bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in the First Cuneiform–Second Metatarsal Distance After Simulated Ligamentous Lisfranc Injury Evaluated by Weightbearing CT Scans
Authors: Sripanich Yantarat , Weinberg Maxwell , Krähenbühl Nicola , Rungprai Chamnanni , Saltzman Charles L. , Barg Alexej 
Published: August 2020

Background: This study aimed to investigate the widening between the first cuneiform (C1) and second metatarsal (M2) in a Lisfranc ligamentous complex (LLC) joint injury model subjected to successive ligament dissections evaluated by weightbearing computed tomography (CT) scans. Methods: Twenty-four intact cadaveric feet served as the control (condition 1). Each component of the LLC (dorsal, interosseous, and plantar ligaments—conditions 2, 3, and 4, respectively) were then sequentially dissected. The specimens were equally randomized to 1 of 3 additional dissections (first or second tarsometatarsal [TMT] joint capsule or first-second intercuneiform ligament [ICL]—conditions 5a, 5b, and 5c, respectively). One additional ligament was then randomly transected (eg, condition 6ac—transection of the first TMT capsule and ICL). Finally, the remaining ligament was transected (condition 7). After each dissection, CT scans were acquired under nonweightbearing (NWB, 0 kg), partial-weightbearing (PWB, 40 kg), and full-weightbearing (FWB, 80 kg) conditions. The distance between the lateral border of C1 and the medial border of M2 was assessed to evaluate diastasis. Linear regressions with 95% CIs and converted q values were used to compare the measured data. Results: No significant differences were found within the control. In condition 4, an average axial plane widening relative to control of 1.6 mm (95% CI, 1.5-1.8) and 2.1 mm (95% CI, 1.9-2.2) was observed under PWB and FWB. A coronal plane widening of 1.5 mm (95% CI, 1.3-1.6) and 1.9 mm (95% CI, 1.7-2.1) under PWB and FWB, respectively, was measured. A 95% CI of at least a 2-mm widening during PWB was demonstrated in 5c, 6ac, 6bc, and 7. Conclusions: Weightbearing computed tomography (WBCT) scans were used to detect ligamentous Lisfranc injuries in a cadaveric model. Relative axial widening greater than 1.5 mm under PWB conditions could indicate a complete LLC injury. Complete transection of the intercuneiform 1-2 ligament was required to detect a 2-mm widening in the nonweightbearing condition. Clinical Relevance: This study provides insight on the detection of various severities of LLC injuries using WBCT imaging.
Development of carpal tunnel syndrome in association with checkpoint inhibitors
Authors: Eisenbud Lauren , Ejadi Samuel , Mar Nataliya 
Published: August 2020

Introduction The incidence of neuropathy with checkpoint inhibitors is 0.3–1%, typically occurring 2–12 weeks after treatment initiation. Common neuropathy phenotypes include inflammatory myopathies, myasthenia gravis, acute and chronic demyelinating polyradiculopathies, vasculitic neuropathies, isolated cranial neuropathies, aseptic meningitis, autoimmune encephalitis, multiple sclerosis and hypophysitis. Carpal tunnel syndrome is the most common entrapment neuropathy in the general population; however, the association of carpal tunnel syndrome with checkpoint inhibitors is exceedingly rare. Case Report We report two cases of patients with no prior history of carpal tunnel syndrome treated with checkpoint inhibitors that developed de novo bilateral carpal tunnel syndrome. Management & Outcome: For both patients, the neurologic symptoms improved with cessation of the checkpoint inhibitor and initiation of corticosteroids. Discussion Given the prevalence of carpal tunnel syndrome in the general population, a high index of suspicion for carpal tunnel in patients receiving checkpoint inhibitors and prompt treatment with corticosteroids is essential.
Heterogeneity of acute subdural collections: In search of a unifying feature
Authors: Duy Lindsay , Badeeb Arwa , Duy Walter , Alqahtani Eman , Champion Walter , Kim Dae Hee , Martin Dann , Vartanians Vartan , Coffin Phillip , Small Juan 
Published: August 2020

