bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Size Matter for Cephalomedullary Nails in Geriatric Intertrochanteric Fractures?
Authors: Rinehart Dustin B. , O'Neill David E. , Liu Jennifer W. , Sanders Drew T. 
Published: October 2020

Objectives:
To evaluate the need for reoperation of geriatric intertrochanteric hip fractures treated with 10-mm cephalomedullary nails versus those treated with nails larger than 10 mm.

Design:
Retrospective review at a single institution.

Setting:
Level I trauma center.

Patients/Participants:
All patients age 60 and over treated with cephalomedullary fixation for an intertrochanteric femur fracture at a single institution.

Intervention:
Cephalomedullary fixation with variable nail diameters.

Main Outcome Measurements:
Reoperation rates of geriatric intertrochanteric fractures treated with a size 10-mm diameter cephalomedullary nail compared with patients treated with nails larger than 10 mm.

Results:
There were no significant differences in reoperation rates when the 10-mm cohort was compared with an aggregate cohort of all nails larger than 10 mm (P = 0.99). This result was true for both all-cause reoperation and noninfectious reoperation. There was no difference between cohorts in regards to age, gender, or fracture pattern.

Conclusions:
A 10-mm cephalomedullary nail can be used in lieu of a larger diameter fixation in patients age 60 and older with intertrochanteric femur fractures while still maintaining a comparable rate of reoperation.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Clinical Outcomes and Sagittal Alignment After Different Levels of Anterior Cervical Discectomy and Fusion in Patients With Cervical Spondylotic Myelopathy: From One-level to Three-level
Authors: Guo Shuming , Lu Shibao , Kong Chao , Li Xiangyu , Liu Chengxin 
Published: October 2020

Study Design.
A nonrandomized and prospective study.

Objective.
The aim of this study was to compare clinical outcomes and sagittal alignment after one-level, two-level, and three-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data.
ACDF is a widely used surgical approach for CSM. It remains controversial regarding to whether corrected lordosis can be maintained over time after different levels ACDF.

Methods.
A total of 175 patients with cervical spondylotic myelopathy who underwent ACDF were enrolled in this retrospective study. The neurofunctional assessment was performed with the Japanese Orthopedic Association (JOA) score and the recovery rate of JOA score. Radiographic parameters included C2–C7 lordosis, fused segments lordosis, T1 slope, the cervical sagittal vertical axis (cSVA).

Results.
Patients with more fusion levels had more operative time and blood loss and higher rate of complications. All patients showed a larger cervical lordosis than that preoperatively and the restored lordosis increased with more segments involved. The restored lordosis had little change during the whole follow-up in one-level and two-level group. CL decreased from 25.65 ± 9.31° on the third postoperative day to 20.25 ± 10.03° at the final follow-up in three-level group (P = 0.001). Only T1 slope in three-level increased significantly from preoperative 26.55 ± 9.36° to 29.06 ± 7.54° on the third postoperative day (P = 0.011) and decreased to 26.89 ± 7.22° (P = 0.043) at final follow-up. The JOA score all increased significantly at the last follow-up in each group, but the recovery rate of the JOA score in each group was similar (P = 0.096).

Conclusion.
ACDF with different levels had similar postoperative clinical outcomes. Three-level ACDF has an apparent advantage in restoring lordosis, a poor ability to maintain lordosis, and a higher incidence of complications compared to one-level or two-level ACDF.

Level of Evidence: 3
Do Preoperative Epidural Steroid Injections Increase the Risk of Infection After Lumbar Spine Surgery?
Authors: Kreitz Tyler M. , Mangan John , Schroeder Gregory D. , Kepler Christopher K. , Kurd Mark F. , Radcliff Kris E. , Woods Barrett I. , Rihn Jeffery A. , Anderson D. Greg , Vaccaro Alexander R. , Hilibrand Alan S. 
Published: October 2020

Study Design.
Retrospective study.

Objective.
To elucidate an association between preoperative lumbar epidural corticosteroid injections (ESI) and infection after lumbar spine surgery.

Summary of Background Data.
ESI may provide diagnostic and therapeutic benefit; however, concern exists regarding whether preoperative ESI may increase risk of postoperative infection.

