bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trochanteric pain and total hip arthroplasty: a systematic review of the literature
Authors: Axelrod Daniel , Madden Kim , Khan Habeeb , Banfield Laura , Winemaker Mitchell , DeBeer Justin , Wood Thomas J. 
Published: May 2020

Background:Total hip arthroplasty (THA) is one of the most common surgical procedures. Although THA surgeries are typically very successful, between 3% and 17% of all patients experience trochanteric pain after surgery. There is little high-quality evidence on this disorder, especially after total hip arthroplasty. The purposes of this review were to describe the prevalence, treatments, prognosis, risk factors, and diagnostic methods available for trochanteric pain among preoperative or postoperative primary THA patients.Methods:The authors conducted a systematic review of trochanteric pain among THA patients. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched to identify relevant articles. Two reviewers systematically screened studies and extracted data independently in duplicate. This study presents descriptive statistics and pooled prevalence of trochanteric pain.Results:We included 36 studies with 7826 patients (mean age of 62 yr, 59% female). The prevalence of trochanteric pain was reported in 25 studies, with a mean prevalence of 3.8% (95% CI 3.3% to 4.4%). Methods of treatment for trochanteric pain included corticosteroid injections, bursectomy, and iliotibial (IT) band lengthening. Risk factors for trochanteric pain were inconsistently reported, but those most commonly listed were female gender and postoperative leg-length discrepancy.Conclusions:Approximately one in 25 patients who has undergone standard THA experiences postoperative trochanteric pain. With low certainty, the results of this review suggest the surgical approach may not influence incidence of trochanteric pain. The heterogeneity in both diagnostic modalities reported and in treatment options suggests that further prospective research is required to better inform treatment decisions for this common condition.Level of Evidence:Level III.
Spondyloarthritis evolution: what is in your history?
Authors: Ashrafi Maedeh , Ermann Joerg , Weisman Michael H. 
Published: May 2020

Purpose of review
This review encompasses a detailed history of spondyloarthritis (SpA) evolution as early as the 17th century, continues on to the current concept of SpA, and ends with current gaps in our understandings of SpA.

Recent findings
Until the early 1960s, ankylosing spondylitis and other SpA family members were considered to be variants of rheumatoid arthritis (RA). The formal medical community separated them from RA at that time, and shortly thereafter they were recognized to be inter-connected based on shared clinical, laboratory, and imaging features. The last two decades have witnessed the formal distinction between axial and peripheral SpA and the connections that exist between nonradiographic and radiographic axial SpA. Recent studies have revealed different microbial compositions among patients with SpA and healthy controls and also between HLA-B27 positive and negative healthy individuals.

Summary
Further investigation of the roles of intestinal microbiome and physical force transduction toward SpA pathogenesis, strategies to improve delay in SpA diagnosis, biomarkers to better predict radiographic progression, and modification of current classification criteria to better address the axial and peripheral groups are gaps in our understandings that pose top priorities for SpA research.
Does K-line (−) in the Neck-flexed Position Predict Surgical Outcome of Cervical Spondylotic Myelopathy?
Authors: Nori Satoshi , Aoyama Ryoma , Ninomiya Ken , Suzuki Satoshi , Anazawa Ukei , Shiraishi Tateru 
Published: May 2020

Study Design.
A retrospective single-center study.

Objective.
The aim of this study was to investigate the influence of the K-line in the neck-flexed position (flexion K-line) on the surgical outcome after muscle-preserving selective laminectomy (SL) for cervical spondylotic myelopathy (CSM).

Summary of Background Data.
Development of CSM is associated with dynamic factors and cervical alignment. The flexion K-line, which reflects both dynamic and alignment factors, provides an indicator of surgical outcome after posterior decompression surgery for patients with ossification of the posterior longitudinal ligament. However, the value of the flexion K-line for patients with CSM has not been evaluated.

Methods.
Our study group included 159 patients treated with SL for CSM. Patients were divided into a flexion K-line (+) group and a flexion K-line (−) group. The influence of the flexion K-line on radiological and surgical outcomes was analyzed, with multivariate analysis conducted to identify factors affecting the surgical outcome.

