bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Prognostic Value of Laboratory Markers and Ambulatory Function at Presentation for Post-Treatment Morbidity and Mortality Following Epidural Abscess
Authors: Goh Brian C. , Ferrone Marco L. , Barghi Ameen , Liu Christina Y. , Cronin Patrick K. , Blucher Justin A. , Makhni Melvin C. , Kang James D. , Schoenfeld Andrew J. 
Published: February 2020

Study Design.
Retrospective cohort study.

Objective.
To develop a comprehensive understanding of the prognostic value of laboratory markers on morbidity and mortality following epidural abscess.

Summary of Background Data.
Spinal epidural abscess is a serious medical condition with high rates of morbidity. The value of laboratory data in forecasting morbidity and mortality after epidural abscess remains underexplored.

Methods.
We obtained clinical data on patients treated for epidural abscess at two academic centers from 2005 to 2017. Our primary outcome was the development of one or more complications within 90-days of presentation, with mortality a secondary measure. Primary predictors included serum albumin, serum creatinine, platelet–lymphocyte ratio, and ambulatory status at presentation. We used multivariable logistic regression techniques to adjust for confounders. The most parsimonious set of variables influencing both complications and mortality were considered to be clinically significant. These were then examined individually and in combination to assess for synergy along with model-discrimination and calibration. We performed internal validation with a bootstrap procedure using sampling with replacement.

Results.
We included 449 patients in this analysis. Complications were encountered in 164 cases (37%). Mortality within 1-year occurred in 39 patients (9%). Regression testing determined that serum albumin, serum creatinine, and ambulatory status at presentation were clinically important predictors of outcome, with albumin more than 3.5 g/dL, creatinine less than or equal to 1.2 mg/dL, and independent ambulatory function at presentation considered favorable characteristics. Patients with no favorable findings had increased likelihood of 90-day complications (odds ratio [OR] 5.43; 95% confidence intervals [CI] 1.98, 14.93) and 1-year mortality (OR 8.94; 95% CI 2.03, 39.37). Those with one favorable characteristic had greater odds of complications (OR 4.00; 95% CI 2.05, 7.81) and mortality (OR 5.71; 95% CI 1.60, 20.43).

Conclusion.
We developed a nomogram incorporating clinical and laboratory values to prognosticate outcomes after treatment for epidural abscess. The results can be used in shared-decision making and counseling.

Level of Evidence: 3
Do Antifibrinolytic Agents Reduce the Risk of Blood Transfusion in Children Undergoing Spinal Fusion?
Authors: Eisler Lisa D. , Lenke Lawrence G. , Sun Lena S. , Li Guohua , Kim Minjae 
Published: February 2020

Study Design.
Retrospective cohort.

Objective.
To evaluate the effectiveness and safety of antifibrinolytic (AF) agents in reducing perioperative blood transfusion in pediatric patients undergoing spinal fusion.

Summary of Background Data.
The potential for AF to decrease bleeding and reduce exposure to allogenic transfusions has led to widespread off-label use in a number of major pediatric surgical procedures. Recent reviews call for improving the body of evidence for their effectiveness and safety in pediatric spinal fusion.

Methods.
Children undergoing spinal fusion were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2016 and 2017 databases. Univariate analyses of patient and perioperative characteristics informed the creation of a propensity score model predicting treatment with AF, followed by 1:1 matching to allow comparison of allogenic red blood cell transfusion rates and secondary outcomes between treated and untreated patients.

Results.
Of 6626 total patients, 5434 (81%) received AF and 1533 (23%) received a blood transfusion. Analysis of data for 1192 propensity score-matched pairs revealed that treatment with AF was associated with a statistically nonsignificant 16% reduction in perioperative transfusion (OR 0.84, 95% confidence interval 0.68–1.05, P = 0.119) and a statistically significant 43% reduction in postoperative transfusion (OR 0.57, 95% confidence interval 0.39–0.81, P = 0.002). No differences in the incidences of postoperative seizure or thrombosis were observed, with overall rates of 7.5 and 22.5 events per 10,000 patients, respectively.

