bluuebunny/crossref_metadata_2025_split huggingface dataset:
More Predictable Return of Motor Function with Mepivacaine Versus Bupivacaine Spinal Anesthetic in Total Hip and Total Knee Arthroplasty
Authors: Wyles Cody C. , Pagnano Mark W. , Trousdale Robert T. , Sierra Rafael J. , Taunton Michael J. , Perry Kevin I. , Larson Dirk R. , Amundson Adam W. , Smith Hugh M. , Duncan Christopher M. , Abdel Matthew P. 
Published: August 2020

Background:
Spinal anesthesia provides several benefits for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but historically comes at the cost of slow and unpredictable return of lower-extremity motor function related to the use of long-acting local anesthetics. In this prospective, double-blinded, randomized clinical trial we sought to determine if an alternative local anesthetic, mepivacaine, would allow more consistent return of motor function compared with low-dose bupivacaine spinal anesthesia during primary THA and TKA.

Methods:
This trial was conducted at a single academic institution. Prior to trial initiation an internal pilot study determined that 154 patients were required to achieve 80% power. Patients were randomized in a 1:1 fashion with use of advanced computerized stratification based on procedure, age group, sex, and body mass index. Following the surgical procedure, motor function was assessed every 15 minutes in the nonoperative lower extremity according to the Bromage scale and discontinued once Bromage 0 was achieved (spontaneous movement at hip, knee, and ankle).

Results:
Return of lower-extremity function was more predictable in patients who received mepivacaine than in those who received low-dose bupivacaine. Among patients who received mepivacaine, 1% achieved motor function return beyond 5 hours compared with 11% of patients who received bupivacaine (p = 0.013). The mean time to return of lower-extremity motor function was 26 minutes quicker in patients who received mepivacaine (185 minutes; 95% confidence interval, 174 to 196 minutes) compared with low-dose bupivacaine (210 minutes; 95% confidence interval, 193 to 228 minutes) (p = 0.016). There were no significant differences in safety outcomes including pain scores, time to participation in physical therapy, incidence of orthostatic hypotension, urinary retention, or transient neurologic symptoms in patients receiving mepivacaine compared with low-dose bupivacaine.

Conclusions:
In patients undergoing primary THA and TKA, spinal anesthesia with mepivacaine allowed more consistent return of lower-extremity motor function compared with low-dose bupivacaine, without a concomitant increase in complications potentially associated with spinal anesthetics. This is particularly of value in an era of short-stay and outpatient surgical procedures.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors for Reoperation Following Final Fusion After the Treatment of Early-Onset Scoliosis with Traditional Growing Rods
Authors: Du Jerry Y. , Poe-Kochert Connie , Thompson George H. , Hardesty Christina K. , Pawelek Jeff B. , Flynn John M. , Emans John B. ,   Pediatric Spine Study Group
Published: August 2020

Background:
Although there is a high rate of reoperation after final fusion following the treatment of early-onset scoliosis with use of traditional growing rods, the risk factors for reoperation are unknown. The purpose of the present study was to identify risk factors associated with the need for reoperation after final fusion for the treatment of early-onset scoliosis.

Methods:
A multicenter database for patients with early-onset scoliosis was retrospectively analyzed. Patients managed with traditional growing rods and final fusion were identified (n = 248). The inclusion criteria were ≥1 lengthening procedure with traditional growing rods and ≥2 years of follow-up after final fusion or revision surgery within 2 years after final fusion (167 patients; 67%). Patients requiring reoperation following final fusion were compared with patients who did not require reoperation. The data that were analyzed included demographic characteristics, comorbidities, spinal deformity characteristics, radiographic measurements, perioperative details, and complications during all stages of treatment. A multivariate regression model was used to identify independent risk factors.

Results:
The mean duration of follow-up from the initial visit to the latest visit was 10.7 ± 4.1 years, and the mean duration of follow-up after final fusion was 4.9 ± 3.1 years. Thirty-two (19%) of the 167 patients required reoperation following final fusion. Curve progression requiring revision surgery during lengthening with traditional growing rods (adjusted odds ratio [aOR], 21.137 per event; p = 0.028), the number of levels spanned with traditional growing rods (aOR, 1.378 per level; p = 0.007), and the duration of treatment with traditional growing rods (aOR, 1.220 per year; p = 0.035) were independently associated with revision surgery after final fusion.