Methods.
Patients who underwent lumbar decompression alone or fusion procedures for radiculopathy or stenosis between 2000 and 2017 with 90 days follow-up were identified by ICD/CPT codes. Each cohort was categorized as no preoperative ESI, less than 30 days, 30 to 90 days, and greater than 90 days before surgery. The primary outcome measure was postoperative infection requiring reoperation within 90 days of index procedure. Demographic information including age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI) was determined. Comparison and regression analysis was performed to determine an association between preoperative ESI exposure, demographics/comorbidities, and postoperative infection.

Results.
A total of 15,011 patients were included, 5108 underwent fusion and 9903 decompression only. The infection rate was 1.95% and 0.98%, among fusion and decompression patients, respectively. There was no association between infection and preoperative ESI exposure at any time point (1.0%, P = 0.853), ESI within 30 days (1.37%, P = 0.367), ESI within 30 to 90 days (0.63%, P = 0.257), or ESI > 90 days (1.3%, P = 0.277) before decompression surgery. There was increased risk of infection in those patients undergoing preoperative ESI before fusion compared to those without (2.68% vs. 1.69%, P = 0.025). There was also increased risk of infection with an ESI within 30 days of surgery (5.74%, P = 0.005) and when given > 90 days (2.9%, P = 0.022) before surgery. Regression analysis of all patients demonstrated that fusion (P < 0.001), BMI (P < 0.001), and CCI (P = 0.019) were independent predictors of postoperative infection, while age, sex, and preoperative ESI exposure were not.

Conclusion.
An increased risk of infection was found in patients with preoperative ESI undergoing fusion procedures, but no increased risk with decompression only. Fusion, BMI, and CCI were predictors of postoperative infection.

Level of Evidence: 3
Rapid Switch From Subcutaneous to Intravenous Treprostinil in Precapillary Pulmonary Hypertension by Pump Implantation
Authors: Steringer-Mascherbauer Regina , Maria Lummerstorfer , Reinhold Függer , Elisabeth Sigmund , Charlotte Huber , Dagmar Engleder , Uwe Fröschl , Josef Aichinger 
Published: October 2020

Abstract:
Limited data are available on the transition from subcutaneous to intravenous prostacyclin in precapillary pulmonary hypertension. We performed a retrospective analysis of all patients who were switched from subcutaneous to intravenous treprostinil with an implantable infusion pump. We included 85 consecutive, clinically stable patients (mean age 66 years and range 16–85), who had been treated with subcutaneous treprostinil for mean 9 months (range 1–78) before pump implantation. An interdisciplinary expert panel defined standards for this procedure before the first implantation. As the first patient experienced a significant hypotensive episode indicating treprostinil overdose postoperatively, the time span to stop subcutaneous treprostinil was reduced to 60 minutes for all following patients. No events associated with the switch from subcutaneous to intravenous treprostinil were observed during postoperative hospital stay in 84 (98.8%) patients. Taking into account a likely depot effect of subcutaneous treprostinil patients can safely be switched to the intravenous route by the implantation of an infusion pump.
Detection of Protein Aggregation and Proteotoxicity Induced by Angiotensin II in Vascular Smooth Muscle Cells
Authors: Cicalese Stephanie , Okuno Keisuke , Eguchi Satoru 
Published: October 2020

Abstract:
Disruption of protein quality control occurs with aging and cardiovascular pathologies including arterial stiffness and hypertension. Angiotensin II (Ang II) is believed to induce endoplasmic reticulum stress in vascular smooth muscle cells (VSMCs), thus contributing to vascular remodeling and dysfunction. However, whether Ang II increases formation of protein aggregates and mediates proteotoxicity in VSMCs remain obscure. Accordingly, this study aimed to establish a quantitative method of protein aggregate detection induced by Ang II and to investigate their potential involvement in inflammatory and senescence responses. Proteostat staining showed increased aggregate numbers per cell on Ang II exposure. Immunoblot analysis further showed an increase in preamyloid oligomer presence in a detergent insoluble protein fraction purified from VSMCs stimulated with Ang II. Moreover, these responses were attenuated by treatment with chemical chaperone, 4-phenylbutyrate. 4-phenylbutyrate further blocked Ang II-induced senescence associated β-galactosidase activity and THP-1 monocyte adhesion in VSMCs. These data suggest that Ang II induces proteotoxicity in VSMCs which likely contributes to aging and inflammation in the vasculature.
Sixty-seven Hours After Cesarean Successfully Redo Prosthetic Mitral Valve Leaflet Replacement at 29th Gestational Week: A Case Report and Literature Review
Authors: Wang Yu-Guang , Xie Bao-Dong , Sun Jing-Xia 
Published: October 2020

