bluuebunny/crossref_metadata_2025_split huggingface dataset:
Allergic conjunctivitis in children: current understanding and future perspectives
Authors: Vazirani Jayesh , Shukla Sachin , Chhawchharia Ritika , Sahu Srikant , Gokhale Nikhil , Basu Sayan 
Published: August 2020

Purpose of review
The rising global burden of allergic diseases, particularly in the pediatric population, is of serious concern. Ocular allergy is one of the most common ocular pathologies met in clinical practice. A large proportion of children and adolescents suffer from allergic eye diseases (AEDs), which affect their quality of life. The available treatments and surgical modalities have their limitations and side effects. Therefore, the development of novel and alternate strategies is the need of the hour and requires a timely review of currently available knowledge.

Recent findings
The current review covers the incidence and prevalence of AEDs, factors influencing occurrence and severity of AED (age, sex, socioeconomic status etc.), underlying mechanisms, role of allergy testing and immunotherapy in children, development of diagnostic markers and novel therapies including cells and molecules.

Summary
Understanding the demographics, clinical patterns and risk factors of AED can help formulate appropriate preventive and therapeutic strategies for the effective management of this common cause of ocular morbidity. The future therapeutics for AED seems to rely primarily on cells (mesenchymal stem cells, Tregs, mast cells), cell products, molecules with immunosuppressive potential and immunotherapy.
Chemokines in allergic conjunctivitis
Authors: Erdinest Nir , London Naomi , Solomon Abraham 
Published: August 2020

Purpose of reviewChemokines are a large group of low molecular weight cytokines that attract and activate leukocytes throughout the body and therefore have a key role in the framework of late-phase allergic responses. The purpose of this article is to provide an overview of the main chemokines involved in allergic conjunctivitis, their primary functions and their physiological roles, and therapies targeted at chemokines and their receptors for ocular allergic diseases.Recent findingsIn recent years, there have been considerable advances in the understanding of ocular pathophysiology of ocular surface inflammatory diseases including both allergic eye diseases and dry eye syndrome. Several therapies being developed for dry eye inflammation are recognized as possible therapies for ocular allergic diseases as there are often common chemokines involved in both disease spectra.SummaryChemokines represent an integral part of the late-phase cascade of ocular allergic inflammation. A deep understanding of specific chemokines and their interactions will help in targeting therapies to effectively manage ocular clinical findings and symptoms of allergic eye disease.
Comorbid Pain and Cognitive Impairment in a Nationally Representative Adult Population
Authors: Nahin Richard L. , DeKosky Steven T. 
Published: August 2020

Objective:
Using a nationally representative sample of adults and pain definitions consistent with the United States National Pain Strategy, we examined the associations of pain and cognitive impairment (CI) with each other and with measures of health status, physical impairment, social impairment, health care utilization, and dissatisfaction with health care.

Materials and Methods:
Prevalence estimates and multivariable logistic regression analyses of the 2017 National Health Interview Survey were performed.

Results:
As the level of reported pain increased from “no pain” to high-impact chronic pain (HICP), there was an increase in the prevalence of CI from 2.99% in those with no pain to 18.19% in those with HICP. Similarly, as the level of CI increased from no impairment to substantial CI, the prevalence of any pain increased from 62.44% to 83.20%. As pain severity and CI increased, we found increased prevalence for all outcomes examined, with the highest prevalence seen in participants with HICP and substantial CI. While 4.15% of individuals without either pain or CI reported poor/fair health, this increased to 33.98% in those with substantial CI or “dementia” but no pain, to 52.22% in those with HICP but no CI, and to 81.8% in individuals reporting both HICP and substantial CI or “dementia.”

Discussion:
Our data suggest that individuals with comorbid chronic pain and CI are in a much higher state of self-reported disability than those with chronic pain or CI alone. Best practice guidelines are generally silent on multidisciplinary, integrated care for these comorbid conditions, increasing the potential for inadequate care.
Headless compression screw fixation of Jones fractures: a clinical and radiographic comparison study
Authors: Ruta David J. , Ellis R. Tyler , Grear Benjamin J. , Richardson David R. , Murphy G. Andrew 
Published: August 2020

Background:
Promising results have been reported with indication-specific partially threaded screws and variable-pitched headless compression screws. Our objective was to compare clinical and radiographic results of Jones fractures treated with these two screw types. We also evaluated the association of patient and fracture characteristics with surgical failure.

Methods:
Retrospective review identified all Jones fractures treated with primary intramedullary screw fixation from 1995 through 2015. Chart review yielded patient and fracture characteristics, implants, postoperative course, and serial radiographs for fracture classification (Torg and anatomic zone) and radiographic union. The primary endpoint was surgical failure (delayed union, nonunion, or refracture). Secondary endpoints included time to radiographic union, weight bearing, and pain resolution.