Results.
Patients in the flexion K-line (−) group were younger (P = 0.003), had a less lordotic cervical alignment (pre-and postoperatively, P < 0.001), a smaller C7 slope (pre-and postoperatively, P < 0.001), and a greater mismatch between the C7 slope and the C2-C7 angle (preoperatively, P = 0.047; postoperatively, P = 0.001). The postoperative increase in Japanese Orthopedic Association (JOA) score and the JOA score recovery rate (RR) were lower for the flexion K-line (−) than for the K-line (+) group (P < 0.001 and P < 0.001, respectively). On multivariate regression analysis, the flexion K-line (−) (β = −0.282, P < 0.001), high signal intensity (SI) changes on T2-weighted image (WI) combined with low SI changes on T1-WI in the spinal cord (β = −0.266, P < 0.001), and older age (β= -0.248, P = 0.001) were predictive of a lower JOA score RR.

Conclusion.
The flexion K-line may be a useful predictor of surgical outcomes after SL in patients with CSM.

Level of Evidence: 4
Disc Degeneration of Young Low Back Pain Patients
Authors: Sääksjärvi Simo , Kerttula Liisa , Luoma Katariina , Paajanen Hannu , Waris Eero 
Published: May 2020

Study Design.
A prospective follow-up study.

Objective.
The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up.

Summary of Background Data.
MRI is an accurate method for studying degenerative changes in intervertebral discs. Decreased signal intensity (SI) can be used as indication of decreased water content. Long-term prognosis of early DD remains unclear.

Methods.
In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI. The images were evaluated for decreased SI and other degenerative changes. Association between decreased SI of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. Association between decreased baseline SI and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.

Results.
The total number of lumbar discs with decreased SI increased from 23 of 130 (18%) to 92 of 130 (71%)—from 0.9 to 3.5 per subject during the follow-up. Distribution of DD changed from being mostly in L4–L5 and L5–S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased SI at baseline were more likely to have severely decreased SI at follow-up, compared to healthy discs (57% vs. 11%, P < 0.001). Other degenerative changes were also more common in these discs. Severity of DD at baseline did not have a significant association with current pain or disability.

Conclusion.
In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.

Level of Evidence: 4
Employment Status for the First Decade Following Randomization to Cervical Disc Arthroplasty Versus Fusion
Authors: Badve Siddharth A. , Florman Jeffrey E. , Levi Allan D. , Kurra Swamy , Riew K. Daniel , Lavelle William F. 
Published: May 2020

Study Design.
An analysis of employment status data up to 10 years following the Federal Drug Administration (FDA) Investigational Device Exemption (IDE) randomized trial and extension as post-approval study comparing BRYAN® cervical disc (Medtronic, Minneapolis, MN) arthroplasty (CDA) versus single-level anterior cervical discectomy and fusion (ACDF) was performed.

Objective.
Ten-year experience with the BRYAN® disc arthroplasty trial provides opportunity to report patient employment data.

Summary of Background Data.
The long-term consequences of arthroplasty remain incomplete, including the occurrence of occupational compromise.

Methods.
Patients’ employment status were measured at regular intervals in both groups up to 10 years.

Results.
The preoperative employment status proportion was comparable between investigational (BRYAN CDA) and control (ACDF) groups. In the investigational group, 49.2% returned to work at 6 weeks compared with 39.4% of the control group (P = 0.046). At 6 months and 2 years postoperatively, there was a similar likelihood of active employment in both groups. After 2 years at all time points, 10% drop-off seen in control group employment, but not in investigational group. At 10 years, 76.2% CDA patients were employed to 64.1% ACDF patients (P = 0.057). Preoperative variables influencing work status at 10 years following CDA included: preoperative work status, age, and SF-36 Mental Component Score (SF-36 MCS); whereas, no significant preoperative factor identified with ACDF. Time to return to work was influenced in both groups by preoperative work status; and in the ACDF group: reaching age 65 at 10-year visit, preoperative arm pain and NDI score had significant influences.

Conclusion.
More patients returned to work at 6 weeks after CDA compared with ACDF, although there was no difference by 6 months. After 2 years, a nonsignificant trend toward higher employment rates in the arthroplasty group was evident, but this difference could not be validated due to the very high rate of loss of patients to the follow-up.