Abstract
On April 3, 2020, a 37-year-old woman successfully completed heart valve replacement after cesarean section 67 hours in the First Affiliated Hospital of Harbin Medical University.The woman underwent the mechanical mitral valve replacement in the same hospital 10 years ago. She used low molecular weight heparin instead of warfarin, when she realized her pregnancy. On March 25, 2020 (28+5 weeks of gestation), due to New York Heart Association class IV, severe pneumonia, type I respiratory failure, the patient was admitted to the hospital for treatment. Three days later, she discharged herself from hospital by refusing the cesarean section. The next day she was re-admitted to the ward because of the worsen symptoms and oliguria. Cesarean section was performed 50 hours after admission. The neonate was 1 400 g; Apgar score was 5 in 1 minute, 8 in 5 minutes, transferred to neonatal intensive care unit. Because of the unrecovered heart function, she was confirmed stuck mechanical prosthetic mitral valves. On April 3, 2020, through multi-disciplinary cooperation, the patient was safe without any life-threatening emergency. Eleven days after the replacement, the patient was discharged smoothly, so was the neonate 33 days after delivery.
Effect of anti-inflammatory regimen on early postoperative inflammation after cataract surgery
Authors: Erichsen Jesper H. , Forman Julie L. , Holm Lars M. , Kessel Line 
Published: October 2020

Purpose:
To investigate whether a combination of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids were superior in controlling early postoperative inflammation after cataract surgery compared with topical NSAIDs alone and with dropless surgery where a sub-Tenon depot of steroid was placed during surgery.

Setting:
Department of Ophthalmology, Rigshospitalet-Glostrup, Denmark.

Design:
Prospective randomized controlled trial with masked statistical analyses.

Methods:
Patients undergoing phacoemulsification for age-related cataract were randomized to 1 of 5 regimens: ketorolac and prednisolone eyedrops combined (Pred+NSAID-Pre [control group] and Pred+NSAID-Post group) vs ketorolac monotherapy (NSAID-Pre and NSAID-Post groups) vs sub-Tenon depot of dexamethasone (dropless group). Drops were used until 3 weeks postoperatively, starting 3 days preoperatively in the Pre groups and on the day of surgery in the Post groups. Aqueous flare was measured at baseline and 3 days postoperatively.

Results:
Four hundred fifty-six participants, with a mean age of 72.1 (SD 7.0) years and 283 (62%) women, were included. Flare increased significantly more in the dropless group compared with the control group (Pred+NSAID-Pre), but none of the other groups differed significantly from the control group. Intraocular pressure decreased in all groups but significantly less in groups receiving prednisolone eyedrops (Pred+NSAID-Pre and Pred+NSAID-Post groups) compared with NSAID monotherapy and dropless groups. No differences in postoperative visual acuity were found compared with the control group.

Conclusions:
No differences were found between groups randomized to NSAID monotherapy or combination of NSAID and steroid in controlling early inflammation after cataract surgery, but sub-Tenon depot of dexamethasone was less efficient. Initiating prophylactic eyedrops prior to surgery did not influence early postoperative anterior chamber inflammation.
Changing practice patterns in European cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery 2008 to 2017
Authors: Lundström Mats , Dickman Mor , Henry Ype , Manning Sonia , Rosen Paul , Tassignon Marie-José , Young David , Behndig Anders , Stenevi Ulf 
Published: October 2020

Purpose:
To study practice patterns in European cataract surgery over a 10-year period.

Setting:
European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).

Design:
Registry cohort study.

Methods:
The EUREQUO contains preoperative, intraoperative, and postoperative parameters reported by surgeons in many European clinics. All data reported to the registry are anonymized. Preoperative parameters included age, sex, visual acuity, target refraction, ocular comorbidity, and surgical difficulties. Surgical data included anesthesia, surgical technique, intraocular lens optic biomaterial, and complications. Postoperative parameters included visual acuity, refraction, and short-term complications.