Results:
Fifty-nine consecutive patients (47 with partially threaded screws and 12 with headless compression screws) with a mean age of 30 yr and follow-up of 9.6 mo were included. The group with partially threaded screws showed more failures (10/47, 21.3% vs. 1/12, 8.3%; P=0.31) and longer time to full weight bearing (4.2 vs. 3.3 wk, P=0.06), without differences in time to radiographic union or pain resolution. Pooled union rate was 96.6%.

Conclusions:
Factors significantly correlated with failure were age, diabetes, and body mass index, without significant correlation with tobacco or gender. No differences were found between zone II and III fractures. The two groups had similar clinical and radiographic results, both with high union rates. The 21% failure rate with partially threaded screws is concerning and may warrant further investigation. This supports the headless compression screw as a viable Jones fracture treatment.

Level of Clinical Evidence:
Level III.
Orthopaedic implant cost perceptions: a survey of surgeons and healthcare administrators
Authors: Albersheim Melissa , Parikh Harsh R. , Peck Sarah C. , Lindell Jackson S. , Vang Sandy , Blaschke Breanna L. , Cole Peter A. , Cunningham Brian P. 
Published: August 2020

Background:
Few studies to date have investigated healthcare administrators’ knowledge of implant costs, and, to the authors’ knowledge, none have evaluated surgeons’ knowledge of implant costs comparing their own cases to a general cohort. The purpose of this study was to analyze cost perceptions surrounding orthopaedic implants across subspecialties within a cohort of musculoskeletal surgeons and healthcare administrators.

Methods:
A 10-question survey, consisting of 10 fracture patients with their associated postoperative radiographs and the corresponding implant list, was distributed to administrators and musculoskeletal surgeons at a single Level I trauma hospital. Surgeons and administrators were asked to estimate the total cost of each of the constructs given on the survey. The estimates were subtracted from the actual implant costs, with average cost differences assessed as a net value for cohorts, surgeon specialties, and question type.

Results:
Administrators averaged an overestimation of $4655.22/case and surgeons averaged an overestimation of $41.61/case. The surgeon cohort averaged an underestimation of $608.06/case for their subspecialty cases and an underestimation of $3160.07/case for the control cases, neurosurgeons excluded. Traumatologists averaged an underestimation of $381.24/case overall, an underestimation of $379.72/case for their subspecialty cases, and an underestimation of $13.06/case for control cases.

Conclusions:
This study identified that neither surgeons nor administrators could accurately estimate implant costs. Orthopaedic surgeons appeared more accurate and may be uniquely positioned to interface with administrators. Although our study was limited by a small sample size, it pointed to opportunity for collaboration between surgeons and administrators to better understand implant costs and maximize value.

Level of Evidence:
Level VI.
Characteristics and Hospital Costs of Spica Cast Treatment of Non–accidental-related Diaphyseal Femoral Fractures in Children Before Walking Age
Authors: Magee Lacey C. , Mahmoud Mahmoud A.H. , Baldwin Keith , Talwar Divya , Gandhi Jigar S. , Arkader Alexandre 
Published: August 2020

Background:
Fractures are one of the most common presentations of child abuse second only to soft tissue damage, with ∼60% of fractures being femur, humerus or tibia fractures. Although studies have shown increased health care costs associated with nonaccidental trauma (NAT), there is little data regarding the cost of NAT-associated fractures compared with accidental trauma (AT) related fractures. The purpose of this study was to consider the economic burden of NAT related femoral fractures compared with AT femoral fractures.

Methods:
We performed a retrospective study of children under the age of one with femoral fractures treated with a spica cast at a Level 1 Pediatric Trauma Center between 2007 and 2016. Variables included age, sex, length of hospital stay, and estimated total billing cost obtained from this hospital’s billing department. In addition, fracture site (mid-shaft, distal, proximal, and subtrochanteric) and pattern were assessed.

Results:
Sixty children with a mean age of 7 months were analyzed. NAT was suspected in 19 cases (31.7%) and confirmed in 9 (15%) before discharge. Two groups were analyzed: the NAT group included suspected and confirmed cases of abuse (28) and the AT group contained the remaining 32 cases. There was no significant difference in the demographics between these 2 groups. Children in NAT group had a longer length of stay compared with AT group (78.9 vs. 36.7 h, P<0.001). Overall consumer price index-adjusted hospital costs were $24,726 higher for NAT group compared with AT group (P=0.024), with costs of laboratory workup, radiology, and nonorthopaedic physician fees being the top 3 components contributing to the increased costs.

