bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Performance Tests Provide Distinct Information in Both Predicting and Assessing Patient-Reported Outcomes Following Lumbar Spine Surgery
Authors: Master Hiral , Pennings Jacquelyn S. , Coronado Rogelio A. , Henry Abigail L. , O’Brien Michael T. , Haug Christine M. , Skolasky Richard L. , Riley Lee H. , Neuman Brian J. , Cheng Joseph S. , Aaronson Oran S. , Devin Clinton J. , Wegener Stephen T. , Archer Kristin R. 
Published: September 2020

Study Design.
Secondary analysis of randomized controlled trial data.

Objective.
The aim of this study was to examine whether preoperative physical performance is an independent predictor of patient-reported disability and pain at 12 months after lumbar spine surgery.

Summary of Background Data.
Patient-reported outcome measures (PROMs) are commonly used to assess clinical improvement after lumbar spine surgery. However, there is evidence in the orthopedic literature to suggest that PROMs should be supplemented with physical performance tests to accurately evaluate long-term outcomes.

Methods.
A total of 248 patients undergoing surgery for degenerative lumbar spine conditions were recruited from two institutions. Physical performance tests (5-Chair Stand and Timed Up and Go) and PROMs of disability (Oswestry Disability Index: ODI) and back and leg pain (Brief Pain Inventory) were assessed preoperatively and at 12 months after surgery.

Results.
Physical performance tests and PROMs significantly improved over 12 months following lumbar spine surgery (P < 0.01). Weak correlations were found between physical performance tests and disability and pain (ρ = 0.15 to 0.32, P < 0.05). Multivariable regression analyses controlling for age, education, preoperative outcome score, fusion, previous spine surgery, depressive symptoms, and randomization group found that preoperative 5-Chair Stand test was significantly associated with disability and back pain at 12-month follow-up. Each additional 10 seconds needed to complete the 5-Chair Stand test were associated with six-point increase in ODI (P = 0.047) and one-point increase in back pain (P = 0.028) scores. The physical performance tests identified an additional 14% to 19% of patients as achieving clinical improvement that were not captured by disability or pain questionnaires.

Conclusion.
Results indicate that physical performance tests may provide distinct information in both predicting and assessing clinical outcomes in patients undergoing lumbar spine surgery. Our findings suggest that the 5-Chair Stand test may be a useful test to include within a comprehensive risk assessment before surgery and as an outcome measure at long-term follow-up.

Level of Evidence: 3
Histopathologic Observations of Eyes in Exenterated Orbits After Neoadjuvant Intra-Arterial Cytoreductive Chemotherapy for Adenoid Cystic Carcinoma of the Lacrimal Gland
Authors: Liao Sophie D. , Erickson Benjamin P. , Kapila Neha , Dubovy Sander R. , Tse David T. 
Published: September 2020

Purpose:
To assess whether exenteration specimens obtained after neoadjuvant intra-arterial cytoreductive chemotherapy (IACC) for adenoid cystic carcinoma of the lacrimal gland demonstrate significant ocular histopathologic alterations that might preclude future pursuit of globe-preserving therapy.

Methods:
Retrospective histopathologic analysis of globes in IACC-treated exenteration specimens among the same cohort of patients whose survival outcomes have been reported.

Results:
Twenty patients had specimens available. Nineteen globes revealed no abnormalities of the iris, ciliary body, lens, retinal pigment epithelium, choroid, or chorioretinal vasculature. Eighteen globes showed no optic nerve abnormalities. One globe from a patient who refused exenteration until adenoid cystic carcinoma recurrence supervened demonstrated optic nerve edema with a peripapillary hemorrhage and cotton wool spot, as well as hemorrhage and necrosis within an extraocular muscle. Eighteen globes showed no retinal abnormalities attributable to intra-arterial chemotherapy. Three globes showed incidental retinal findings: 2 globes contained 1 to 2 small peripheral retinal hemorrhages and 1 had a pigmented retinal hole. Seven demonstrated mild, chronic extraocular muscle inflammation, and 13 had unremarkable musculature. The single patient who received IACC via the internal carotid rather than the external carotid artery developed ophthalmic artery occlusion with orbital apex syndrome prior to exenteration, and diffuse necrosis and hemorrhage were evident histopathologically.