Conclusions:
Independent risk factors for curve progression requiring reoperation during lengthening with traditional growing rods that require operative intervention include increasing number of levels spanned with traditional growing rods and longer duration of treatment with traditional growing rods. These findings may help with patient counseling and potentially guide surgeon decision-making.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
When (Almost) Everyone is Above Average
Authors: Inclan Paul M. , Cooperstein Alisa A. , Powers Alexa , Dy Christopher J. , Klein Sandra E. 
Published: August 2020

Introduction:
The American Orthopaedic Association introduced standardized letters of recommendations (SLORs) to improve on traditional letters of recommendations by “providing a global prospective on an applicant.” However, no study has defined the utilization of SLORs, the distribution of applicant ratings in SLORs, or the impact of sex, race, or degree of involvement between the letter writer and applicant on SLOR domain ratings.

Methods:
One-hundred seventy-nine applications were randomly selected from all applicants submitted to a single, academic orthopaedic residency program. A single reviewer extracted both applicant characteristics and SLOR characteristics from applications. Descriptive statistics, chi-square tests, and nonparametric one-way analysis of variance analysis were conducted.

Results:
Six hundred twenty-eight letters of recommendation from 179 applicants were analyzed. Four hundred ninety-seven of 628 (79.1%) letters contained a SLOR. Mean percentile ratings were calculated for all the following domains: patient care (mean ± SD = 86.7 ± 8.7), medical knowledge (87.2 ± 8.6), interpersonal and communication (87.7 ± 9.3), procedural (86.6 ± 8.9), research (88.9 ± 9.0), ability to work within a team (89.6 ± 8.4), professionalism (90.8 ± 7.3), initiative and drive (90.6 ± 7.6), and commitment to orthopaedic surgery (91.1 ± 6.7). Forty-eight percent of applicants were indicated as “ranked to guarantee match.” When compared with male applicants, female applicants demonstrated higher percentile ratings in patient care (88.6 ± 8.2 vs. 86.3 ± 8.7, p = 0.010), interpersonal and communication skills (90.6 ± 7.3 vs. 86.9 ± 9.6, p < 0.001), and ability to work within a team (91.3 ± 6.3 vs. 89.2 ± 8.8, p = 0.045). Higher United States Medical Licensing Examination step 1 (r = 0.08, p = 0.05) and step 2 scores (r = 0.10, p = 0.02) correlated with higher medical knowledge ratings. The number of publications (r = 0.3, p < 0.001) and presentations (r = 0.25, p < 0.001) correlated with research ratings.

Conclusion:
SLORs demonstrated a profound ceiling effect, potentially limiting the utility of the instrument for the comparison of applicants. Future modifications to this instrument may include measures to better delineate between applicants.
An assessment of Antimicrobial Activity of Three Endodontic Sealers on Enterococcus faecalis, Candida albicans and Staphylococcus aureus by a Direct Contact Test: An In Vitro Study
Authors: Chakraborty Trishnika , Taneja Sonali 
Published: August 2020

Abstract
For successful endodontic treatment, the antimicrobial property of endodontic filling is mandatory. Hence, the aim of this in vitro study was to assess the antibacterial efficacy of three endodontic sealers on Enterococcus faecalis, Candida albicans and Staphylococcus aureus by direct contact test (DCT).Materials and MethodsThe antimicrobial efficacy of three different sealers, AH Plus, MTA Fillapex and Endo Sequence BC, was tested against Enterococcus faecalis ATCC 29212, Candida albicans ATCC 10231 and Staphylococcus aureus ATCC 25923 by DCT. Freshly mixed sealers were placed in flat bottom test tubes incubated at 37°C. Thereafter, 10 μL of suspension was drawn and spread over culture plates to determine the colony count using a digital colony counter. Readings were taken at 1 hr (fresh specimen), and then at 24 hrs (after setting). The results were tabulated, and statistical analysis was performed using one-way ANOVA and Tukey’s HSD test.ResultsDCT showed a significant decrease in microbial count in AH Plus, MTA Fillapex and Endoseq BC at both time intervals. Group 3 (Endosequence BC) showed minimum microbial count followed by Group 2 (MTA Fillapex) and maximum microbial count for Group 1 (AH Plus) for both time intervals (1 hour and 24 hours).ConclusionEndosequence BC showed maximum antimicrobial efficacy against all the tested microorganisms for both time intervals, followed by MTA Fillapex and AH Plus.
Comparison of Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea
Authors: Shin Sun Mi , Lee Hee Woo 
Published: August 2020

