bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Multiple Comorbid Mental Health Disorders on Health-related Quality of Life Following ACDF
Authors: Mangan John J. , Tadley Madeline , Divi Srikanth N. , Stull Justin D. , Goyal Dhruv K.C. , McKenzie James C. , Casper David S. , Galetta Matthew S. , Kaye Ian D. , Kurd Mark F. , Woods Barrett I. , Radcliff Kris E. , Rihn Jeffery A. , Anderson David G. , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: March 2020

Study Design:
Retrospective comparative study.

Objective:
The goal was to determine whether comorbid depression and/or anxiety influence outcomes after anterior cervical discectomy and fusion (ACDF) for patients with degenerative cervical pathology.

Background Data:
The role preoperative mental health has on patient reported outcomes after ACDF surgery is not well understood.

Methods:
Patients undergoing elective ACDF for degenerative cervical pathology were identified. Patients were grouped based on their preoperative mental health comorbidities, including patients with no history, depression, anxiety, and those with both depression and anxiety. All preoperative medical treatment for depression and/or anxiety was identified. Outcomes including Physical Component Score (PCS-12), Mental Component Score (MCS-12), Neck Disability Index (NDI), Visual Analogue Scale neck pain score (VAS Neck ), and Visual Analogue Scale arm pain score (VAS Arm) were compared between groups from baseline to postoperative measurements using multiple linear regression analysis—controlling for factors such as age, sex, and body mass index, etc. A P-value <0.05 was considered statistically significant.

Results:
A total of 264 patients were included in the analysis, with an average age of 53 years and mean follow-up of 19.8 months (19.0–20.6). All patients with a diagnosis of depression or anxiety also reported medical treatment for the disease. The group with no depression or anxiety had significantly less baseline disability than the group with 2 mental health diagnoses, in MCS-12 (P=0.009), NDI (P<0.004), VAS Neck (P=0.003), and VAS Arm (P=0.001) scores. Linear regression analysis demonstrated that increasing occurrence of mental health disorders was not a significant predictor of change over time for any of the outcome measures included in the analysis.

Conclusions:
Despite more severe preoperative symptoms, patients with a preoperative mental health disorder(s) demonstrated significant improvement in postoperative outcomes after ACDF. No differences were identified in postoperative outcomes between each of the groups.

Level of Evidence:
Level III.
“Locking the Head Technique” For Femoral Head Removal in Intracapsular Neck Femur Fractures
Authors: Ansari Naved F. , Sonawane Dhiraj , Mehta Ajit K. , Pawar Eknath 
Published: March 2020

Background:
Intracapsular neck femur fractures are one of the most commonly operated fractures. Head excision is done with engagement of corkscrew, which is a difficult step especially in subcapital type of fractures as the head femur rotates and spins while engaging the corkscrew and slips off and thereby requiring multiple attempts for corkscrew engagement and risking the head with a cut through and damage to the head and the acetabulum. We have a simple technique which can make engaging the corkscrew in the head easier and thereby making the femoral head removal easier and safer.

Technique:
Using a 2 mm guide wire placed in the head after exposure and Locking the Head, to stabilize it before placing the corkscrew then engaging the corkscrew firmly and removing the head with crockscrew with ease.

Discussion:
Improves accuracy of corkscrew fitting in the head and retaining the contour of the head and thereby easing the removal of the head and making the technique easier.
Differences of maternal mortality rate between Shanghai and New York city from the perspective of regulatory policy
Authors: Li Li , Li Cheng-Yue , Zhou Qing-Yu , Pu Chuan , Xu Ling-Zhong , Xu Tian-Qiang , Hao Chao , Hu Zhi , Hao Mo 
Published: March 2020

Abstract

Background
Regulatory policy (RP) is known as a major factor to improve health care system performance. A significant difference in maternal mortality rates (MMRs) was observed between New York city (NYC) and Shanghai (SH), both first-class international metropolises. This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities.

Methods
Based on collection of all publicly released policy documents regarding maternal health in the two cities, we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate (RECR), departmental responsibility clarity rate (DRCR), and accountability mechanism clarity rate (AMCR), based on two characteristics of comprehensiveness and effectiveness of RPs. Pearson correlation analysis, principal component analysis, and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC.