Level of Evidence: 2
Implications of Obesity for the Management of Severe Coronavirus Disease 2019 Pneumonia
Authors: Lemyze Malcolm , Courageux Nathan , Maladobry Thomas , Arumadura Clothilde , Pauquet Philippe , Orfi Annis , Komorowski Matthieu , Mallat Jihad , Granier Maxime 
Published: May 2020

Objectives:
To investigate patients’ characteristics, management, and outcomes in the critically ill population admitted to the ICU for severe acute respiratory syndrome coronavirus disease 2019 pneumonia causing an acute respiratory distress syndrome.

Design:
Retrospective case-control study.

Setting:
A 34-bed ICU of a tertiary hospital.

Patients:
The first 44 coronavirus disease 2019 acute respiratory distress syndrome patients were compared with a historical control group of 39 consecutive acute respiratory distress syndrome patients admitted to the ICU just before the coronavirus disease 2019 crisis.

Interventions:
None.

Measurements and Main Results:
Obesity was the most frequent comorbidity exhibited by coronavirus disease 2019 patients (n = 32, 73% vs n = 11, 28% in controls; p < 0.001). Despite the same severity of illness and level of hypoxemia at admission, coronavirus disease 2019 patients failed more high flow oxygen via nasal cannula challenges (n = 16, 100% vs n = 5, 45% in controls; p = 0.002), were more often intubated (n = 44, 100% vs n = 22, 56% in controls; p < 0.001) and paralyzed (n = 34, 77% vs n = 3, 14% in controls; p < 0.001), required higher level of positive end-expiratory pressure (15 vs 8 cm H2O in controls; p < 0.001), more prone positioning (n = 33, 75% vs n = 6, 27% in controls; p < 0.001), more dialysis (n = 16, 36% vs n = 3, 8% in controls; p = 0.003), more hemodynamic support by vasopressors (n = 36, 82% vs n = 22, 56% in controls; p = 0.001), and had more often a prolonged weaning from mechanical ventilation (n = 28, 64% vs n = 10, 26% in controls; p < 0.01) resulting in a more frequent resort to tracheostomy (n = 18, 40.9% vs n = 2, 9% in controls; p = 0.01). However, an intensive management requiring more staff per patient for positioning coronavirus disease 2019 subjects (6 [5–7] vs 5 [4–5] in controls; p < 0.001) yielded the same ICU survival rate in the two groups (n = 34, 77% vs n = 29, 74% in controls; p = 0.23).

Conclusions:
In its most severe form, coronavirus disease 2019 pneumonia striked preferentially the vulnerable obese population, evolved toward a multiple organ failure, required prolonged mechanical ventilatory support, and resulted in a high workload for the caregivers.
Restoring the Severed Breast and Chest following Seat Belt Trauma
Authors: Noel Olivier F. , Fornadley Jeffrey , Potochny John 
Published: May 2020

Summary:
In this article, we presented 2 cases of rare clinical presentation of 3-point lap-diagonal seat belt injuries and provided a brief overview of the spectrum of the associated deformity and morbidity. Both of our patients presented in a delayed fashion during the subacute period at 12 and 4 months, respectively, following their traumatic seat belt injuries, which improved with surgical intervention. Ideally, these injuries should be repaired during the subacute period once any life-threatening injuries have been addressed, because seat belt–restraint injuries may otherwise lead to chronic pain, functional loss, and physical deformity.
Leader Legacy Building: An Organization’s Life Insurance Policy
Authors: Akin Terrence B. , Eaton Mandy C. 
Published: May 2020

SUMMARY
Healthcare is uniquely destined for growth, largely because of the increasing demands of an aging population. In this field bursting with highly trained professionals driven by a passion for serving others, we as healthcare leaders are well positioned to cultivate an environment where high-performing employees can achieve their potential.
Unfortunately, we are not well positioned to face the risk of losing continuity. Most healthcare C-suites are occupied by baby boomers who will soon exit the workforce. The impending transitions, adding to the effects of system consolidations and market demands for leadership talent, call for a concerted effort to prepare the next generation of leaders. There are significant benefits to promoting from within, yet formal succession plans are hard to build and even harder to embed in an organization’s culture.
The planning and attention required to develop the next generation is not a static process. The work is hard and ongoing. However, the return on the human investment in succession planning can be substantial for an organization, its senior executives, and its emerging leaders. Preparing the next generation should be an imperative for all senior leaders. An effective approach involves a defined plan, development tools, alignment with a leadership competency framework, and attention to diversity and inclusion. Handled effectively, early careerists who are taught the skills needed to succeed as leaders will be able to help guide their organizations and healthcare in general when called on to make a difference. There is great potential to be realized in developing future leaders internally, and we as today’s leaders must start that work now.
Ocular Manifestations of Chordin-like 1 Knockout Mice
Authors: Chen Di , Liu Yang , Shu Guanhua , Chen Chinfei , Sullivan David A. , Kam Wendy R. , Hann Steven , Fowler Megan , Warman Matthew L. 
Published: May 2020

