bluuebunny/crossref_metadata_2025_split huggingface dataset:
Familial Predisposition and Differences in Radiographic Patterns in Spontaneous Nonaneurysmal Subarachnoid Hemorrhage
Authors: Lai Pui Man Rosalind , Ng Isaac , Gormley William B , Patel Nirav J , Frerichs Kai U , Aziz-Sultan M Ali , Du Rose 
Published: August 2020

Abstract

BACKGROUND
Subarachnoid hemorrhage (SAH) from an intracranial aneurysmal rupture is the most common nontraumatic etiology for SAH, but up to 15% of patients with SAH have no identifiable source.

OBJECTIVE
To assess familial predisposition to spontaneous nonaneurysmal SAH (naSAH) and to evaluate whether family history affects the severity of presentation and prognosis of this condition.

METHODS
We conducted a retrospective analysis of all spontaneous SAH with negative digital subtraction angiography from 2004 to 2018. Patients were divided into 2 groups: patients with first- or second-degree relatives with intracranial aneurysms and patients with no family history. Univariate and multivariate regression analyses were used to study patient presentation, radiographic patterns of hemorrhage, and clinical outcome.

RESULTS
A total of 100 patients met the inclusion criteria. There were no individuals with family history of naSAH. A total of 15 patients (15%) had at least one family member with an intracranial aneurysm, of which 12 (12%) presented as SAH. Patients without family history had a higher percentage of perimesencephalic presentation, whereas those with family history had a higher percentage of nonperimesencephalic SAH presentation (47% vs 13%, odds ratio [OR] 0.17 [95% CI 0.04, 0.81]).

CONCLUSION
We found a high rate of family history of intracranial aneurysms in patients who presented with naSAH. Although there was no difference in clinical outcome in patients with and without family history, there appears to be a higher percentage of nonperimesencephalic radiographic patterns of SAH in those with family history, suggesting possible different etiologies of these hemorrhages.
Enhanced Recovery After Surgery Reduces Postoperative Opioid Use and 90-Day Readmission Rates After Open Thoracolumbar Fusion for Adult Degenerative Deformity
Authors: Adeyemo Emmanuel A , Aoun Salah G , Barrie Umaru , Nguyen Madelina L , Badejo Olatunde , Pernik Mark N , Christian Zachary , Dosselman Luke J , El Ahmadieh Tarek Y , Hall Kristen , Reyes Valery Peinado , McDonagh David L , Bagley Carlos A 
Published: August 2020

Abstract

BACKGROUND
The role of enhanced recovery after surgery (ERAS) pathways implementation has not been previously explored in adult deformity patients.

OBJECTIVE
To determine the impact of ERAS pathways implementation in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis on postoperative outcome, opioid consumption, and unplanned readmission rates.

METHODS
In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Primary outcomes consisted of postoperative supplementary opioid consumption in morphine equivalent dose (MED), postoperative complications, and readmission rates within the postoperative 90-d window.

RESULTS
There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 yr. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05 vs 314.05 MED, P = .04), a lower rate of urinary retention requiring catheterization (5.97% vs 19.3%, P = .024) and of severe constipation (1.49% vs 31.57%, P < .0001), and fewer readmissions after their surgery (2.98% vs 28.07%, P = .0001).

CONCLUSION
A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 90-d readmissions in the elderly adult population.
Development of a Complication- and Treatment-Aware Prediction Model for Favorable Functional Outcome in Aneurysmal Subarachnoid Hemorrhage Based on Machine Learning
Authors: Maldaner Nicolai , Zeitlberger Anna M , Sosnova Marketa , Goldberg Johannes , Fung Christian , Bervini David , May Adrien , Bijlenga Philippe , Schaller Karl , Roethlisberger Michel , Rychen Jonathan , Zumofen Daniel W , D’Alonzo Donato , Marbacher Serge , Fandino Javier , Daniel Roy Thomas , Burkhardt Jan-Karl , Chiappini Alessio , Robert Thomas , Schatlo Bawarjan , Schmid Josef , Maduri Rodolfo , Staartjes Victor E , Seule Martin A , Weyerbrock Astrid , Serra Carlo , Stienen Martin Nikolaus , Bozinov Oliver , Regli Luca ,   on behalf of the Swiss SOS study group
Published: August 2020

Abstract

BACKGROUND
Current prognostic tools in aneurysmal subarachnoid hemorrhage (aSAH) are constrained by being primarily based on patient and disease characteristics on admission.