Abstract
Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within end-stage renal disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with end-stage renal disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and prevalence of catastrophic expenditure. Mixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-stage Renal Disease.Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If total household income decile was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 92.2%, but 58.8% in Medical Aid (P<0.001). Conclusion: Serious disease such as end-stage renal disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor.
Monitoring the evolution of posttraumatic symptomatology, depression and anxiety during the COVID-19 pandemic in Brazilians (COVIDPsiq)
Authors: Calegaro Vitor Crestani , Negretto Bianca Lorenzi , Weber Leopoldo Pompeo , Kerber Natalia , Zoratto Gustavo , Rodrigues Leonardo , Braun Luiza Elizabete , Kochler Julia , Girardi Fernando Leite , Picinin Vitor Daniel , Maciel Luísa , Labre Gabriel Salomão , Costa Fernanda Coloniese Dala 
Published: August 2020

Abstract
In view of the evolution of the pandemic by COVID-19 in Brazil, and the adoption of social restriction measures, an increase in cases of posttraumatic stress disorder (PTSD), anxiety disorder and depression is expected. In epidemic situations, mental health services can become overloaded; however, the evolution of these disorders over time is not known. This study aims to monitor the evolution of PTSD symptoms, anxiety and depression during the COVID-19 pandemic in Brazilians, and to investigate sociodemographic risk factors related to psychiatric history and contagion, as well as maladaptive personality traits and posttraumatic growth. It will be a longitudinal study, conducted through online questionnaires, with a sample of non-probabilistic convenience. The inclusion criteria are: being brazilian born or living in Brazilian territory; be over 18 years old; have access to digital devices; and be literate. A sample of at least 2000 people is expected. The instruments applied are a research questionnaire, the Posttraumatic Checklist 5 (PCL-5), the Depression, Anxiety and Stress Scale (DASS-21), the Personality Inventory for the DSM-5 – brief form (PID-5-BF), and the PostTraumatic Growth Inventory (PTGI). The study will be carried out in four stages: entry, one month, three months, and six months after the entry. The study relies on voluntary participation, with the agreement through the Free and Informed Consent Form. Data collection will be conducted in 2020, and the study will be completed in 2021. It will be financed with its own resources, and encouragement will be sought through research funding agencies.
Degenerative central lumbar spinal stenosis: Is endoscopic decompression through bilateral transforaminal approach sufficient?
Authors: Zhang Bin , Kong Qingquan , Yan Yuqing , Feng Pin 
Published: August 2020

Abstract
Background: At present, few percutaneous endoscopic transforaminal decompression surgery has been reported to solve central lumbar spinal stenosis (CLSS). Whether endoscopic decompression through lateral transforaminal approach decompression is sufficient for degenerative CLSS.Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through a bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.Results：All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dura tear and 3 cases of transient postoperative dysthesia. The cross sectional area of the dural sac was significantly enlargement at the last fellow up (74.28±13.08 mm2 vs.104.91±12.40 mm2, P=0.00).Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.
Weight maintenance interventions for people with type 2 diabetes mellitus: A systematic review protocol
Authors: Sauchelli Sarah , Bradley Julia , Cox Jennifer , England Clare , Perry Rachel 
Published: August 2020

Abstract
Background: Weight loss maintenance is a challenge for people with Type 2 Diabetes Mellitus (T2DM), which attenuates the long-term benefits of weight loss for diabetes management. Medication, specific dietary requirements, and the psychosocial burden of T2DM signify that weight loss maintenance designed for obesity may not suit people with T2DM. The primary objective of this review is to comprehensively evaluate existing weight maintenance interventions for people with or at high risk of T2DM.Methods: We registered a protocol for the systematic review and meta-analysis of randomised and non-randomised weight maintenance interventions for T2DM. Studies included will have been carried out in adults with clinical diagnosis of T2DM or pre-diabetes. All intervention types will be accepted (e.g. behavioural/lifestyle change and pharmacological). The primary outcomes will be weight control, glycaemic control, and adverse effects. Secondary outcomes will include cardiovascular risk factors (e.g. total cholesterol, LDL-cholesterol, blood pressure control), psychological wellbeing (including health-related quality of life), change in glucose medication and waist circumference. Multiple electronic databases will be searched such as MEDLINE, EMBASE, Web of Science, PsychINFO and international registers (e.g. Cochrane Central Register of Controlled Trials, WHO ICTRP). OpenGrey will be searched for grey literature. Two researchers will screen all citations and abstracts. This process will also be conducted by an additional researcher using a semi-automated tool to reduce human error. Full-text articles will be further examined by the researchers to select a final set for further analysis, and a narrative synthesis of the evidence will be presented. Potential sources of heterogeneity will be assessed, and a meta-analysis will be conducted if feasible. Risk of bias will be evaluated using the Cochrane risk of bias tool and the certainty of evidence using the GRADE (grading of recommendations, assessment, development, and evaluation) approach.Discussion: This review will critically appraise existing weight maintenance interventions targeting T2DM. Findings will inform future intervention development to support people with T2DM delay weight regain and prolong successful diabetes management.Systematic Review Registration: PROSPERO CRD42020168032
Teladorsagia circumcincta beta tubulin: the presence of the E198L polymorphism on its own is associated with benzimidazole resistance
Authors: Valladares Maria Martinez , Valderas-García Elora , Gandasegui Javier , Skuce Philip , Morrison Alison , de Agüero Verónica Castilla Gómez , Cambra-Pellejà Maria , Balaña-Fouce Rafael , Vázquez Francisco A. Rojo 
Published: August 2020