Results
By 2017, disparities of maternal health care RP are found between SH and NYC, from the indicators of RECR (100% vs. 77.0%), DRCR (38.9% vs. 45.1%), and AMCR (29.2% vs. 22.5%). From 2006 to 2017, RECR, DRCR, and AMCR in SH have shown a higher growth of 8.7%, 53.2%, and 45.2%, compared with growth of 25.0%, 12.5%, and 2.9% in NYC. The three indicators were found all negatively correlated with MMR in SH (Coefficients = −0.831, −0.833, and −0.909, and P < 0.01), while only RECR and DRCR had negative correlation with MMR in NYC (Coefficients = −0.736 and −0.683, and P < 0.05). Linear regression showed that the principal components of the three indicators were found with significant impact on MMRs both in SH (R = 0.914, R
2 = 0.836, P < 0.001) and NYC (R = 0.854, R
2 = 0.357, P = 0.04).

Conclusion
Compared with NYC, the more comprehensive and effective maternal health care RPs in SH had a stronger impact on MMR control, which contributed to the differences between the two cities’ MMRs to some extent. The methods and indicators we adopted for assessment are reasonable and comparable.
Erythema Migrans and Interface Changes: More Than a Fortuitous Association
Authors: Tekin Burak , Song Yali , DiCostanzo Damian , Lee Bonnie A. 
Published: March 2020

Abstract:
The histology of erythema (chronicum) migrans (ECM) is classically described as a nonspecific perivascular infiltrate with a variable number of plasma cells and eosinophils. However, deviations from this pattern were described, such as focal interface changes or spongiosis, potentially posing a clinicopathological challenge. In this study, cases submitted with a serologically confirmed, clinically unequivocal, or highly suspicious diagnosis of ECM/Lyme disease between January 01, 2016, and September 01, 2018, were retrieved from the electronic database system and reviewed to delineate the histopathologic features of ECM. The series consisted of 14 cases. A superficial perivascular lymphocytic infiltrate was noted in all biopsies, accompanied by a deep and/or interstitial inflammatory infiltrate in 9 cases (64%). The inflammation ranged from relatively sparse to dense and prominent. At least focal interface changes were noted in 12 biopsies (86%). Eosinophils and plasma cells were noted in 7 (50%) and 10 (71%) cases, respectively. From a histologic standpoint, ECM is a protean entity and may manifest with a variable density of perivascular and/or interstitial lymphocytic infiltrate admixed with eosinophils and/or plasma cells and accompanied by focal interface dermatitis. Within the appropriate clinical context, ECM should be considered in the differential diagnosis of focal interface and/or sparse perivascular dermatitis.
TOPOGRAPHIC OPTICAL COHERENCE TOMOGRAPHY SEGMENTATION SHOWS LIMITED ELLIPSOID ZONE RECOVERY IN MILD HYDROXYCHLOROQUINE RETINOPATHY
Authors: de Sisternes Luis , Pham Brandon H. , Durbin Mary , Marmor Michael F. 
Published: March 2020

Purpose:
Optical coherence tomography (OCT) cross-sections have shown limited ellipsoid zone (EZ) improvement in mild hydroxychloroquine (HCQ) retinopathy within a few years after drug cessation. However, the extent, functional significance, and stability of such changes over time remain unclear.

Methods:
We created en face EZ maps using automated pixel-by-pixel segmentation for four patients with early-moderate HCQ toxicity followed for 6-8 years after drug cessation. These maps were compared with OCT cross-sections, fundus autofluorescence, and automated 10-2 visual fields.

Results:
One patient had no EZ line loss; one had stable EZ loss throughout follow-up; two showed 30 to 40% reduction in the area of loss, largely in the first 2 years. This limited recovery mostly occurred in regions where the EZ line was only thinned or fragmented; other similar areas did not improve. Fundus autofluorescence hyperfluorescence and visual fields did not show consistent correlation with topography.