Conclusions:
Neoadjuvant IACC does not cause significant histopathologic damage to key ocular structures or compromise visual function in patients receiving intra-arterial chemotherapy through the external carotid artery. However, delivering chemotherapy through the internal carotid artery may result in visually significant thrombotic vascular events. The generally benign histopathological findings in these exenteration specimens support the concept of IACC delivery through the external carotid system as the cornerstone of a future globe-preserving strategy for lacrimal gland adenoid cystic carcinoma.
Evaluation of the Initiation Timing of Hydrocortisone in Adult Patients With Septic Shock
Authors: Sacha Gretchen L. , Chen Alyssa Y. , Palm Nicole M. , Duggal Abhijit 
Published: September 2020

ABSTRACT

Introduction:
Clinical studies evaluating the use of hydrocortisone in patients with septic shock are heterogeneous in design with conflicting results. The appropriate time in which to initiate hydrocortisone after shock onset is unknown. This study sought to compare clinical outcomes including vasopressor duration and mortality in patients with septic shock who received hydrocortisone based on timing of initiation after shock onset.

Methods:
Retrospective cohort study of patients between 2011 and 2017 admitted to 10 medical, surgical, and neurosciences intensive care units (ICUs) at a large, tertiary care academic medical center. Adult patients with vasopressor-dependent septic shock who received hydrocortisone were included. Patients were divided into five timing cohorts based on time after shock onset: 0–6, 6–12, 12–24, 24–48, or >48 h. The primary outcome was days alive and free from vasopressors.

Results:
One thousand four hundred seventy patients were included: 567 (38.6%) received hydrocortisone between 0 and 6 h, 231 (15.7%) 6 and 12 h, 260 (17.7%) 12 and 24 h, 195 (13.3%) 24 and 48 h, and 217 (14.8%) >48 h after shock onset. Patients who received hydrocortisone earlier were sicker at baseline with higher APACHE III scores, lactate concentrations, and norepinephrine requirements. On univariate analysis, days alive and free from vasopressors did not significantly differ amongst the timing groups (median 3.3 days for 0–6 h; 1.9 for 6–12 h; 1.9 for 12–24 h; 0 for 24–48 h; 0 for >48 h; P = 0.39); similarly, ICU mortality did not differ. On multivariable linear regression, timing of hydrocortisone was independently associated with more days alive and free from vasopressors when comparing initiation within 0 to 6 h with >48 h (beta-coefficient 2.8 days [95% CI 0.8–4.7]), 6–12 h with >48 h (2.5 days [95% CI 0.2–4.7]), and 12–24 h with >48 h (2.3 days [95% CI 0.2–4.5]). On multivariable logistic regression, timing of hydrocortisone was associated with reduced ICU mortality when comparing receipt within 0 to 6 h of shock onset to >48 h after shock onset (OR 0.6, 95% CI 0.4–0.8).

Conclusions:
In patients in whom hydrocortisone is prescribed for vasopressor-dependent septic shock, timing is crucial and hydrocortisone should be started within the first 12 h after shock onset.
COVID-19 Associated Hypercoagulability: Manifestations, Mechanisms, and Management
Authors: Mazzeffi Michael A. , Chow Jonathan H. , Tanaka Kenichi 
Published: September 2020

ABSTRACT
Patients with severe coronavirus disease-2019 (COVID-19) frequently have hypercoagulability caused by the immune response to the severe acute respiratory syndrome coronavirus-2 infection. The pathophysiology of COVID-19 associated hypercoagulability is not fully understood, but characteristic changes include: increased fibrinogen concentration, increased Factor VIII activity, increased circulating von Willebrand factor, and exhausted fibrinolysis. Anticoagulant therapy improves outcomes in mechanically ventilated patients with COVID-19 and viscoelastic coagulation testing offers an opportunity to tailor anticoagulant therapy based on an individual patient's coagulation status. In this narrative review, we summarize clinical manifestations of COVID-19, mechanisms, monitoring considerations, and anticoagulant therapy. We also review unique considerations for COVID-19 patients who are on extracorporeal membrane oxygenation.
Group A emergency-release plasma in trauma patients requiring massive transfusion
Authors: de Roulet Amory , Kerby Jeffrey D. , Weinberg Jordan A. , Lewis Richard H. , Hudgins Jay P. , Shulman Ira A. , Fox Erin E. , Holcomb John B. , Brasel Karen J. , Bulger Eileen M. , Cohen Mitchell Jay , Cotton Bryan A. , Fabian Timothy C. , O’Keeffe Terence , Rizoli Sandro , Scalea Thomas M. , Schreiber Martin A. , Inaba Kenji ,   the PROPPR Study Group
Published: September 2020

BACKGROUND
Both groups A and AB plasma have been approved for emergency-release transfusion in acutely bleeding trauma patients before blood grouping being performed. The safety profile associated with this practice has not been well characterized, particularly in patients requiring massive transfusion.