OBJECTIVE
To develop and validate a complication- and treatment-aware outcome prediction tool in aSAH.

METHODS
This cohort study included data from an ongoing prospective nationwide multicenter registry on all aSAH patients in Switzerland (Swiss SOS [Swiss Study on aSAH]; 2009-2015). We trained supervised machine learning algorithms to predict a binary outcome at discharge (modified Rankin scale [mRS] ≤ 3: favorable; mRS 4-6: unfavorable). Clinical and radiological variables on admission (“Early” Model) as well as additional variables regarding secondary complications and disease management (“Late” Model) were used. Performance of both models was assessed by classification performance metrics on an out-of-sample test dataset.

RESULTS
Favorable functional outcome at discharge was observed in 1156 (62.0%) of 1866 patients. Both models scored a high accuracy of 75% to 76% on the test set. The “Late” outcome model outperformed the “Early” model with an area under the receiver operator characteristics curve (AUC) of 0.85 vs 0.79, corresponding to a specificity of 0.81 vs 0.70 and a sensitivity of 0.71 vs 0.79, respectively.

CONCLUSION
Both machine learning models show good discrimination and calibration confirmed on application to an internal test dataset of patients with a wide range of disease severity treated in different institutions within a nationwide registry. Our study indicates that the inclusion of variables reflecting the clinical course of the patient may lead to outcome predictions with superior predictive power compared to a model based on admission data only.
Median Effective Dose of Lidocaine for the Prevention of Pain Caused by the Injection of Propofol Formulated with Medium- and Long-Chain Triglycerides Based on Lean Body Weight
Authors: Tian, Shunping , Zhang Dongsheng , Zhou, Wei , Tan, Chao , Shan, Qing , Ma, Rongrong , Xing, Zhi , Sui, Wei , Zhang Zhuan 
Published: August 2020

Abstract

Objective
To determine the median effective dose (ED50) of prophylactic intravenous lidocaine for the prevention of propofol medium-chain triglyceride/long-chain triglyceride (MCT/LCT) emulsion injection pain.

Design
Prospective trial, Dixon up-and-down sequential method.

Setting
Operating room of a single hospital.

Patients
Thirty patients aged 18–65 years with American Society of Anesthesiologists (ASA) status I or II who were scheduled for elective surgery under general anesthesia (GA) were included.

Interventions
The initial dose of prophylactic lidocaine before propofol MCT/LCT emulsion injection was set at 0.5 mg/kg lean body weight (LBW). The lidocaine dose was adjusted according to the degree of patients’ injection pain using the Dixon up-and-down sequential method.

Measurements
The ED50 and 95% confidence intervals (CIs) of lidocaine were calculated using the Dixon–Massey formula. Vital signs and adverse effects were recorded. In the postanesthesia care unit (PACU), patients were asked if they recalled feeling any injection pain with visual analog scale (VAS) evaluation.

Results
The ED50 of lidocaine for the prevention of propofol MCT/LCT emulsion injection pain was 0.306 mg/kg LBW (95% CI, 0.262–0.357 mg/kg LBW). No adverse reactions to lidocaine occurred. In the PACU, 90.9% of patients who experienced injection pain recalled this pain (VAS score, 2.8±1.8).