Introduction A variety of different acute subdural hematoma patterns of density have been reported in the literature and are commonly seen in clinical practice, including rare hypodense acute subdural hematomas. It is unclear if these acute hypodense collections are entirely hypodense or if on close inspection, they can reveal subtle, tiny hyperdense components. The purpose of this study was to determine if all acute subdural hemtomas contain a hyperdense component, including seemingly entirely hypodense subdural collections. Methods Non-contrast CT scans of 111 patients containing 320 hyperacute or acute subdural collections were analyzed for the presence of a hyperdense component. Hounsfield measurements were recorded. Results All hyperacute and acute subdural hematomas in our study had a hyperdense component. Hyperacute subdural hematomas have a hyperdense component >97.5% of the time (95% confidence), and acute subdural hematomas have a hyperdense component >99% of the time (95% confidence). Conclusion Lack of a hyperdense component in a subdural hematoma makes acute or hyperacute hematoma highly unlikely, and alternative diagnoses should be considered.
Saudi women’s physical activity habits during pregnancy
Authors: Alaglan Abeer A , Almousa Rania F , Alomirini Arwa A , Alabdularazaq Elaf S , Alkheder Renad S , Alzaben Khawlah A , Alonayzan Ghaida A , Saquib Juliann 
Published: August 2020

Background: Despite many benefits of physical exercise to women during pregnancy, the majority of Saudi women do not engage in an adequate amount of activity because of common barriers such as fatigue, lack of motivation, and childcare. The purpose of this study was to estimate the proportion of Saudi women who get adequate exercise during pregnancy as well as to evaluate their knowledge of, attitude toward, and barriers to physical exercise during pregnancy. Methods: This study had a cross-sectional design. Data were collected retrospectively (average time: 1 year after the birth), using translated questionnaires (English to Arabic), from primary health care centers and from the Maternity and Children Hospital in Qassim, Saudi Arabia. Logistic regression was employed to assess the a priori correlates of adequate exercise during pregnancy (primary outcome). Results: The sample included 274 women, who had a mean age of 31.9 years. A majority of the women thought that physical exercise during pregnancy was necessary and had high knowledge levels (mean = 77; median = 75) about types and amount of physical activity. Less than half of the women were either walking (26%) or exercising (42%) adequately (i.e. ⩾150 min/week). Age (odds ratio: 1.79), number of pregnancies (odds ratio: 2.41), attitude toward exercise (odds ratio: 2.71), and self-rated health (odds ratio: 2.50) were significant correlates of adequate exercise during pregnancy. Among those who reported no physical exercise during pregnancy ( n = 68), the following barriers were most common: tiredness (25.0%), fear (18.1%), dislike of exercise (16.7%), and lack of information (16.7%). Conclusion: For Saudi women, interventions are needed during pre-natal checkups to promote and maintain adequate physical activity levels during pregnancy.
The Lisfranc Injury: A Literature Review of Anatomy, Etiology, Evaluation, and Management
Authors: Chen Jie , Sagoo Navraj , Panchbhavi Vinod Kumar 
Published: August 2020

Despite being first described in the 1800s, the Lisfranc injury remains one of the most controversial topics in foot and ankle surgery. From the basic anatomy of the ligament complex to the optimal diagnostic and management methods, new research both sharpens and yet confounds our understanding of this unique injury. This article reviews the literature from established and classic papers to recent studies evaluating newer techniques. We discuss the unique bony and ligamentous anatomy, which confer strength to the Lisfranc complex, the typical mechanisms of injury, the most common classification systems, the clinical presentation, current imaging modalities, and conservative and surgical treatment options. We review studies comparing open reduction and internal fixation with primary arthrodesis of acute injuries, in addition to studies evaluating the various methods for obtaining fixation, including intra-articular screws, dorsal plates, and flexible fixation. It is clear from this review that despite the vast number of studies in the literature, much is still to be learned about the diagnosis and management of this challenging injury. Levels of Evidence: Level V: Expert opinion
Subcutaneous Mepolizumab Injection: An Adjunctive Treatment for Recalcitrant Allergic Fungal Rhinosinusitis Patients With Asthma
Authors: Karp John , Dhillon India , Panchmatia Rikesh , Javer Amin 
Published: August 2020