Conclusion:
Anatomic EZ recovery, when present, was restricted to regions of mild damage and did not correlate with fundus autofluorescence or improvement in visual fields. Topographic mapping seemed no more sensitive locally than cross-sectional OCT but may aid detection and longitudinal follow-up of toxicity by showing early damage or changes in the macula that could be missed with individual cross-sections.
Risk assessment of dementia after hysterectomy: Analysis of 14-year data from the National Health Insurance Research Database in Taiwan
Authors: Chen Yi-Chun , Oyang Yen-Jen , Lin Tzu-Yun , Sun Wei-Zen 
Published: March 2020

Background:
Anesthesia and surgery may increase the risk of dementia in the elderly, but the higher prevalence of dementia in women and other evidence suggest that dementia risk increases in younger women undergoing hysterectomy. In this study, we assessed the risk of dementia after hysterectomy.

Methods:
Hysterectomies registered in the National Health Insurance Research Database from 2000 to 2013 were evaluated using a retrospective generational research method. Multivariate Cox regression analysis was used to assess the effect of age at surgery, anesthesia method, and surgery type on the hazard ratio (HR) for the development of dementia.

Results:
Among 280 308 patients who underwent hysterectomy, 4753 (1.7%) developed dementia. Age at surgery and anesthesia method were associated with the occurrence of dementia, independent of surgery type. Among patients 30–49 years of age, general anesthesia (GA) was associated with a higher risk of dementia than spinal anesthesia (SA). The HR for GA was 2.678 (95% confidence interval [CI] = 1.269–5.650) and the risk of dementia increased by 7.4% for every 1-year increase in age (HR = 1.074; 95% CI = 1.048–1.101). In patients >50 years of age, the HR for GA was 1.206 (95% CI = 1.057–1.376), and the risk of dementia increased by 13.0% for every 1-year increase in age (HR = 1.130; 95% CI = 1.126–1.134).

Conclusion:
The risk of dementia in women who underwent hysterectomy was significantly affected by older age at surgery, and the risk might not increase linearly with age, but show instead an S-curve with exponential increase at about 50 years of age. Although less significant, GA was associated with higher risk than SA, and the effect of the anesthesia method was greater in patients <50 years of age. In contrast, the surgical procedure used was not associated to the risk of dementia.
To Admit or Not to Admit: Emergency Department Discharges After Request for Medicine Admission
Authors: Allaudeen Nazima , Breckenridge Julia S. , Vashi Anita A. 
Published: March 2020

ABSTRACT

Background:
The decision to discharge versus admit a patient from the emergency department (ED) carries significant consequences to the patient and healthcare system.

Methods:
We evaluated all ED visits at a single facility from January 1–December 31, 2015, where the ED provider initially requested admission to medicine; however, following medicine evaluation, the patient was discharged from the ED.

Results:
8.1% of medicine referrals resulted in discharge from the ED after referral for admission. 62.6% lacked documentation by medicine or another consulting service. Patients completed clinic follow-up within 7 or 30 days, 52.8% and 76.0% respectively. Emergency department revisit rates were similar for patients not referred versus referred for admission (8.0% vs. 8.1%, 13.3% vs. 14.6%, and 29.9% vs. 28.9% at 3, 7, and 30 days, respectively p-value > .05). Hospital admission during the follow-up period was also similar for these two groups (1.8% vs. 2.8%, 3.9% vs. 5.7%, and 11.3% vs. 15.0% at 3, 7, and 30 days, respectively p-value > .05).

Conclusions:
Patients discharged from the ED after referral for medicine admission were not at significantly increased risk of subsequent ED revisit or hospital admission compared with nonreferred patients. This study illustrates the opportunity for collaboration between ED and medicine providers to refine disposition plans for patients who may fall into the “gray zone.”
Rising Incidence of Sporadic Vestibular Schwannoma: True Biological Shift Versus Simply Greater Detection
Authors: Marinelli John P. , Lohse Christine M. , Grossardt Brandon R. , Lane John I. , Carlson Matthew L. 
Published: March 2020

Objective:
The incidence of sporadic vestibular schwannoma (VS) has increased significantly over recent decades. The rising incidence of VS has been largely attributed to the increasing use of magnetic resonance imaging (MRI), especially with regard to incidentally diagnosed tumors. However, no study to date has directly investigated this supposed etiology beyond the observation that VS incidence rates have risen in the post-MRI era. Therefore, the primary objective of the current study was to characterize the incidence of head MRIs over the previous two decades in Olmsted County, Minnesota and compare this trend to the incidence of asymptomatic, incidentally diagnosed VS over the same time period.

Study Design:
Population-based incidence study.