Conclusions
Prophylactic intravenous lidocaine (0.306 mg/kg LBW) effectively prevented propofol MCT/LCT emulsion injection pain in 50% of patients scheduled for elective surgery under GA with no adverse reaction occurring.
A syncing feeling: reductions in physiological arousal in response to observed social synchrony
Authors: Kragness Haley E , Cirelli Laura K 
Published: August 2020

Abstract
Synchronized movements are often key elements in activities where social bonding and emotional connection are a shared goal, such as religious gatherings, sporting events, parties and weddings. Previous studies have shown that synchronous movements enhance prosocial attitudes and affiliative behaviors. Similarly, observers attribute more social closeness to people moving synchronously together than people moving asynchronously. The mechanisms by which synchrony modulates these attributions are not well understood. In the present study, we ask whether viewing synchronous activities influences physiological arousal as measured by skin conductance and whether group size impacts this effect. Undergraduates viewed a series of short videos depicting people moving either (1) in or out of synchrony with each other and (2) in a large or small group. Participants’ skin conductance was measured. Change in skin conductance levels and response counts were attenuated while watching synchronous movement, but only in the large-group condition. Post-hoc analyses suggest that viewer enjoyment/interest in the large-group synchronous videos mediated this association for phasic skin conductance responses, but no evidence of mediation was found for tonic skin conductance levels. Results extend previous research on affiliative effects of first-person interpersonal synchrony and demonstrate that watching others moving synchronously has an attenuating effect on observers’ physiological state.
Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis
Authors: Conneely Maev , McNamee Philip , Gupta Veenu , Richardson John , Priebe Stefan , Jones Janelle M , Giacco Domenico 
Published: August 2020

AbstractBackground and ObjectiveExperiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature.MethodsElectronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis.ResultsOf 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss.ConclusionsOur conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.
Medications for Opioid use Disorder Associated With Less Against Medical Advice Discharge Among Persons Who Inject Drugs Hospitalized With an Invasive Infection
Authors: Nolan Nathanial S. , Marks Laura R. , Liang Stephen Y. , Durkin Michael J. 
Published: August 2020

Objectives:
To identify the incidence, characteristics, and factors associated with against medical advice (AMA) discharge among hospitalized patients with opioid use disorder (OUD) and injection related infections (eg, endocarditis, osteomyelitis, epidural abscesses).

Methods:
This retrospective cohort study evaluated adults with OUD admitted to an academic medical center from January 1, 2016 to January 7, 2019 for an invasive injection related infection. Multivariable logistic regression was used to determine independent factors associated with AMA discharge.

Results:
Among 262 adults admitted with serious injection related infections and comorbid OUD, 138 received inpatient medications for opioid use disorder (MOUD). Univariate analysis showed a decreased odds ratio (OR) of AMA discharge when patients received MOUD inpatient (OR 0.55; 95% CI 0.34–0.91.). Adjusting for covariates associated with social determinants of health and other substance use, inpatient receipt of MOUD was associated with a decreased risk of AMA discharge (adjusted OR 0.49; 95% CI 0.028–0.84).

Conclusions:
Among patients with OUD and serious injection related infections, inpatient initiation of MOUD is associated with decreased risk of AMA discharge.
Severe Hip Dysplasia in Skeletally Mature Patients With Spastic Cerebral Palsy: The Technique and Early Outcome of Comprehensive Surgical Correction (Including the Bernese PAO)
Authors: Miller Mark L. , Clohisy John C. , Pashos Gail E. , Berglund Lisa M. , Schoenecker Perry L. 
Published: August 2020

Background:
Treatment of symptomatic hip dysplasia in skeletally mature patients with spastic cerebral palsy (CP) can be challenging. This study examines our technical experience with the Bernese periacetabular osteotomy (PAO) in combination with adjunctive procedures in the treatment of this complex hip deformity.

Methods:
Sixteen consecutive patients (18 hips) with symptomatic CP hip dysplasia were treated with a PAO and variable adjunctive procedures and retrospectively reviewed. Two patient (2 hips) were excluded due to insufficient follow-up. The average age at the time of surgery was 17.7 years (range: 13 to 28 y). We compared the preoperative to postoperative changes in radiographic parameters as well as early outcomes as measured by patient assessment of hip pain and function using the modified Harris Hip Score (mHHS).