Purpose:
In humans, loss-of-function mutations in the gene encoding Chordin-like 1 (CHRDL1) cause X-linked megalocornea (MGC1), characterized by bilateral corneal enlargement, decreased corneal thickness, and increased anterior chamber depth (ACD). We sought to determine whether Chrdl1 knockout (KO) mice would recapitulate the ocular findings found in patients with MGC1.

Methods:
We generated mice with a Chrdl1 KO allele and confirmed that male Chrdl1 hemizygous KO mice do not express Chrdl1 mRNA. We examined the eyes of male mice that were hemizygous for either the wild-type (WT) or KO allele and measured corneal diameter, corneal area, corneal thickness, endothelial cell density, ACD, tear volume, and intraocular pressure. We also harvested retinas and counted retinal ganglion cell numbers. Eye segregation pattern in the dorsal lateral geniculate nucleus were also compared between male Chrdl1 KO and WT mice.

Results:
Male Chrdl1 KO mice do not have larger cornea diameters than WT mice. KO mice have significantly thicker central corneas (116.5 ± 3.9 vs. 100.9 ± 4.2 μm, P = 0.013) and smaller ACD (325.7 ± 5.7 vs. 405.6 ± 6.3 μm, P < 0.001) than WT mice, which is the converse of what occurs in patients who lack CHRDL1. Retinal–thalamic projections and other ocular measurements did not significantly differ between KO and WT mice.

Conclusions:
Male Chrdl1 KO mice do not have the same anterior chamber abnormalities seen in humans with CHRDL1 mutations. Therefore, Chrdl1 KO mice do not recapitulate the human MGC1 phenotype. Nevertheless, Chrdl1 plays a role during mouse ocular development because corneas in KO mice differ from those in WT mice.
Safety of Metronidazole in Late Pre-term and Term Infants with Complicated Intra-abdominal Infections
Authors: Commander Sarah Jane , Gao Jamie , Zinkhan Erin K. , Heresi Gloria , Courtney Sherry E. , Lavery Adrian P. , Delmore Paula , Sokol Gregory M. , Moya Fernando , Benjamin Danny , Bumpass Tedryl G. , Debski Julie , Erinjeri Jinson , Sharma Gaurav , Tracy Elisabeth T. , Smith P. Brian , Cohen-Wolkowiez Michael , Hornik Christoph P. 
Published: May 2020

Background:
Metronidazole is frequently used off-label in infants with complicated intra-abdominal infections (cIAI) to provide coverage against anaerobic organisms, but its safety and efficacy in this indication are unknown.

Methods:
In the Antibiotic Safety in Infants with Complicated Intra-Abdominal Infections open-label multicenter trial infants ≥34 weeks gestation at birth and <121 days postnatal age with cIAIs were administered metronidazole as part of multimodal therapy. Metronidazole safety was evaluated by reporting of adverse events (AEs) and safety events of special interest. Cure from disease was determined by blood cultures and a clinical cure score >4. A blinded adjudication committee reviewed all safety events of special interest.

Results:
Fifty-five infants were included, median gestational age was 36 weeks (range: 34–41) and postnatal age was 7 days (0–63). The most common additional antibiotics received included gentamicin, piperacillin-tazobactam, ampicillin and vancomycin. Only one AE, a candidal rash, was identified to be potentially caused by metronidazole administration. One infant died of cardiopulmonary failure, which was deemed unrelated to metronidazole. The most common events of special interest included feeding intolerance in 18 (33%) infants, and exploratory laparotomy in 10 (18%) requiring intestinal anastomosis in 7 (13%) infants. There was 1 (2%) intestinal stricture. Fifty-three infants (96%) achieved overall therapeutic success, 54 (98%) were alive through 30 days post-study therapy, and 54 (98%) had 30-day clinical cure score >4.