METHODS
This secondary analysis of the Pragmatic, Randomized, Optimal Platelet and Plasma Ratios trial examined whether exposure to group A emergency-release plasma (ERP) was noninferior to group AB ERP. We also examined patients whose blood groups were compatible with group A ERP versus patients whose blood groups were incompatible with group A ERP. Outcomes included 30-day mortality and complication rates including systemic inflammatory response syndrome, infection, renal injury, pulmonary dysfunction, and thromboembolism.

RESULTS
Of the 680 patients predicted to receive a massive transfusion, 584 (85.9%) received at least 1 U of ERP. Of the 584 patients analyzed, 462 (79.1%) received group AB and 122 (20.9%) received group A ERP. Using a hazard ratio (HR) of 1.35 as the noninferiority margin, transfusion with group A versus group AB ERP was not associated with increased thromboembolic rates (HR, 0.52; 95% confidence interval [CI], 0.31–0.90). Mortality (HR, 1.15; 95% CI, 0.91–1.45) and nonfatal complication rates (HR, 1.24; 95% CI, 0.87–1.77) were inconclusive. In the subgroup analysis, transfusion with incompatible ERP (group B or AB patients receiving group A ERP) was not associated with increased nonfatal complications (HR, 1.02; 95% CI, 0.80–1.30). There were no reported hemolytic transfusion reactions.

CONCLUSION
The use of ERP is common in patients requiring massive transfusion and facilitates the rapid balanced resuscitation of patients who have sustained blood loss. Group A ERP is an acceptable option for patients requiring massive transfusion, especially if group AB ERP is not readily available.

LEVEL OF EVIDENCE
Therapeutic/Care Management, level IV; Prognostic, level III.
Association of timing of initiation of pharmacologic venous thromboembolism prophylaxis with outcomes in trauma patients
Authors: Hecht Jason P. , Han Emily J. , Cain-Nielsen Anne H. , Scott John W. , Hemmila Mark R. , Wahl Wendy L. 
Published: September 2020

BACKGROUND
Patients are at a high risk for developing venous thromboembolism (VTE) following traumatic injury. We examined the relationship between timing of initiation of pharmacologic prophylaxis with VTE complications.

METHODS
Trauma quality collaborative data from 34 American College of Surgeons Committee on Trauma–verified levels I and II trauma centers were analyzed. Patients were excluded if they were on anticoagulant therapy at the time of injury, had hospitalization <48 hours, or received no or nonstandard pharmacologic VTE prophylaxis (heparin drip). Patient comparison groups were based on timing of initiation of VTE prophylaxis relative to hospital presentation (0 to <24 hours, 24 to <48 hours, ≥48 hours). Risk-adjusted rates of VTE events were calculated accounting for patient factors including type of pharmacologic agent in addition to standard trauma patient confounders. A sensitivity analysis was performed excluding patients who received blood in the first 4 hours and/or patients with a significant traumatic brain injury.

RESULTS
Within the 79,386 patients analyzed, there were 1,495 (1.9%) who experienced a VTE complication and 1,437 (1.8%) who died. After adjusting for type of prophylaxis and patient factors, the risk of a VTE event was significantly increased in the 24- to <48-hour (odds ratio, 1.26; 95% confidence interval, 1.09–1.47; p = 0.002) and ≥48-hour (odds ratio, 2.35; 95% confidence interval, 2.04–2.70; p < 0.001) cohorts relative to patients initiated at 0 to <24 hours. These VTE event findings remained significant after exclusion of perceived higher-risk patients in a sensitivity analysis.

CONCLUSION
Early initiation of pharmacologic VTE prophylaxis in stable trauma patients is associated with lower rates of VTE.