Results:
During the study period (January 1, 2008, to December 31, 2017), a total of 2 714 108 cataract extractions were reported to the EUREQUO. Preoperative data changed over time, with decreases in mean age (74.5–73.0 years), proportion of women from 60.6% (100 373/165 628) to 57.2% (174 908/305 845), and proportion of coexisting eye diseases from 30.0% (49 638/165 650) to 27.0% (82 704/305 846) and with improvements in preoperative visual acuity (mean logarithm of minimum angle of resolution [logMAR] 0.46 to 0.37). The use of topical anesthesia increased over time from 28.1% (26 238/93 320) to 71.7% (130 525/182 083). Surgical complications showed a significant decrease from 2.5% (4107/165 650) to 1.2% (3573/305 846). The visual outcome improved over time (mean logMAR 0.08 to 0.05), as did the absolute median prediction error (0.38 diopter [D] to 0.28 D).

Conclusions:
Trends in European cataract surgery practice patterns from 2008 to 2017 have moved toward younger patients with better preoperative visual acuity, fewer surgical complications, and better predicted refractions and visual outcomes.
Handover From the Emergency Department to Inpatient Units
Authors: Tobiano Georgia , Ryan Christine , Jenkinson Kim , Scott Lucie , Marshall Andrea P. 
Published: October 2020

Background:
Intrahospital handovers are high risk. Standardization of content and process is recommended.

Local Problem:
Emergency department to inpatient unit handovers were inefficient.

Interventions:
The intervention was a standardized operating protocol, including checklist and procedures.

Methods:
The intervention was coproduced and prototyped. Handovers were observed for intervention adherence, and the Handover Evaluation Scale was used to measure nurses' perceived quality of handover.

Results:
The handover had 3 steps. Step 1 had more content, prompting by the receiver, and family participation postintervention. Step 3 was shorter in duration, had less content, and occurred at the bedside more postintervention. Receiving nurses were able to ask questions and found that information provided was timely, current, and easy to follow. Sending nurses perceived that handover was less succinct postimplementation, despite decreases in handover duration and repetition of information.

Conclusions:
This project has triggered ongoing improvement initiatives, necessary to keep accommodating the needs of nurses that work across boundaries.
Do Falls and Other Safety Issues Occur More Often During Handovers When Nurses Are Away From Patients? Findings From a Retrospective Study Design
Authors: Demaria Jessica , Valent Francesca , Danielis Matteo , Bellomo Fabrizio , Farneti Federico , Bressan Valentina , Palese Alvisa 
Published: October 2020

Background:
No studies have assessed the differences in the incidences of falls and other patient safety events (PSEs) during handovers performed away from patients compared with when nurses are on the unit.

Purpose:
The primary aim was to explore the incidence of falls and their severity during handovers compared with during nonhandover times; the secondary aim was to explore the occurrence of other PSEs during handover versus nonhandover times.

Methods:
This was a retrospective study of all PSEs that occurred from 2013 to 2017 in a large Italian academic trust.

Results:
There were 1966 falls and 1523 other PSEs. The incidence of falls per 100 hours was 4.9 during handovers and 4.4 during nonhandover times. The incidences of other PSEs were 2.9 and 3.5, respectively. No significant differences in fall outcome severity emerged.

Conclusions:
No differences emerged in the occurrence of falls during handovers performed away from patients and when nurses were on the unit. Other PSEs decreased in occurrence during handovers as compared with other times during the shifts.
Motor Evoked Potentials Double Train Stimulation: Optimal Number of Pulses per Train
Authors: Kale Emily B. , Lutz Michael W. , Husain Aatif M. 
Published: October 2020

Purpose:
In neurophysiologic intraoperative monitoring, double train transcranial electrical stimulation (dt-TES) for motor evoked potentials (MEP) consists of an initial, facilitating train of stimuli followed by a second, testing, train. The optimal number of pulses per train has not been determined. The authors wanted to determine the optimal combination of pulses per train that produced the highest MEP amplitude.

Methods:
Dt-TES of 4 + 4, 2 + 7, and 7 + 2 pulses were attempted in 20 patients and compared with single train TES of nine pulses. Latencies of the MEP responses were also compared. Additionally, statistical comparisons were made of the differences between the amplitude and latency measurements within the patients.