Results:
The average time of follow-up was 3.3 years (range: 2.0 to 6.3 y). Tönnis angles decreased from a median of 30 degrees (range: 18 to 45 degrees) preoperatively to a median of 6 degrees (range: −9 to 21 degrees) postoperatively. Lateral center-edge angles increased from a median of −8 degrees (range: −28 to 15 degrees) to a median of 32 degrees (range: 19 to 38 degrees). Anterior center-edge angles increased from a median of 2 degrees (range: −22 to 39 degrees) to a median of 35 degrees (range: 22 to 47 degrees). The extrusion index decreased from a median of 57% preoperatively (range: 35% to 73%) to a median of 21% (range: 11% to 36%) postoperatively.
The median mHHS was 62 (range: 37 to 81) preoperatively and 85 (range: 65 to 100) postoperatively. Notably, the pain component of the mHHS improved from 20 (range: 0 to 44) to 42 (range: 30 to 44). Tönnis osteoarthritis grade preoperatively was either 0 (11 hips) or 1 (5 hips) and remained unchanged in 11 hips and increased by 1 grade in 5 hips.

Conclusions:
It has been our experience that the Bernese PAO in combination with appropriate adjunctive treatments has provided a very satisfactory surgical approach in the treatment of CP hip dysplasia. In the adolescent and young adult with spastic CP, utilizing the Bernese PAO technique makes it possible to obtain redirection of often a very severe acetabular dysplasia. Adjunctive soft tissue procedures and a proximal femoral osteotomy are frequently necessary to maintain postoperative stability. A notable improvement in the quality of life and function directly attributable to our surgical treatment of their pre-existing problematic hip dysplasia has been consistently noted in early follow-up for our patients.

Level of Evidence:
Level IV—therapeutic.
The Frequency of Mediastinal Injury in Acute Posterior Sternoclavicular Dislocations: A Multicenter Study
Authors: Fournier Matthew N. , Sinclair Mark R. , Zheng Evan T. , Spiegel David A. , Johnson Anna L. , Shah Apurva S. , Riccio Anthony I. , Elliott Marilyn E. , Bae Donald S. , Sawyer Jeffrey R. 
Published: August 2020

Background:
Acute posterior sternoclavicular dislocations (APSCD) are rare injuries that historically have prompted concern for injury to the great vessels and other mediastinal structures from initial trauma or subsequent treatment, resulting in the recommendation that a thoracic or vascular surgeon be present or available during operative treatment. The objectives of the study were to characterize the demographic, clinical, and radiographic characteristics of a large series of APSCDs in skeletally immature patients and to describe the rate and nature of any vascular or mediastinal complications that occurred during treatment.

Methods:
Following Institutional Review Board approval, records of consecutive patients under 25 years of age treated for APSCD were collected from each of 6 participating centers. Only acute injuries (sustained fewer than 10 days before presentation) were included. Patient demographics, injury mechanism, associated mediastinal injuries, and need for thoracic/vascular surgery were recorded. Mediastinal structures injured or compressed by mass effect were specifically characterized by review of preoperative computed tomography imaging.

Results:
Review identified 125 patients with a mean age of 14.7 years; 88% were male. APSCD most commonly resulted from a sporting injury (74%) followed by falls from standing height (10%) and high-energy motor vehicle trauma (10%). The most common finding on cross-sectional imaging was compression without laceration of the ipsilateral brachiocephalic vein (50%). Eleven patients had successful closed reduction, and 114 (90%) had open reduction and internal fixation, with 25 failed or unstable closed reductions preceding open treatment. There were no vascular or mediastinal injuries during reduction or fixation that required intervention.

Conclusions:
In this multicenter series of 125 APSCDs no injuries to the great vessels/mediastinal structures requiring intervention were identified. Although more than half of patients had evidence of extrinsic vascular compression at the time of injury, careful open reduction of acute injuries can be safely performed. Although vascular injuries following APSCD seem to be quite rare, vascular complications can be catastrophic. Treating providers should consider these data and their own institutional resources to maximize patient safety during the treatment of APSCD.

Level of Evidence:
Level III—therapeutic case control study.
An Updated Analysis of the Pediatric Section of the Orthopaedic In-Training Examination
Authors: Ellsworth Bridget K. , Premkumar Ajay , Shen Tony , Lebrun Drake G. , Cross Michael B. , Widmann Roger F. 
Published: August 2020

Background:
An updated analysis of the pediatrics section of the Orthopaedic In-Training Examination (OITE) is helpful for resident education and preparation for the OITE. The purpose of this study is to provide an updated evaluation of the pediatric category of the OITE, and to explore trends in question topics and taxonomy compared with the previously published analysis from 2011 to 2014.