LEVEL OF EVIDENCE
Diagnostic, level III.
Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review
Authors: Ibraheem Kareem , Wong Sunnie , Smith Alison , Guidry Chrissy , McGrew Patrick , McGinness Clifton , Duchesne Juan , Taghavi Sharven , Harris Charles , Schroll Rebecca 
Published: September 2020

BACKGROUND
Penetrating neck trauma (PNT) continues to present a diagnostic dilemma. Practice guidelines advocate the use of computed tomography angiography (CTA) for suspected vascular or aerodigestive injuries in all neck zones. There is also an evolving evidence of “no-zone” approach where the decision to obtain a CTA is guided by physical examination findings and clinical presentation. The aim of this systematic review was to examine existing literature on the diagnostic accuracy of CTA as an integral component of the no-zone approach in stable patients with PNT.

METHODS
We performed a systematic review using an electronic search of three databases (PubMed, Medline, Cochrane Review) from 2000 to 2017.

RESULTS
A total of 5 prospective and 8 retrospective studies were included. The sensitivity of CTA ranged from 83% to 100%; specificity, from 61% to 100%; positive predictive value, from 30% to 100%; and negative predictive value, from 90% to 100%. Three studies reported high sensitivity and specificity for the detection of vascular injuries but low specificity for aerodigestive tract injuries. When stratified by clinical presentation, CTA had a sensitivity of 89.5% to 100% and specificity of 61% to 100% in stable patients presenting with soft signs (SSs). In a combined group of stable patients with either hard signs (HSs) or SSs, the sensitivity of CTA was 94.4% to 100% and the specificity was 96.7% to 100%. Among patients presenting with HSs, the sensitivity of CTA was 78.6% to 90% and the specificity was 100%.

CONCLUSIONS
This is the first systematic review to examine the role of CTA in PNT. In combination with physical examination, CTA demonstrated a reliable high sensitivity and specificity for detecting injuries in PNT in stable patients with SSs of injury and select patients with HSs of injury. These results support the management of PNT using no-zone approach based on physical examination and the use of CTA in stable patients.

LEVEL OF EVIDENCE
Systematic review, level IV.
Quantifying the expense of deferring surgical stabilization of rib fractures: Operative management of rib fractures is associated with significantly lower charges
Authors: Coleman Julia R. , Leasia Kiara , Douglas Ivor S. , Hosokawa Patrick , Lawless Ryan A. , Moore Ernest E. , Pieracci Fredric 
Published: September 2020

INTRODUCTION
Surgical stabilization of rib fractures (SSRF) remains a relatively controversial operation, which is often deferred because of concern about expense. The objective of this study was to determine the charges for SSRF versus medical management during index admission for rib fractures. We hypothesize that SSRF is associated with increased charge as compared with medical management.

METHODS
This is a retrospective chart review of a prospectively maintained database of patients with ≥3 displaced rib fractures admitted to a level 1 trauma center from 2010 to 2019. Patients who underwent SSRF (operative management [OM]) were compared with those managed medically (nonoperative management [NOM]). The total hospital charge between OM and NOM was compared with univariate analysis, followed by backward stepwise regression and mediation analysis.

RESULTS
Overall, 279 patients were included. The majority (75%) were male, the median age was 54 years, and the median Injury Severity Scale score (ISS) was 21. A total of 182 patients underwent OM, whereas 97 underwent NOM. Compared with NOM, OM patients had a lower ISS (18 vs. 22, p = 0.004), less traumatic brain injury (14% vs. 31%, p = 0.0006), shorter length of stay (10 vs. 14 days, p = 0.001), and decreased complications. After controlling for the differences between OM and NOM patients, OM was significantly associated with decreased charges (β = US $35,105, p = 0.01). Four other predictors, with management, explained 30% of the variance in charge (R
2 = 0.30, p < 0.0001): scapular fracture (β = US $471,967, p < 0.0001), ISS per unit increase (β = US $4,139, p < 0.0001), long bone fracture (β = US $52,176, p = 0.01), bilateral rib fractures (β = US $34,392, p = 0.01), and Glasgow Coma Scale per unit decrease (β = US $17,164, p < 0.0001). The difference in charge between NOM and OM management was most strongly, although only partially, mediated by length of stay.

CONCLUSION
Our analysis found that OM, as compared with NOM, was independently associated with decreased hospital charges. These data refute the prevailing notion that SSRF should be withheld because of concerns for increased cost.