Background Allergic Fungal Rhinosinusitis (AFRS) is a non-invasive fungal disease that results from chronic allergic inflammation of the sinonasal mucosa. Failure to respond to mainstay medical therapies and sinus surgery leaves AFRS patients with limited alternatives and a decreased quality of life. Mepolizumab is a known IL-5 antagonist for patients with severe eosinophilic asthma. Objective To identify the efficacy of mepolizumab on improving Modified Lund-Kennedy (MLK) endoscopic scores in recalcitrant AFRS patients with asthma. Methods Retrospective chart review of 27 recalcitrant AFRS patients with asthma receiving a monthly mepolizumab injection between January 2017 and July 2019. Patients were evaluated endoscopically at baseline and at each follow-up visit every 6–8 weeks until their third visit. Secondary outcomes included SNOT-22 scores, serum eosinophil counts and the rate of prednisone rescues required in patients receiving mepolizumab compared to a retrospective control arm. Results Total median MLK scores improved significantly for all patients over three follow-up visits (6[4,7], 4[2,6], 5[2,6], 3.5[2.25,5]; p = 0.04). Amongst patients with a baseline polyposis score of 1 or more, combined MLK edema and polyposis sub-scores significantly improved (6[5.25,6], 3.5[2.25,5,75], 4[2.75,5.25], 4[3,4]; p = 0.02) versus patients with no polyposis (4[3,4], 3[1,4], 4[2,4], 3[0,4]; p = 0.90). Total SNOT-22 scores (56 vs 43; p = 0.04) and eosinophil counts (0.40 × 109/L vs 0.00 × 109/L; p < 0.01) decreased significantly when comparing baseline to last follow up. There was no significant difference in rate of prednisone rescues per 1000 person-days when comparing control to Mepolizumab population (1.19 vs 1.23; p = 1). Conclusion Mepolizumab injections administered once monthly as an adjunctive treatment for recalcitrant AFRS patients with asthma appear to significantly reduce endoscopic signs of inflammation, patient-reported symptomatology and serum eosinophil levels. Patients with evidence of more severe endoscopic inflammation appear to benefit the most. Adjunctive treatment with mepolizumab does not reduce the need for prednisone rescues.
Patient-Reported Outcomes Following Inpatient Multimodal Treatment Approach in Chronic Pain-Related Rheumatic Diseases
Authors: Romeyke Tobias , Noehammer Elisabeth , Stummer Harald 
Published: August 2020

Introduction Musculoskeletal disorders may cause chronic pain, which is associated with deterioration in physical well-being, functions, and quality of life. There are worldwide shortfalls in the care that is provided to the affected patients. Holistic, interdisciplinary care is rare. Monomodal therapeutic approaches dominate when health-care resources are scarce. In this study, we test the patient-relevant outcomes of multimodal treatment for rheumatic diseases that are associated with pain and check for remuneration. Methods We performed a retrospective data analysis of an inpatient multimodal treatment. The target parameter was the patient perspective, which we assessed by means of Patient-Reported Outcomes (PRO). We applied the Visual Analogue Scale (mental and physical condition), the Heidelberg Short Early Risk Assessment Questionnaire, the Pain Disability Index, and the pain grading according to Kohlmann/Raspe (N = 375 patients). We also investigated compensation for inpatient treatments with and without multimodal treatments. Moreover, we compared Diagnosis-Related Group remuneration with and without complex treatment. Results After implementing a multimodal treatment, improved mental (mood) status was significantly better (Wilcoxon signed-rank test, P < . 001), despite high levels of pain (Kohlmann/Raspe) reported on admission. Apart from the underlying rheumatic disease, 111 patients also reported chronic back pain, which was improved following the treatment ( t test, P < . 001). Subjective impairments associated with pain were significantly lower at the end of the hospital stay (Wilcoxon signed-rank test, P < . 001). Compensation for inpatient treatments with multimodal treatments increased noticeably in German hospitals in 2016 to 2019, while remunerations for monomodal treatments show mixed results. Conclusion PROs regarding mood, pain, and perceived impairments improved following the multimodal complex treatment. Compensation of hospitals should take into account additional performance requirements of holistic treatments, whereby the promotion and further studies of PROs are recommended.
The effect of intraoperative goal-directed crystalloid versus colloid administration on perioperative inflammatory markers - a substudy of a randomized controlled trial
Authors: Obradovic Mina , Kurz Andrea , Kabon Barbara , Roth Georg , Kimberger Oliver , Zotti Oliver , Bayoumi Ahamed , Reiterer Christian , Stift Anton , Fleischmann Edith 
Published: August 2020