Conclusion.
AF agents appear to reduce postoperative allogenic transfusion in children undergoing spinal fusion surgery. Adverse drug effects such as thromboembolic complications and seizure were extremely rare and warrant continued monitoring, though this is the largest study to date providing evidence for the safety profile of these drugs.

Level of Evidence: 3
The Epidemiology of Back Pain in American Children and Adolescents
Authors: Fabricant Peter D. , Heath Madison R. , Schachne Jonathan M. , Doyle Shevaun M. , Green Daniel W. , Widmann Roger F. 
Published: February 2020

Study Design.
Cross-sectional survey.

Objective.
To determine the prevalence of back pain in American children and adolescents, with a focus on anatomic region, duration, severity, and treatment patterns, and to investigate for any predictive variables.

Summary of Background Data.
No study has examined the prevalence of back pain in American children and adolescents in the last 15 years. Because the prevalence of back pain varies greatly by country and year of investigation, previous studies are not generalizable.

Methods.
A United States epidemiologic cross-sectional survey-based investigation was performed in children and adolescents ages 10 and 18 years old, equally split by age and sex, and representing census-weighted distributions of state of residence, race/ethnicity, and health insurance status. Prevalence of back pain was evaluated and described.

Results.
In total, 1236 (33.7%) participants reported experiencing back pain within the last year and 325 (8.9%) reported severe back pain within the last year. Prevalence of back pain increased with age and was significantly more common in females, P < 0.001 for both. Treatment for back pain was sought by 505 (40.9%) of the participants with pain, of which physical therapy was the most common. Invasive procedural treatment (e.g., injections, surgery) were rare and comprised only 61 (1.6%) of study participants. In addition, government insurance and lack of insurance coverage was associated with low treatment seeking behavior compared to private insurance users (P = 0.010 and P = 0.006, respectively).

Conclusion.
Despite how commonly it presents, the majority of young patients with back pain do not report procedural treatment such as injections or surgery. However, because many American children and adolescents seek treatment, future research on the etiology, treatment, and prevention of back pain in children and adolescents is essential to reducing a common and financially demanding problem.

Level of Evidence: 4
Anatomical and clinical study of a new mallet fracture classification method
Authors: Yang Yong , Zhang Wei-Guang , Li Zhong-Zhe , Chen Shan-Lin , Tian Wen 
Published: February 2020

Abstract

Background
Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a bony fragment. This study was performed to evaluate the anatomical characteristics of mallet fractures, investigate a new mallet fracture classification system using anatomical and imaging methods, and discuss the treatment schemes for different types of mallet fracture.

Methods
Sixty-four fresh cadaveric fingers were divided into four groups, and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%, 50%, 75%, and 100% of the bilateral collateral ligaments. The effect of mallet fractures on the stability of the distal interphalangeal joint was then observed. The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture, the thickness of fracture, the untreated time after injury, and the complication of distal interphalangeal joint palmar subluxation. Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion, the Ishiguro method, or single Kirschner wire fixation.

Results
The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral ligaments were cut off by 25% (t = –0.415, P = 0.684) and significantly unstable when this range was ≥50% (50% transection: t = –6.363, P < 0.001; 75% transection: t = –17.036, P < 0.001; 100% transection: t = –30.977, P < 0.001, respectively). The mallet fractures were divided into Types I, II, and III (fracture involving <20%, 20%–50%, and >50% of the joint surface, respectively). Type II was further divided into Types IIa and IIb according to whether the course of injury was < or ≥2 weeks, respectively. The mean post-operative flexion of the distal interphalangeal joint was 63.4° ± 7.9°, and the mean extension lag was 6.7° ± 4.6°.