Setting/Patients:
Using the unique resources of the Rochester Epidemiology Project, procedure codes for head MRIs and diagnostic codes for VS among residents of Olmsted County, Minnesota between Jan 1, 1995 and Dec 31, 2016 were retrieved. Incidence rates of head MRI and incidentally diagnosed VS were calculated on a per-year basis.

Results:
A total of 43,561 head MRIs among 30,002 distinct persons were identified from 1995 to 2016. The incidence of head MRI significantly increased between 1995 and 2003 (p < 0.001), but remained stable between 2004 and 2016 (p = 0.14). Over the same time interval, 25 cases of incidentally diagnosed VS were identified. The incidence of asymptomatic VS increased over time from 0.72 per 100,000 person-years between 1995 and 1999 to 1.29 between 2012 and 2016 (p = 0.058). No plateauing of incidence rates was observed in incidental tumors over the study period. The size of incidentally diagnosed tumors did not change over the study period (p = 0.93), suggesting that the increasing incidence of asymptomatic tumors is not explained by improved diagnostic capability of more recent MRI studies.

Conclusions:
Despite the plateauing of head MRI incidence rates after 2004, the incidence of asymptotic, incidentally diagnosed VS continued to increase. Our findings suggest that there may be additional contributory etiologies for the rising incidence of VS beyond greater detection alone.
EUS-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE)
Authors: Tyberg Amy , Kedia Prashant , Tawadros Augustine , Tarnasky Paul R. , Gaidhane Monica , Nieto Jose , Kahaleh Michel 
Published: March 2020

Introduction:
Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) is a minimally invasive option for pancreaticobiliary access in patients with Roux-en-Y anatomy. The procedure involves creating a fistulous tract between the remnant stomach or jejunum and the bypassed stomach with the deployment of a lumen-apposing metal stent (LAMS), followed by the advancement of an endoscope through the LAMS to perform an ERCP or EUS. It is a technically challenging procedure, requiring skills in EUS, fluoroscopy, and LAMS deployment. The aim of this study was to determine the learning curve for EDGE.

Methods:
Consecutive patients undergoing EDGE by a single operator were included from a prospective registry over 3 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum analyses were conducted for the learning curve. Technical success was defined as the successful creation of the fistulous tract. Clinical success was defined as successful EUS or ERCP via the LAMS.

Results:
Nineteen patients were included (21% male, mean age 58.7 y). Indication included symptomatic biliary stricture (n=6, 32%), choledocholithiasis (n=5, 26%), pancreatitis (n=3, 16%). Technical success was 100%. All patients had a 15 mm LAMS placed, 3 (16%) had cautery-enhanced LAMS. Clinical success was achieved in 18/19 (95%) patients. Fourteen patients had an ERCP, 1 patient had a EUS, and 3 patients had both. Adverse events included 2 cases of bleeding, 1 case of post-ERCP pancreatitis, and 1 jejunal perforation during duodenoscope insertion managed endoscopically.
Median procedure time was 54.5 minutes (range: 31 to 88 min). Cumulative sum chart shows a 54-minute procedure time was achieved at the ninth procedure hence indicating efficiency. Apart from 2 outliers, the procedure duration further reduced with consequent procedures with the last 3 being under 40 minutes indicating that after 25 to 35 procedures a plateau may be reached indicating mastery (nonlinear regression P<0.0001).

Conclusions:
Endoscopists experienced in EDGE are expected to achieve a reduction in procedure time over successive cases, with efficiency reached 54.5 minutes and a learning rate of 9 cases. After 25 to 35 procedures, a plateau may be reached indicating mastery.
Transmission of respiratory tract infections at mass gathering events
Authors: Petersen Eskild , Memish Ziad A. , Zumla Alimuddin , Maani Amal Al 
Published: March 2020