Abstract
Background
Excessive perioperative fluid administration may result in iatrogenic endothelial dysfunction and tissue edema, transducing inflammatory markers into the bloodstream. Colloids remain longer in the circulation, requiring less volume to reach similar hemodynamic endpoints compared to crystalloids. Thus, we tested the hypothesis that a goal-directed colloid regimen attenuates the inflammatory response compared to a goal-directed crystalloid regime.

Methods
Patients undergoing moderate- to high-risk open abdominal surgery were randomly assigned to goal-directed lactated Ringer’s solution (n = 58) or a hydroxyethyl starch 6% 130/0.4 (n = 62) fluid regimen. Our primary outcome was perioperative levels of pro- and anti-inflammatory cytokines. Secondary outcome was perioperative levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT) and lipopolysaccharide-binding protein (LBP). Measurements were performed preoperatively, immediate postoperatively, on postoperative day one, two and four.

Results
The areas under the curve of Interleukin (IL) 6 (p = 0.60), IL 8 (p = 0.46), IL 10 (p = 0.68) and tumor necrosis factor α (p = 0.47) levels did not differ significantly between the groups. WBC, CRP and PCT values were also comparable. LBP, although significantly higher in the crystalloid group, remained in the normal range. Patients assigned to crystalloids received a median (IQR) amount of 3905 mL (2880–5288) of crystalloid. Patients assigned to colloids received 1557 mL (1207–2116) of crystalloid and 1250 mL (750–1938) of colloid.

Conclusion
Cytokine and inflammatory marker levels did not differ between goal-directed crystalloid and colloid administration after moderate to high-risk abdominal surgery.

Trial registration
ClinicalTrials.gov (NCT00517127). Registered 16th August 2007.
Late stage diagnosis of mucinous adenocarcinoma of the appendix: a case report of an unusual tumor with a rare presentation
Authors: Roma Katerina , Baldwin Mark , Sedmak Daniel , Silva Matthew , Stellar William , Many Gina 
Published: August 2020

Abstract
Background
The incidence of mucinous appendiceal adenocarcinomas (MAA) has increased over the past three decades. Advanced stage tumor diagnosis is likely attributable to non-specific findings. Here we describe advanced stage appendiceal MAA presenting as inguinal ulcers, scrotal abscesses, and other nonspecific symptoms. To our knowledge, this is the first report of MAA presenting as inguinal pain with inflamed phlegmonous tissue and scrotal abscess.

Case presentation
A 67-year-old male presented to a rural facility complaining of weight-loss, fatigue, hematuria, dysuria, painful right inguinal ulceration, and right scrotal abscess drainage. Computed tomography of the abdomen and pelvis revealed a distended appendix (> 1.3 cm) and a fistula between the appendix, urinary bladder, right scrotum, and right groin. Laparoscopic appendectomy was performed and diagnosed as MAA. After a right hemicolectomy, the MAA was staged as pT3b pN0 M0 G2.

Conclusion
This case highlights a unique presentation of late stage appendiceal MAA. Due to the increased incidence of appendiceal MAAs, reports of unique clinical features are needed to facilitate early diagnosis and intervention, especially in rural settings with limited access to specialists.
Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model
Authors: Aljuboori Zaid , Ugiliweneza Beatrice , Wang Dengzhi , Andaluz Norberto , Boakye Maxwell , Williams Brian 
Published: August 2020

Abstract
Background
The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model “Bundled Payment for Care Improvement (BPCI)” which reimburses providers a predetermined payment in advance to cover all possible services rendered within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assessed the feasibility of the BPCI model in these neurosurgical diseases.