Conclusions
The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint. Classification that combines the involvement of the joint surface in the fracture, the thickness of the fracture, and the untreated time after injury is reasonable and will help to choose an appropriate operational method.
How to Distinguish Best Evidence from Bias: A Basic Guide to Understanding a Systematic Review
Authors: Camargo Cristina Pires , Gemperli Rolf , Rohrich Rod J. 
Published: February 2020

Summary:
A systematic review is a powerful tool to synthesize and show concise and robust evidence for clinical practice. Thus, the inclusion of biased, low-quality studies should be avoided, for otherwise, the resulting systematic review will not reflect the best medical evidence. Because the methodology of systematic review is relatively new, this review aims to present basic rules to guide the reader’s interpretation of a systematic review.
Negative Pressure Wound Therapy Reduces Wound Breakdown and Implant Loss in Prepectoral Breast Reconstruction
Authors: Irwin Gareth W. , Boundouki George , Fakim Bilal , Johnson Richard , Highton Lyndsey , Myers Dave , Searle Richard , Murphy John A. 
Published: February 2020

Background:
Single-use negative pressure wound therapy (NPWT) has been shown to encourage wound healing. It is often used when patient factors impair wound healing, or in more complex wounds, such as in implant-based breast reconstruction. We report the findings of a prospective cohort study comparing the use of NPWT with standard dressings in prepectoral breast reconstruction.

Methods:
A prospective database of implant-based reconstruction from a single institution was mined to identify patients who underwent prepectoral reconstruction. Patient demographics, operative data, surgical complications, and 90-day outcomes were compared between patients who had NPWT and those who had standard dressings.

Results:
Prepectoral implant-based breast reconstruction was performed on 307 breasts. NPWT dressings were used in 126 cases, with standard dressings used in 181 cases. Wound breakdown occurred in 10 cases after standard dressings versus 1 where NPWT was utilized. Of the standard dressing cases, only 3 implants were salvaged, while 7 cases led to implant loss. The 1 case of wound breakdown in the NPWT cohort settled with conservative measures. The cost of a reconstructive failure was £14,902, and the use of NPWT resulted in a cost savings of £426 per patient.

Conclusions:
The utilization of single-use NPWT reduces the rate of wound breakdown and implant loss in prepectoral implant-based reconstruction. In addition to the significant clinical benefits, this approach is cost-saving compared with standard dressings. These data suggest that prepectoral implant reconstruction should be considered as an indication for the use of NPWT.
Atrial arrhythmias in patients with left ventricular assist devices
Authors: Ozcan Cevher , Deshmukh Amrish 
Published: February 2020

Purpose of review
Atrial arrhythmias commonly occur in patients with advanced heart failure with reduced ejection fraction (HFrEF) who require left ventricular assist devices (LVADs) implantation. This review summarizes the current literature regarding the incidence, prevalence, and predictors of atrial arrhythmias in LVAD patients and its impact on the clinical outcomes. Moreover, we review the mechanisms and management strategies of atrial arrhythmias in this population.

Recent findings
Atrial arrhythmias including atrial fibrillation, atrial flutter, and atrial tachycardia are highly prevalent in patients with advanced HFrEF before or after the LVAD implantation. Atrial arrhythmias have a significant impact on overall clinical outcome including survival, heart failure hospitalization, quality of life, thromboembolic events and resource utilization. Atrial fibrillation and other atrial arrhythmias frequently coexist in this population. In patients with atrial arrhythmias and LVAD, anticoagulation and cardiovascular implantable electronic devices should be closely monitored and managed to prevent thromboembolic events or inappropriate shocks. Rhythm and rate control strategies are comparable regarding overall clinical outcomes in this population. LVADs induce favorable atrial remodeling in patients with HFrEF.

Summary
Atrial arrhythmias are highly common in LVAD patients and have significant impact on overall clinical outcomes. Further studies are needed to determine optimal management and prevention of atrial arrhythmias in LVAD population.
Dopamine-Related Genes Moderate the Association Between Family Environment and Executive Function Following Pediatric Traumatic Brain Injury: An Exploratory Study
Authors: Smith-Paine Julia , Fisher Allison P. , Wade Shari L. , Zhang Nanhua , Zang Huaiyu , Martin Lisa J. , Yeates Keith Owen , Taylor H. Gerry , Kurowski Brad G. 
Published: February 2020

Objective:
This study examined whether carrying dopamine-related “risk” genes—either the dopamine transporter (DAT1) 10-repeat allele or dopamine receptor-4 (DRD4) 7-repeat allele—moderated the association of family environment and executive function (EF) following traumatic brain injury (TBI) in early childhood.