Conclusions:
The overall incidence of NAT was 46.6% in children presenting with femoral fracture under 1 year of age. The overall hospital cost of treating fractures in the NAT group was 1.5 times higher than the AT group, with imaging charges the most significant contributor to cost difference.

Level of Evidence:
Level III—retrospective review.
External Validation of an Algorithm to Predict Adjacent Musculoskeletal Infection in Pediatric Patients With Septic Arthritis
Authors: Hunter Sarah , Kennedy Jim , Baker Joseph F. 
Published: August 2020

Background:
Septic arthritis (SA) remains a potentially morbid disease in the pediatric population. Magnetic resonance imaging (MRI) is the most sensitive tool for recognizing associated osteomyelitis and intramuscular abscess, but is a limited resource. The aim of this study is to externally validate a previously developed algorithm (Rosenfeld and colleagues) to predict adjacent infection in pediatric patients diagnosed with SA.

Methods:
We identified 120 children under 16 with presumed SA presenting to a tertiary referral center between 2008 and 2018. Patients without confirmed SA, those with insufficient data, and patients who did not receive perioperative MRI were excluded, leaving 53 patients. The previous algorithm suggests that patient age (above 4 y), C-reactive protein (>8.9 mg/L), platelet count (<310×103 cells/µL), duration of symptoms (>3 d), and absolute neutrophil count (>7.2×103 cells/µL) are risk factors for adjacent infection, with 3 or more variables signifying a “positive” result. Comparing against the gold standard of MRI, the accuracy of the algorithm was validated in terms of sensitivity, specificity, likelihood ratio (LR), and positive and negative predictive value. Discrimination and calibration of this algorithm have been assessed using receiver operating curve analysis and calibration plots.

Results:
The sensitivity and specificity of criteria from Rosenfeld algorithm were 73% and 44%, respectively. Receiver operating curve showed poor discrimination [area under the curve=0.54, confidence interval (CI): 0.26-0.83]. The positive predictive value was 55.9% and the negative predictive value was 63.1% with LR +1.23 (CI: 0.87-1.98) and LR −0.61 (CI 0.28-1.30). Only 53% of patients with 4 or more criteria had an adjacent infection on MRI. Examining our cohort, children with a positive MRI finding had higher mean C-reactive protein (77 vs. 122 mg/L, P=0.04) and were more likely to have waited >72 hours days between symptom onset and hospital presentation (P=0.03).

Conclusion:
Although treatment algorithms are an attractive tool to guide clinicians and resource allocation, they need to take into account the local population characteristics before routine implementation.

Level of Evidence:
Level IV–retrospective cohort study.
Lengthening Less Than 7 Months Leads to Greater Spinal Height Gain With Rib-based Distraction
Authors: Qiu Catherine , Lott Carina , Agaba Perez , Cahill Patrick J. , Anari Jason B. 
Published: August 2020

Background:
Severe early-onset scoliosis (EOS) has been associated with a multitude of comorbidities, chief among them being deficient thoracic spine growth and pulmonary complications. EOS management with rib-based instrumentation involves repeated lengthening. Despite expansion practice patterns, there is limited literature and no evidence-based guidelines for optimal expansion intervals. Our study evaluates clinical outcomes in relation to lengthening intervals with the aim of optimizing the timing of surgical expansion in EOS patients.

Methods:
A single-institution retrospective review of 60 EOS patients treated with rib-based growth instrumentation with a minimum of 3-year follow-up and 3 expansion/revision surgeries. Patients were separated into 2 expansion cohorts: (1) more frequent lengthening [MFL group (≤7 mo)] and (2) less frequent lengthening [LFL group (>7 mo)]. Demographic information and clinical factors were recorded. Univariate and bivariate analyses were performed.

Results:
Both the MFL group (35 patients) and LFL group (25 patients) were similar in sex distribution, diagnosis, preoperative parameters of interest, and treatment duration. The mean follow-up was 6.0 years. There was an increase in postoperative T1-S1 spine height gained in the MFL group (P=0.006) as well as a higher percent expected spine growth based on normative values (P=0.03) when compared with the LFL group. The MFL group had more expansion/revision surgeries (P=0.003) but no increase in the number of complications (P=0.86).

Conclusions:
More frequent lengthenings were associated with statistically significant overall spinal height gain and percent expected growth without a significant increase in complication rates. It was shown that change in major curve and space available for the lungs was not associated with the lengthening intervals.

Level of Evidence:
Level III—a comparative retrospective study.
Surgical Reconstruction of Missed Monteggia Lesions in Children
Authors: Zheng Evan T. , Waters Peter M. , Vuillermin Carley B. , Williams Kathryn , Bae Donald S. 
Published: August 2020

Background:
Chronic Monteggia lesions in children may cause pain, deformity, decreased range of motion, and neurological symptoms. Numerous surgical techniques have been advocated to reconstruct long-standing Monteggia injures in efforts to maximize long-term upper limb function. The purpose of this investigation was to assess the clinical and radiographic results of a modified surgical technique for missed Monteggia fracture-dislocations.