Conclusions:
In a cohort of late pre-term and term infants with cIAIs, combination antibiotic therapy that included metronidazole was safe, and therapeutic success was high.
Cefepime Versus Cefepime Plus Amikacin as an Initial Antibiotic Choice for Pediatric Cancer Patients With Febrile Neutropenia in an Era of Increasing Cefepime Resistance
Authors: Lee Na Hee , Kang Ji-Man , Lee Ji Won , Huh Hee Jae , Lee Nam Yong , Yoo Keon Hee , Sung Ki Woong , Koo Hong Hoe , Kim Yae-Jean 
Published: May 2020

Background:
We investigated the treatment outcomes before and after the addition of amikacin to cefepime monotherapy as an initial empirical antibiotic treatment in pediatric cancer patients with febrile neutropenia.

Methods:
This was a retrospective historical cohort study. The subjects were pediatric cancer patients who visited the emergency room at the Samsung Medical Center, Seoul, Korea, due to chemotherapy-induced febrile neutropenia, between January 2011 and December 2016. Since September 2014, the empirical antimicrobial treatment regimen for febrile neutropenia was changed from high-dose cefepime monotherapy to combination therapy of adding a single dose of amikacin.

Results:
Two hundred twenty-five bacteremia episodes in 164 patients were reported during the study period. Bacteremia caused by cefepime-resistant Gram-negative bacteria was observed in 16% of patients before September 2014 and in 21% of the patients after September 2014 (P = 0.331). Use of appropriate empirical antibiotic treatments increased from 62% to 83% following addition of amikacin to cefepime treatment (P = 0.003). The duration of fever was shorter in the cefepime plus amikacin group than in the cefepime group (22 vs. 34 hours, P = 0.014); however, rates of septic shock and pediatric intensive care unit hospitalizations were not significantly different between the 2 groups (septic shock, both 7%, P = 0.436; pediatric intensive care unit 3% vs. 1%, P = 0.647).

Conclusions:
We observed no additional benefit of amikacin addition to high-dose cefepime monotherapy. Therefore, adding amikacin to cefepime monotherapy in conditions where cefepime-resistant Gram-negative bacteremia amounts to 20% or less may not be justified.
Noninvasive motor cortex stimulation effects on quantitative sensory testing in healthy and chronic pain subjects: a systematic review and meta-analysis
Authors: Giannoni-Luza Stefano , Pacheco-Barrios Kevin , Cardenas-Rojas Alejandra , Mejia-Pando Piero F. , Luna-Cuadros Maria A. , Barouh Judah L. , Gnoatto-Medeiros Marina , Candido-Santos Ludmilla , Barra Alice , Caumo Wolnei , Fregni Felipe 
Published: May 2020

Abstract
One of the potential mechanisms of motor cortex stimulation by noninvasive brain stimulation (NIBS) effects on pain is through the restoration of the defective endogenous inhibitory pain pathways. However, there are still limited data on quantitative sensory testing (QST), including conditioned pain modulation (CPM), supporting this mechanism. This systematic review and meta-analysis aimed to evaluate the effects of noninvasive motor cortex stimulation on pain perception as indexed by changes in QST outcomes. Database searches were conducted until July 2019 to include randomized controlled trials that performed sham-controlled NIBS on the motor cortex in either the healthy and/or pain population and assessed the QST and CPM. Quality of studies was assessed through the Cochrane tool. We calculated the Hedge's effect sizes of QST and CPM outcomes and their 95% confidence intervals (95% CIs) and performed random-effects meta-analyses. Thirty-eight studies were included (1178 participants). We found significant increases of pain threshold in healthy subjects (ES = 0.16, 95% CI = 0.02-0.31, I2 = 22.2%) and pain populations (ES = 0.48, 95% CI = 0.15-0.80, I2 = 68.8%), and homogeneous higher CPM effect (pain ratings reduction) in healthy subjects (ES = −0.39, 95% CI = −0.64 to −0.14, I2 = 17%) and pain populations (ES = −0.35, 95% CI = −0.60 to −0.11, I2 = 0%) in the active NIBS group compared with sham. These results support the idea of top-down modulation of endogenous pain pathways by motor cortex stimulation as one of the main mechanisms of pain reduction assessed by QST, which could be a useful predictive and prognostic biomarker for chronic pain personalized treatment with NIBS.