LEVEL OF EVIDENCE
Economic, level II.
Protein and Microbial Biomarkers in Sputum Discern Acute and Latent Tuberculosis in Investigation of Pastoral Ethiopian Cohort
Authors: HaileMariam Milkessa , Yu Yanbao , Singh Harinder , Teklu Takele , Wondale Biniam , Worku Adana , Zewde Aboma , Monaud Stephanie , Tsitrin Tamara , Legesse Mengistu , Ameni Gobena , Pieper Rembert 
Published: September 2020

ABSTRACTDifferential diagnosis of tuberculosis (TB) and latent TB infection (LTBI) remains a public health priority in high TB burden countries. Pulmonary TB is diagnosed by sputum smear microscopy, chest X-rays, and PCR tests for distinctMycobacterium tuberculosis(Mtb) genes. Clinical tests to diagnose LTBI rely on immune cell stimulation in blood plasma with TB-specific antigens followed by measurements of interferon-γ concentrations. The latter is an important cytokine for cellular immune responses against Mtb in infected lung tissue. Sputum smear microscopy and chest X-rays are not sufficiently sensitive while both PCR and interferon-γ release assays are expensive. Alternative biomarkers useful for developing diagnostic tests to discern TB disease states are desirable. This study’s objective was to discover biomarkers in sputum, assessing the proteomes and microbiomes of 74 TB patients, 46 individuals with LTBI, and 51 negative community controls (NCC). Study participants were from the South Omo province, a pastoral region in southern Ethiopia. A total of 161 and 115 samples were used to determine the 16S rRNA sequence-based bacterial taxonomies and proteomic profiles, respectively. Sputum microbiota did not reveal statistically significant differences in α-diversity comparing the three groups. The genusMycobacterium, representing Mtb, was only identified for the TB group. The latter featured reduced abundance of the genusRothiain comparison to the LTBI and NCC groups.Rothiais a human respiratory tract commensal and may be sensitive to the inflammatory milieu caused by TB infection. Proteomic data strongly supported innate immune responses against Mtb in subjects with pulmonary TB. Ferritin, an iron storage protein released by damaged host cells, was markedly increased in abundance in TB sputum compared to the LTBI and NCC groups, along with α-1-acid glycoproteins ORM1 and ORM2. These proteins are acute phase reactants and inhibit excessive neutrophil activation. Proteomic data also supported effector roles of neutrophils in the anti-Mtb response which was not observed for LTBI cases. Less abundant in sputum of the LTBI group versus the NCC group were two immunomodulatory proteins, mitochondrial TSPO and the extracellular ribonuclease T2. If validated, these proteins are of interest as diagnostic biomarkers for LTBI.
Vaccination for some childhood diseases may impact the outcome of covid-19 infections
Authors: Gobe Irene , Koto Garesego F , Mokomane Margaret , Molebatsi Kesaobaka , Kasvosve Ishmael , Motswaledi Modisa S 
Published: September 2020

AbstractBackgroundCOVID-19 found the world in a state of unpreparedness. While research efforts to develop a vaccine are on-going, others have suggested the use of available vaccines to boost innate immunity.ObjectiveWe analysed three databases: UNICEF Immunization Coverage, Worldometer Corona Virus Updates and World Bank List of Economies to establish the association, if any, between vaccination for various diseases and COVID-19 death rates and recoveries across world economies.ResultsMean percentage death rates were lower in countries that vaccinated for Hepatitis-B birth dose (2.53% vs 3.79%, p = 0.001), Bacille Calmette-Guérin Vaccine (2.93% vs 5.10%, p = 0.025) and Inactivated Polio Vaccine 1st dose (2.8% vs 4.01%, p = 0.022) than those which did not report vaccination. In high income countries, a significant negative correlation with death rates was observed with vaccination for Measles-containing vaccine 2nd dose (r = –0.290, p = 0.032), Rubella-containing vaccine 1st dose (r = –0.325, p = 0.015), Hepatitis B 3rd dose (r = –0.562, p = 3.3 x10−5), Inactivated Polio vaccine 1st dose (r = –0.720, p = 0.008). Inactivated Polio Vaccine 1st dose and Measles-containing vaccine 2nd dose also correlated with better recoveries. In Low Income countries, only Rubella-containing vaccine correlated with lower deaths while Yellow fever vaccine was associated with poorer recoveries.ConclusionOur analysis corroborates the potential benefit of vaccination and warrant further research to explore the rationale for repurposing other vaccines to fight COVID-19.