Methods:
A retrospective evaluation of 52 patients who underwent surgical reconstruction of missed Monteggia fracture-dislocations at a tertiary pediatric hospital was performed. The median patient age at the time of surgery was 6.8 years, and the median time from injury to surgery was 12.9 weeks. Electronic medical records, including clinic notes, radiographic images, and operative reports, were reviewed for study analysis. Median clinical and radiographic follow-up was 19.1 months.

Results:
The median elbow range of motion improved from 108 degrees of flexion and 5 degrees short of full extension preoperatively to 140 degrees of flexion (P<0.001) and full extension (P=0.10) postoperatively. Forearm range of motion also improved from a median of 80 degrees of pronation and 58 degrees of supination preoperatively to 80 degrees of pronation (P=0.54) and 80 degrees of supination (P<0.001) postoperatively. Congruent radiocapitellar alignment was maintained in 39 patients (75%). Nine patients (17%) had redislocation of the radiocapitellar joint, and 4 patients (8%) had radiographic resubluxation. Six of the 9 patients who experienced redislocation underwent early revision and achieved uncomplicated longer term results. Patients who received repair of the native annular ligament were more likely to achieve lasting radiocapitellar joint stability (P=0.03) when compared with patients who received annular ligament reconstruction or if the annular ligament was not addressed.

Conclusion:
Meaningful improvements in elbow motion and radiocapitellar stability can be safely achieved in the majority of children following surgical reconstruction of missed Monteggia lesions.

Level of Evidence:
Level IV—retrospective case series.
Preoperative 6-Minute Walk Performance in Children With Congenital Scoliosis
Authors: Nakashima Hiroaki , Kawakami Noriaki , Matsumoto Hiroko , Redding Gregory J. 
Published: August 2020

Background:
The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies.

Methods:
The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis.

Results:
The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=−0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49).

Conclusions:
The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment.

Level of Evidence:
Level IV—retrospective cohort study.
Is Proximal Fibula Epiphysiodesis Necessary When Performing a Proximal Tibial Epiphysiodesis?
Authors: Boyle Jonathan , Makarov Marina R. , Podeszwa David A. , Rodgers Jennifer A. , Jo Chan-Hee , Birch John G. 
Published: August 2020

Background:
Controversy exists regarding the need for proximal fibular epiphysiodesis in conjunction with proximal tibial epiphysiodesis to prevent relative overgrowth of the fibula. The purpose of this study was to determine the incidence of relative fibular overgrowth in patients who had undergone proximal tibial epiphysiodesis with or without proximal fibular epiphysiodesis to manage leg-length discrepancy.

Methods:
We identified patients who had undergone proximal tibial epiphysiodesis, with or without concomitant fibular epiphysiodesis, followed to skeletal maturity, and with adequate scanograms to measure tibial and fibular lengths. We assessed tibial and fibular lengths, ratios, and distances between the tibia and fibula proximally and distally preoperatively and at skeletal maturity, and obvious radiographic proximal migration of the fibular head.

Results:
A total of 234 patients met inclusion criteria, including 112 girls and 122 boys. In total, 179 patients had undergone concomitant fibular epiphysiodesis, and 55 had not. The fibular epiphysiodesis group was significantly younger preoperatively than the nonfibular epiphysiodesis group (average: 12.3 vs. 13.6 y), which accounted for most of the preoperative differences noted between the groups. Within the subset of younger patients (≥2 y of growth remaining at the time of epiphysiodesis), there were statistically significant differences between those with or without fibular epiphysiodesis at skeletal maturity in the proximal tibial-fibular distance (P<0.01) and the tibia:fibula ratio (0.96±0.02 vs. 0.98±0.02; P<0.02), but not in the distal tibial-fibular distance (P=0.46). Obvious fibular head proximal migration was noted in 10 patients, including 5/179 with concomitant proximal fibular epiphysiodesis, and 5/55 without (P<0.01). No patient was recorded as symptomatic with radiographic overgrowth, and no peroneal nerve injury occurred in any patient in this cohort.

Conclusions:
On the basis of this study, concomitant proximal fibular epiphysiodesis does not appear to be necessary in patients with 2 years or less of growth remaining, nor does it unequivocally prevent fibular head overgrowth. While the tibia:fibula ratio was quite consistent in general, there were individuals with relative fibular head prominence for whom fibular epiphysiodesis may be appropriate, particularly in relatively immature patients.

Level of Evidence:
Level III—retrospective comparative study.