Purpose of reviewMass gathering events bring people from across all continents increasing the risk of spread of aerosol transmissible respiratory tract infections. Respiratory tract infections for instance in pilgrims attending the world's largest recurring annual pilgrimage, the Hajj are common. We review recent literature on viral and bacterial infectious diseases with special focus on the Hajj.Recent findingsThe prevalence of bacterial and viral infections continue to increase, because of the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1,Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureusduring Hajj. Whilst MERS-CoV continues to circulate in the Middle East, no cases of MERS-CoV have yet been identified in pilgrims during Hajj.SummaryRespiratory tract infections are a major cause of morbidity in pilgrims attending mass gathering events. The management of severe respiratory infections should consider investigation and empirical coverage for the most likely agents based on syndromic surveillance data from hosting country and /or other relevant exposure history during events. Pneumococcal and Pertussis vaccines should be recommended for Hajj pilgrims.
Cutaneous nontuberculous mycobacterial infection in Thailand
Authors: Chirasuthat Phatcharawat , Triyangkulsri Korn , Rutnin Suthinee , Chanprapaph Kumutnart , Vachiramon Vasanop 
Published: March 2020

Abstract
A remarkable increase in the prevalence of cutaneous nontuberculous mycobacterial (NTM) infection has occurred worldwide. However, updated data regarding cutaneous NTM infection in Thailand is limited.
This study aim to describe the clinical manifestations, pathogenic organism, and prognostic factors of cutaneous NTM infections among patients living in Thailand.
The electronic medical records of all patients with confirmatory diagnosis of cutaneous NTM infection from either positive cultures or polymerase chain reaction were retrospectively reviewed at a university-based hospital.
From 2011 to 2017, a total of 88 patients with a confirmed diagnosis of cutaneous NTM infection were included. Mycobacterium abscessus was the most common pathogens followed by M haemophilum and M marinum (61.4%, 10.2%, and 8.1%, respectively). Nodule and plaque were 2 most common lesions (26.4% and 25.5%, respectively) and lower leg is the most common site of involvement (50.9%). The majority of patients presented with single lesion (67%). Seven patients (7.9%) had history of surgical procedure and/or cosmetic injection before the development of lesion and all pathogenic organisms in this group were rapidly growing mycobacteria. Sweet's syndrome and erythema nodosum were the 2 most common reactive dermatoses, presented in 3.4% and 2.3%, respectively. The majority of patients infected with cutaneous M haemophilum infections were immunocompromised and lacked history of preceding trauma (77.8%). Patients with cutaneous NTM that receiving less than 3 medications was associated with higher disease relapse (odds ratio 65.86; P = .02).

M abscessus is the most common pathogen of cutaneous NTM infection in Thailand. The prevalence of M haemophilum is increasing and should be particularly cautious in immunocompromised patients. Rapidly growing mycobacteria should be suspected in all cases of procedure-related cutaneous NTM. We recommend at least 3 antibiotics should be considered for cutaneous NTM infection to reduce the rate of relapse.
Association of polymorphisms of preptin, irisin and adropin genes with susceptibility to coronary artery disease and hypertension
Authors: Wang Haidong , Wang Xiaojing , Cao Yuan , Han Wenxiu , Guo Yujin , Yang Guangsheng , Zhang Jun , Jiang Pei 
Published: March 2020

Abstract

Objectives:
Preptin, irisin and adropin are 3 new players in energy regulation that are related body mass index, lipids, glucose and insulin levels which may affect incidence of cardiovascular diseases. The aim of the present study was to evaluate eight single nucleotide polymorphisms (SNPs) of preptin genes (rs1003483, rs1004446, rs2239681, rs680, and rs3741204), irisin (rs16835198 and rs3480) and adropin (rs2281997) gene in patients with coronary artery disease (CAD) and hypertension.

Methods:
This case-control study was carried out on 372 volunteers, which were divided into 3 subgroups including: CAD patients with hypertension (CAD+H+), CAD patients with no hypertension (CAD+H-), and non-hypertensive non-CAD subjects as control group (CAD-H-) as health control. Genomic DNA from whole blood was extracted and eight SNPs were assessed using polymerase chain reaction- ligase detection reaction method.

Results:
A significant difference was found in the genotype and allele frequency of preptin rs1003483 gene in CAD+H+ compared to CAD+H- groups (P = .019 and P = .018, respectively). Allele frequency of rs1003483 was significantly different between CAD+H- groups and healthy control groups (P = .043). There also existed a significant difference the genotype frequency of rs1004446 gene in CAD+H+ compared to CAD+H- groups (P = .027).

Conclusions:
The findings of present study revealed that the preptin rs1003483 and rs1004446 gene polymorphism might serve as predisposing factor in CAD and hypertension.