Methods:
Caregivers of children with TBI or orthopedic injury (OI) completed the Behavior Rating Inventory of Executive Function (BRIEF) at postinjury visits. General linear models examined gene by environment interactions as moderators of the effects of TBI on EF at 12 months and 7 years postinjury.

Results:
At 12 months, we did not find any significant gene by environment interactions. At 7 years, we found a significant 3-way interaction among combined carrier status, level of permissive parenting, and injury type. For children exposed to more optimal parenting, carriers of DAT1 and/or DRD4 risk alleles with TBI showed significantly worse parent-reported EF than carriers with OI. In those with less optimal parenting, carriers and noncarriers with TBI, as well as carriers with OI, showed significantly worse parent-reported EF than noncarriers with OI, with medium to large effect sizes.

Conclusions:
The findings highlight the importance of considering polygenetic and environmental factors in future studies of recovery following TBI and other injuries in childhood.
Prevalence of Pseudoexfoliation Glaucoma Risk–associated Variants Within Lysyl Oxidase–like 1 in an Irish Population
Authors: Eivers Sarah B. , Greene Alison G. , Dervan Edward , O’Brien Colm , Wallace Deborah 
Published: February 2020

Precis:
High-risk alleles of risk-associated single-nucleotide polymorphisms (SNPs) within the lysyl oxidase-like 1 (LOXL1) gene are associated with pseudoexfoliation in patients recruited from an Irish population.

Purpose:
SNPs within the LOXL1 gene have been identified as a major risk factor for pseudoexfoliation syndrome (PXF) and pseudoexfoliation glaucoma (PXFG), specifically SNPs within exon 1 and intron 1 regions of the gene. The common haplotype (G-G) of 2 SNPs within exon 1, rs1048661, and rs3825942, is the strongest associated risk factor for PXF in white populations, but is switched in some populations to act as protective or low risk. Herein, a study was undertaken to genotype an Irish population for PXF/PXFG risk-associated SNPs within LOXL1.

Materials and Methods:
Patient cohorts of PXFG, PXF, and controls were recruited and genotyped for risk-associated SNPs within exon 1 (rs1048661 and rs3825942), along with 3 SNPs within intron 1 (rs1550437, rs6495085, and rs6495086) of LOXL1.

Results:
The risk G alleles of rs1048661 and rs3825942 were most prevalent in PXFG patients, and a significant association was found between rs3825942 and pseudoexfoliation (P=0.04). Genotypes of several intron 1 SNPs were found to be present at higher frequencies within the pseudoexfoliation patient cohort (PXF/PXFG) compared with control patients, wherein rs6495085 showed statistical association (P=0.04). The G-G-G haplotype of rs1048661, rs3825942, and rs6495085 was the most prevalent in PXFG patients compared with control patients or patients with PXF alone. Patients with the G-G-G haplotype were more likely to need surgery, suggestive of a more severe form of disease.

Conclusion:
Collectively, these results represent the first study to assess the association of LOXL1 SNPs with PXFG in an Irish population.
Factors Contributing to Symptom Duration and Viral Reduction in Outpatient Children With Respiratory Syncytial Virus Infection
Authors: Utsunomiya Takeshi , Hibino Akinobu , Taniguchi Kiyosu , Nagai Takao , Saito Naruo , Tanabe Ikumi , Odagiri Takashi , Shobugawa Yugo , Kaneko Akira , Saito Reiko ,   for the Japanese HRSV Collaborative Study Group
Published: February 2020

Background:
We investigated the association between age, duration of clinical symptoms and viral shedding in outpatient children infected with respiratory syncytial virus (RSV) in Japan.

Methods:
Outpatients younger than 2 years of age, with suspected RSV infection between 2014 and 2018, were enrolled in the study. Following informed consent, nasal samples were collected at first and second clinic visits (with 0–9 days gap). RSV-A or -B infection and viral load were determined by real-time polymerase chain reaction. Clinical symptoms were recorded at first clinic visit, and fever and symptoms were recorded at home for up to 8 days. Association between clinical symptoms and patient characteristics, such as age, sex and birth weight, were analyzed using ordered logistic regression analysis. The association between viral reduction and estimated shedding period was examined using linear regression analysis.