Methods
We selected patients with chordoma/chondrosarcoma from inpatient admission table using the International Classification of Disease, 9th (ICD-9), and 10th (ICD-10) revision codes. We collected the patients’ demographics and insurance type at the index hospitalization. We recorded the following outcomes length of stay, total payment, discharge disposition, and complications for the index hospitalization. For post-discharge, we collected the 30 days and 3/6/12 months inpatient admission, outpatient service, and medication refills. Continuous variables were summarized by means with standard deviations, median with interquartile and full ranges (minimum-maximum); Continuous outcomes were compared by nonparametric Wilcoxson rank-sum test. All tests were 2-sided with a significance level of 0.05. Statistical data analysis was performed in SAS 9.4 (SAS Institute, Inc, Cary, NC).

Results
The population size was 2041 patients which included 1412 patients with cranial (group1), 343 patients with a mobile spine (group 2), and 286 patients with sacrococcygeal (group 3) chordoma and chondrosarcoma. For index hospitalization, the median length of stay (days) was 4, 6, and 7 for groups 1, 2, and 3 respectively (P<.001). The mean payments were ($58,130), ($84,854), and ($82,440), for groups 1, 2, and 3 respectively (P=.02). The complication rates were 30%, 35%, and 43% for groups 1, 2, and 3 respectively (P<.001). Twelve months post-discharge, the hospital readmission rates were 44%, 53%, and 65% for groups 1, 2, and 3, respectively (P<.001). The median payments for this period were ($72,294), ($76,827), and ($101,474), for groups 1, 2, and 3, respectively (P <.001).

Conclusion
The management of craniospinal chordoma and chondrosarcoma is costly and may extend over a prolonged period. The success of BPCI requires a joint effort between insurers and hospitals. Also, it should consider patients’ comorbidities, the complexity of the disease. Finally, the adoptionof quality improvement programs by hospitals can help with cost reduction.
Health may be compromised by social interactions depending on culture among postpartum Arab and Jewish Israeli women
Authors: Puddister Sadie , Ali-Saleh Ola , Cohen-Dar Michal , Baron-Epel Orna 
Published: August 2020

Abstract
Background
Social support is generally perceived to facilitate health in postpartum women; however, previous research shows that this is not always true. Social interactions intended to provide support can be perceived as negative and in turn, may have negative impacts on maternal health. The purpose of the present study was to asses if social support and negative interactions at one month after childbirth can predict maternal health four months after childbirth, and if this relationship is influenced by culture.

Methods
This prospective longitudinal cohort study included randomly selected Arab (n = 203) and Jewish (n = 202) women who attended Mother and Child Health Clinics in Northern Israel one month after giving birth. The women were interviewed at one and four months after childbirth using a questionnaire including measures of health (self-reported health (SRH) and health problems), socioeconomic and demographic status, obstetric characteristics, social support, negative social interactions and perceptions of customs and traditions intended to help the mother cope after childbirth. Multivariable regressions were run to identify the variables predicting health four months after childbirth.

Results
The response rate for both interviews was 90%. Negative social interactions one month after childbirth significantly predicted health problems in Arab and Jewish women (Beta 0.20 and 0.37 respectively) and SRH among Arab women only (odds ratio (OR) 0.32, confidence interval (CI) 0.19–0.54) four months after childbirth. Social support at one month after childbirth significantly predicted better SRH in both Jewish and Arab women four months after childbirth (OR 2.33, CI 1.38–3.93 and 1.59, CI 1.01–2.46 respectively) and fewer health problems only among Jewish women (Beta − 0.37).

Conclusions
Social support and negative social interactions appear to be predictive of health in postpartum women. Associations varied between Arabs and Jews, indicating that social support may be more important for predicting health among Jewish women and negative interactions may be more important among Arab women. Healthcare practitioners should be aware of the cultural context and social circumstances of postpartum women to ensure they receive the social support and care they need.