Abstract
Background: Benzimidazole resistance is associated with isotype-1 β-tubulin gene F200Y, E198A and F167Y SNPs. In this study, the recently described polymorphism E198L was reported and analysed in Teladorsagia circumcincta.Methods: The benzimidazole phenotypic resistance was measured by the faecal egg count reduction test (FECRT) and the egg hatch test (EHT) using a discriminating dose (DD) in 39 sheep flocks. Around 1000 larvae collected before and after treatment were used for DNA extraction. The resistant species identified in all flocks was T. circumcincta. The resistance alleles frequencies were measured for F200Y and E198A. A 371-bp fragment of the isotype-1 β-tubulin gene was analysed, including the three codons of interest, and a new pyrosequencing assay was designed for testing E198L.Results: The percentage of resistant flocks was 35% by FECRT or 26% by EHT; however, F200Y and E198A SNPs were absent in T. circumcincta. The amplification of a 371-bp fragment confirmed the absence of F167Y and F200Y in 6 resistant flocks. Regarding codon 198, all samples after treatment carried a leucine (CTA). A pyrosequencing assay analysed the allele frequencies for the first two bases at codon 198 independently, G/C and A/T. The correlation between C and T frequencies was almost 1 (r = 0.929, P < 0.0001) and the mean value of both was calculated to measure the leucine frequency; this value ranged between 10.4–80.7% before treatment, and 82.3–92.8% after treatment. High and similar correlations were reported between the genotypic variables (C frequency, T frequency or mean of both frequencies) and phenotypic resistance (r > 0.720, P < 0.0001), although negatively associated with the FECRT and positively with the EHT. According to multivariate linear regression analysis, the T frequency was the most significant variable influencing the phenotypic resistance (FECRT or EHT; P < 0.0001). In the EHT, 67.1% of the phenotypic variability is associated with the T frequency but in the FECRT only 33.4%; therefore, the EHT using a DD seems to detect the genotypic resistance more accurately than the FECRT.Conclusions: The E198L polymorphism can confer BZ resistance on its own in T. circumcincta.
The miR-187 Induced Bone Reconstruction and Healing in a Mouse Model of Osteoporosis, and Accelerated Osteoblastic Differentiation of Human Multipotent Stromal Cells by Targeting BARX2
Authors: Zhang Jun , Pan Feng , Tang Benseng , Li Jing , Zha Zhengang 
Published: August 2020

Abstract
Background: Multiple microRNAs (miRNAs) have been proven to regulate osteogenic differentiation by affecting the Runx2 signaling pathway. The intervention of miRNA can delay the progress of osteoporosis (OP) and induce fracture repair by affecting bone regeneration. However, the function and mechanism of miR-187 in osteoporotic fractures are still unknown. Methods: We first established the OP mouse model. Next, the BMD value was certified by iDXA. The miR-187 level in the OP mice and serum of OP patients was identified through qRT-PCR. Bone repair and bone healing were assessed through toluidine blue staining and X-ray, and BARX2 expression was also confirmed. Osteogenesis-related proteins, ALP activity, and the matrix mineralization state were evaluated by western blot, ALP staining, and Alizarin Red staining in hMSCs after transfection with miR-187 mimics, miR-187 inhibitor, or human BarH-like homeobox 2 (BARX2) siRNA. Moreover, the interplay between miR-187 and BARX2 was identified through the dual-luciferase reporter.Results: The BMD value was notably reduced in the OP mice, and miR-187 was markedly downregulated in the OP mice and serum of OP patients. Meanwhile, we proved that miR-187 induced bone reconstruction and healing, and downregulated BARX2 in the OP mouse model. We also proved that BARX2 was a direct target of miR-187, and could be significantly downregulated by miR-187. Furthermore, miR-187 induced osteogenic differentiation of hMSCs by targeting BARX2.Conclusions: The miR-187 might have a significant therapeutic effect in osteoporotic fractures. miR-187 accelerated osteogenic differentiation of hMSCs by directly regulating BARX2.