying 
Published: September 2020

Study Design.
Retrospective analysis.

Objective.
The aim of this study was to investigate the relationship between bony fusion after anterior cervical discectomy and fusion (ACDF) and heterotopic ossification (HO) after cervical disc arthroplasty (CDA) in hybrid surgery (HS).

Summary of Background Data.
The mechanism of postoperative bone formation still remains unknown. It is considered a risk factor in CDA but is essential for a solid union in ACDF. With HS, we could directly study the mechanism and relationship of different forms of postoperative bone formation.

Methods.
Clinical data of 91 patients who had undergone consecutive two-level HS between January 2011 and January 2018 and with a minimum of 2-year follow-up was analyzed. HO was assessed based on McAfee's classifications, whereas fusion success was evaluated according the Food and Drug Administration approved criteria. Clinical outcomes and radiographic parameters were collected and used for the relevant comparisons.

Results.
HO was identified in 48.4% of patients (44/91). The fusion rates of patients in the HO group and the non-HO group at 3, 6, and 12 months postoperatively, and the final follow-up were 81.8% and 19.1%, 95.4% and 74.5%, 95.4% and 85.1%, and 97.7% and 93.6%, respectively. The fusion rates were significantly higher at 3 and 6 months after operation in the HO group than in the non-HO group (P < 0.05). Patients in both groups had significant improvements across all clinical outcomes at final follow-up.

Conclusion.
There was a significant relationship between bony fusion and occurrence of HO after HS, suggesting that both bony fusion and HO are reflections of individual osteogenic capacity. However, a reliable predictor of postoperative bone formation is needed in the future to guarantee a solid bony fusion after ACDF and to further take full advantage of the motion-preserving from CDA.

Level of Evidence: 3
Differences in Bone Mineral Density and Bone Turnover Markers Between Subjects With and Without Diffuse Idiopathic Skeletal Hyperostosis
Authors: Uehara Masashi , Takahashi Jun , Ikegami Shota , Tokida Ryosuke , Nishimura Hikaru , Sakai Noriko , Nakamura Yukio , Kato Hiroyuki 
Published: September 2020

Study Design.
Japanese resident cohort study based on a municipal registry.

Objective.
This study of a community-dwelling elderly Japanese population employed random sampling from the basic resident registry of a rural town for subject selection to investigate the differences in bone mineral density (BMD) and bone turnover markers between subjects with and without diffuse idiopathic skeletal hyperostosis (DISH).

Summary of Background Data.
DISH is a condition characterized by the calcification and ossification of soft tissues. Although some reports have addressed BMD in DISH, the precise status of BMD and bone metabolism in individuals with DISH remains unclear.

Methods.
Eight groups based on age (50s, 60s, 70s, and 80s) and sex after random sampling from the resident registry of Obuse town were established. A total of 411 participants (202 males and 209 females) were enrolled for the evaluation of BMD and bone turnover markers. All subjects underwent a single whole-spine lateral radiographic examination for the existence of DISH. The BMD and bone turnover markers of subjects with and without DISH were analyzed for associations with the disorder using multivariate analysis.

Results.
DISH was detected in 66 (16.1%) participants in our population cohort. According to multivariate analysis, increased lumbar and hip BMD were significantly related to DISH (odds ratio: 7.47 and 22.8, respectively).

Conclusion.
This study clarified the differences in BMD and bone turnover markers between subjects with and without DISH on a general population basis. Multivariate analysis revealed increased lumbar and hip BMD to be significantly associated with DISH, with no remarkable findings for bone turnover markers.

Level of Evidence: 4
Health Care Lobbying, Political Action Committees, and Spine Surgery
Authors: Menger Richard , Shaw Thomas , Bunch Jaclyn , Barry James , Marciano Gerard , Menger Austin , Martino Anthony , Lenke Lawrence , Vitale Michael G. 
Published: September 2020

Study Design.
Retrospective review.