Results:
The mean age of the patients was 44.3 years (range, 9–84 years). Dt-TES of 2 + 7 pulses resulted in significantly higher mean amplitudes than dt-TES of 4 + 4 and 7 + 2 pulses and single train TES of nine pulses (p < 0.001). The MEP latency with dt-TES of 2 + 7 pulses was longer than the latencies of single train TES of nine pulses and dt-TES of 4 + 4 and 7 + 2 pulses.

Conclusions:
Asymmetric dt-TES with 2 + 7 pulses improved MEP amplitudes. This type of stimulation may be preferable to single train TES and dt-TES with symmetric pulse trains.
Is sleep apnea-hypopnea index relevant for impaired brain perfusion and desaturation in patients with severe obstructive sleep apnea syndromes?
Authors: Zhang Zhongxing , Qi Ming , Hügli Gordana , Khatami Ramin 
Published: October 2020

AbstractBackgroundObstructive sleep apnea syndrome (OSAS) is a common sleep disorder with the prevalence of 9-38% in the general population. Severe OSAS defined as apnea-hypopnea index (AHI) ≥ 30/h is a major risk factor for developing cerebro-cardiovascular diseases like stroke. Treatments such as continuous positive airway pressure (CPAP) therapy are recommended for those patients because untreated OSA can cause tremendous medical expenses and economic burden. Understanding the mechanisms of how repetitive sleep apneas/hypopneas induce changes in cerebral hemodynamics in severe OSAS is crucial for the understanding of disease severity, disease progression in brain damage and the treatment efficacy. However, these mechanisms and the association between AHI and the induced changes in cerebral hemodynamics in severe OSAS are essentially unknown. Using a stepwise incremental CPAP titration protocol we aim to identify the most relevant physiological factors including AHI and their quantitative contributions to cerebral hemodynamic changes before and during CPAP treatment in severe OSAS patients.Methods and findings29 newly diagnosed severe OSAS patients underwent incremental CPAP titration during polysomnography recordings: 1-h sleep without CPAP served as self-controlled baseline followed by stepwise increments of 1-cmH2O pressure per-hour starting from 5-8 cmH2O individually. Frequency-domain near-infrared spectroscopy measured the changes in blood volume (BV) and oxygen saturation (StO2) in the left forehead. The coefficients of variation of BV (CV-BV) and the decreases of StO2 (de-StO2) during more than 2000 respiratory events were predicted by various predictors including AHI using linear mixed-effect models, respectively. The best predictors were automatically selected by stepwise regression. Surprisingly, AHI was excluded from the final selected models. Longer events and apneas rather than hypopneas induce larger changes in CV-BV and stronger cerebral desaturation. Respiratory events occurring during higher baseline StO2 before their onsets, during rapid-eye-movement sleep and those associated with higher heart rate (HR) during the events trigger smaller changes in CV-BV and de-StO2. CPAP pressures attenuate the changes in CV-BV and de-StO2.ConclusionsIn severe OSAS the length and the type of respiratory event rather than widely used AHI may be better parameters to indicate the severity of cerebral vascular damage. Thus both, length and type of respiratory events should be considered as predictors of cerebro-cardiovascular events in future epidemiological studies and in clinical practice. OSAS patients with profound long apnea events need to pay special attention and quickly treated with CPAP therapy as it can restore the induced cerebral hemodynamic changes.
Intrinsic Signal Amplification by Type-III CRISPR-Cas Systems Provides a Sequence-Specific Viral Diagnostic
Authors: Santiago-Frangos Andrew , Hall Laina N. , Nemudraia Anna , Nemudryi Artem , Krishna Pushya , Wiegand Tanner , Wilkinson Royce A. , Snyder Deann T. , Hedges Jodi F. , Jutila Mark A. , Taylor Matthew P. , Wiedenheft Blake 
Published: October 2020

AbstractTo combat viral pandemics, there is an urgent need for inexpensive new technologies that enable fast, reliable, and scalable detection of viruses. Here we repurposed the type III CRISPR-Cas system for sensitive and sequence specific detection of SARS-CoV-2 in an assay that can be performed in one hour or less. RNA recognition by type III systems triggers Cas10-mediated polymerase activity, which simultaneously generates pyrophosphates, protons and cyclic oligonucleotides. We show that amplified products of the Cas10-polymerase are detectable using colorimetric or fluorometric readouts.