Methods:
Five years (2015-2019) of OITE questions, answers, and references were reviewed. The number of pediatric questions per year was recorded, and questions were subcategorized based on topic tested. The presence or absence of imaging or a clinical photograph was noted. Each question was also assigned a cognitive taxonomy level, based on a previously published classification system.

Results:
The percentage of pediatric questions on the 2015-2019 OITEs averaged 11.4% compared with 12.6% from 2011 to 2014 (P=0.349). The 3 most commonly tested pediatric topics were general trauma (17.8%), elbow trauma (13.2%), and genetic disorders/syndromes (11.2%). There was a significant increase in questions that required diagnosis and interpretation (27.6% vs. 8%, P<0.001) and a slight but not significant decrease in the questions requiring simple knowledge recall (26.3% vs. 35.5%, P=0.120) and decisions about management (46.1% vs. 56.5%, P=0.077). Overall, 65% of questions utilized clinical photographs or imaging studies compared with 62% from 2011 to 2014 (P=0.621). The most common references were the Journal of Pediatric Orthopaedics, Journal of American Academy of Orthopaedic Surgeons, and Journal of Bone and Joint Surgery. Textbooks were cited less frequently than in the past.

Conclusions:
While the percentage of pediatric questions on the OITE has remained consistent over time, the percentage of questions requiring diagnosis and interpretation has increased. In addition, questions testing genetic disorders/syndromes have become more prevalent in recent years. The most commonly cited resources were high-impact journal articles, with textbooks cited less frequently than in previous years.

Clinical Relevance:
Knowledge of the most frequently tested topics and resources cited may assist orthopaedic residents in preparing for the OITE and orthopaedic faculty to focus didactic sessions on the most commonly tested topics.
Patella Alta in Ambulatory Children With Cerebral Palsy: Prevalence and Functional Significance
Authors: Davids Jon R. , Kulkarni Vedant A. , Bagley Anita M. , Cung Nina Q. , Davis Roy B. , Westberry David E. , Carpenter Ashley 
Published: August 2020

Background:
Gait dysfunction associated with patella alta (PA) in subjects with cerebral palsy (CP) has been presumed but not objectively established clinically or through biomechanical modeling. It is hypothesized that PA is associated with increasing level of motor impairment, increasing age, obesity, and worse stance phase knee kinematics and kinetics in children with CP.

Methods:
Retrospective case series of 297 subjects with CP studied in our Motion Analysis Center. Data analyzed included patient demographics (age, body mass index, CP classification), patella height (Koshino-Sugimoto Index), and knee kinematics and kinetics.

Results:
PA was present in 180 of 297 subjects (61%), in 68 of the 146 (47%) with unilateral CP, and 112 of 151 subjects (74%) with bilateral CP. For unilateral CP, the prevalence of PA was not significantly different between Gross Motor Function Classification System (GMFCS) I and II (P=0.357). For bilateral CP, the prevalence of PA in GMFCS III was significantly greater than in GMFCS I and II (P=0.02). Regression analysis showed a significant trend between increasing age and PA in unilateral and bilateral groups (P<0.001 and 0.001, respectively). The prevalence of PA was not significantly different across body mass index categories for either unilateral or bilateral groups. There were only 2 of 10 significant correlations between PA and gait parameters for subjects with unilateral CP functioning at the GMFCS I and II levels. There were 8 of 12 significant correlations between PA and gait parameters for subjects with bilateral CP functioning at the GMFCS I, II, and III levels.

Conclusions:
PA is common in ambulatory children with CP across topographic types and motor functional levels. PA is well tolerated with respect to gait dysfunction in unilateral CP, but may contribute to crouch gait in bilateral CP. Gait dysfunction cannot be inferred from the radiographic assessment of patellar height, and radiographic evidence of PA by itself does not justify surgical correction with patellar tendon advancement or shortening.

Level of Evidence:
Level III—prognostic, retrospective series.