Objective.
The aim of this study was to analyze the political contributions and strategies of the Political Action Committee (PACs) lobbying for the political interests of spine surgeons.

Summary of Background Data.
In 2016, a presidential election year, $514,224,628 was spent on health care lobbying. Only 16% ($85,061,148) was on behalf of health professionals providing care. Below we chronicle the overlapping contributions between the three different physician-based Political Action Committee (PAC) lobbying entities as it relates specifically to spine surgery.

Methods.
Data were abstracted for the PACs of the American Association of Neurological Surgeons (AANS), American Association of Orthopedic Surgeons (AAOS), and the North American Spine Society (NASS). These data were obtained using OpenSecrets (opensecrets.org), and the Federal Election Commission (fec.gov) website. All data points were collected biannually from 2006 to 2018 and statistically analyzed as appropriate.

Results.
In 2016, the AAOS PAC contributed $2,648,218, the AANS PAC $348,091, and the NASS PAC $183,612. After accounting for respective group size, the AAOS spent >2.34 times that of the AANS. Orthopedists were 3.84 times (95% confidence interval 3.42–4.3) more likely to donate to their PAC than neurosurgeons (P < 0.001) during the 2016 election. The majority of contributions among the three different lobbyist organizations were to federal candidates, followed by fundraising committees, and finally to the national party. Eighty-eight percent of AANS donations went to Republican candidates, whereas AAOS and NASS were 63% and 67%, respectively. From 2008 to 2016, the AAOS PAC had a highest political contributions spend per active member of parent organization ($126.39) as compared to AANS ($80.52) and NASS ($17.81). The AAOS had five surgeons for every donor to the AAOS PAC, whereas the AANS had 14 surgeons and NASS 38 members per each donor. The AANS had a higher percentage of Republican donations with 78.9% of donations going to Republicans as compared to 61.8% of AAOS contributions and 67.9% of NASS contributions.

Conclusion.
Spine surgery is unique in that three different physician-based lobbyist organizations seek to influence legislative priorities with the AAOS having the most substantial fiscal impact and greatest participation. Choreography of donation strategies is essential to maximize physician voice at the policy level.

Level of Evidence: 5
Targeting HER2 heterogeneity in early-stage breast cancer
Authors: Pernas Sonia , Tolaney Sara M. 
Published: September 2020

Purpose of review
HER2-positive (HER2+) breast cancer is clinically and biologically a heterogenous disease and not all patients benefit to the same extent from current anti-HER2 therapies.

Recent findings
Among HER2+ breast cancer, molecular intrinsic subtypes, PIK3CA mutation status, levels of HER2 gene/protein, immune infiltration, or intratumor heterogeneity modulate HER2-treatment sensitivity. HER2-enriched carcinomas, with high levels of HER2 and tumor-infiltrating lymphocytes (TILs) are highly sensitive to anti-HER2 therapies, regardless of chemotherapy. Luminal A/B tumors are more estrogen receptor-dependent than HER2-dependent, harbor higher rates of PIK3CA mutations, and are less responsive to anti-HER2 treatment. HER2 intratumoral heterogeneity that exists in approximately 10% of HER2+ disease may also cause treatment resistance. Early changes occur during neoadjuvant anti-HER2 therapy that can predict response. Importantly, HER2 expression is not a binary but rather a continuous variable. Overall, 34–63% of HER2-negative breast cancers express HER2, and HER2-low tumors have become a new entity, for which novel targeted therapies may be effective.

Summary
Although much of what is discussed currently remains investigational, it is clear that HER2+ breast cancer is a complex disease comprising different entities. Future strategies to escalate or de-escalate treatment in early-stage HER2+ disease should consider other biomarkers beyond HER2 and estrogen receptor status, including intrinsic subtype, HER2 levels, and TILs; and evaluate different treatment strategies among patients with estrogen receptor-positive/HER2+ and estrogen receptor-negative/HER2+ diseases.