Results:
Among the 205 cases enrolled in the study, no difference was found in patient characteristics between RSV-A and -B infection. Duration of fever was prolonged with increased age. Duration of rhinorrhea and cough was shorter in females than in males and in groups with birth weight ≥3 kg than in those with <2.5 kg. Daily viral reduction increased and estimated viral elimination period decreased with age.

Conclusions:
Fever duration was found to increase while viral shedding decreased with patient age.
A Piece of the Boardroom Pie—An Interview Study Exploring What Drives Swedish Corporate Boards’ Engagement in Occupational Health and Safety
Authors: Lornudd Caroline , Stenfors Terese , Hasson Henna , Frykman Mandus , Sundberg Carl Johan , Schwarz Ulrica von Thiele 
Published: February 2020

Objectives:
To investigate why boards of directors engage in occupational health and safety (OHS) and what influences their level of engagement.

Methods:
Thirty-four board members and chief executive officers at large companies from the manufacturing, construction, trade, and health/social care sectors were interviewed. An inductive thematic analysis was conducted.

Results:
Five drivers organized along a continuum explain why boards engage: legal compliance, untoward events, external expectations/regulations, business drivers, and moral values. Certain factors influence the level of engagement: board's OHS competence, owner's agenda, and competing needs.

Conclusions:
Boards continuously prioritize among multiple foci. If a board's total engagement is likened to a pie, the size of the OHS slice will depend on the drivers, as well as on the influencing factors. We suggest that even boards with many drivers can down-prioritize OHS under certain conditions.
Profiles of BMI and blood pressure in young adults categorized by their components of height
Authors: Zhang Ying-xiu , Wang Shu-rong 
Published: February 2020

Background
Body proportion is an important symbol of human biology. The aim of the present study was to examine the association of components of height with BMI and blood pressure (BP) among young adults.

Methods
A total of 4135 college students (2040 males and 2095 females) aged 19–22 years participated in the study. All subjects were classified into four groups (Q1–Q4) according to their quartiles of height, sitting height and leg length, respectively, comparisons of BMI, SBP and DBP among the four groups were made.

Results
BMI is positively associated with sitting height and inversely associated with leg length, and the BP level is associated with sitting height rather than leg length. BMI and BP level of young adults are also associated with their body proportion, subjects with high sitting height ratio (SHR = sitting height/height × 100) had higher BMI and BP level, and more likely to have overweight/obesity and high BP.

Conclusion
BMI and BP level of young adults are associated with their components of height, young adults with longer sitting height and higher SHR should be given special attention in the prevention of hypertension in their future lives.
Investigation of pulmonary embolism in patients with chest pain in the emergency department: a retrospective multicenter study
Authors: Lefevre-Scelles Antoine , Jeanmaire Paul , Freund Yonathan , Joly Luc-Marie , Phillipon Anne-Laure , Roussel Melanie 
Published: February 2020

Introduction:
Chest pain is a common main complaint in the emergency department. Among its associated differential diagnoses, pulmonary embolism remains a key concern for the clinician. There are no clear recommendations on which patients should have a formal workup for pulmonary embolism diagnosis. The objective of this study was to determine the proportion of patients with chest pain who were investigated for pulmonary embolism diagnosis and to determine the clinical profile of these patients.

Methods:
This was a retrospective multicenter study conducted in three French Emergency Departments. We included all patients who presented to these centers for chest pain during a 2-month period. The primary outcome was the initiation of pulmonary embolism workup. We also aimed to find factors associated with this outcome.

Results:
We included 881 patients with a main complaint of chest pain. Mean age was 50 years and 481 (56%) were men. A total of 263 patients (30%, 95% confidence interval 27–33%) had a formal pulmonary embolism workup, and pulmonary embolism was ultimately diagnosed in 7 cases (prevalence of 2.6%, 95% confidence interval 1.1–5.3%). Five factors were identified as independently associated with a workup for pulmonary embolism diagnosis: female sex, young age, no ischemic heart disease, recent flight and associated dyspnea.

Conclusion:
Among patients presenting to emergency department with chest pain, 30% had a workup for pulmonary embolism. We report five clinical variables independently associated with a higher probability of pulmonary embolism workup in our sample.