bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric tibial shaft fracture with ipsilateral intraarticular distal tibial fracture: A cross sectional study of impact on management and outcomes
Authors: Hill Nina E. , Klingele Kevin E. , Samora Julie Balch 
Published: November 2019

Background:
Tibial fractures are common in a pediatric population. However, this study describes a more complicated fracture pattern that has been infrequently defined in the pediatric orthopaedic literature: tibial shaft fractures with an ipsilateral intraarticular distal tibial fracture.

Methods:
One hundred and ninety patients at a large pediatric tertiary care hospital from 2006-2016 were included in this retrospective chart review, as identified by eligible Current Procedural Terminology (CPT) codes. Variables assessed included patient demographics, injury characteristics, follow-up time, weight bearing, and immobilization. Complications and secondary treatments were recorded when present.

Results:
Of 190 patients included in the study, 16 were identified with an ipsilateral tibial shaft and ankle fracture pattern. The mean age of patients with the combined fracture pattern was 15.3 yr, compared to 12.3 yr for patients who only had a tibial shaft fracture. Additionally, immobilization was employed in patients with combined fractures for 12.3 wk, significantly longer than with isolated shaft fracture (9.0 wk). The mechanism of injury for the combined shaft and ankle fractures was more likely to be described as “twisting,” compared to the isolated shaft fractures. Despite the risk of complications with fracture communication into the articular surface, patients with shaft and ankle fractures had excellent outcomes.

Conclusions:
We describe tibial shaft fractures with an ipsilateral intraarticular distal tibial fracture, an injury pattern that has not been well characterized in the literature. Patient characteristics (age, mechanism of injury) may contribute to development of this injury, and these patients may require different management than those with isolated tibial shaft fractures.

Level of Evidence:
Level IV.
Does certificate-of-need status impact lumbar microdecompression reimbursement and utilization? A retrospective database review
Authors: Ziino Chason , Bala Abiram , Cheng Ivan 
Published: November 2019

Background:
Lumbar microdecompression remains an effective, highly utilized procedure. Changes in reimbursement and practice patterns have pushed for decreased costs and increased outpatient surgery. Certificate of Need (CON) programs were established in response to skyrocketing healthcare costs, although their impact on spine surgery utilization and reimbursement is not well studied. This study sought to examine the effect of CON status on utilization and reimbursement of single-level lumbar microdecompressions in both inpatient and outpatient settings.

Methods:
We analyzed a combined private payer and Medicare administrative claims dataset from 2007 to 2015. All single-level lumbar microdecompressions were divided into CON and non-CON states. We further split each group into inpatient and outpatient. Reimbursement and utilization trends were analyzed using the compound annual growth rate (CAGR). Reimbursement trends were inflation-adjusted by using the US Bureau of Labor Statistics Consumer Price Index (CPI).

Results:
A total of 58,497 single-level lumbar decompressions were identified, with 42,595 performed in the inpatient setting and 15,902 in the outpatient setting. Utilization rates increased across all settings, but the highest growth was seen in the outpatient setting for CON states (CAGR 32.2%), with the lowest growth seen in the inpatient setting in non-CON states (12.9%). Reimbursement decreased in the inpatient setting (−4.9% CON, −4.3% non-CON), although it increased in both outpatient settings (4.4% CON, 3.4% non-CON). Non-CON outpatient had the highest average reimbursement at $2915, while non-CON inpatient reimbursement was the lowest at $812.

Conclusions:
Lumbar decompression utilization is increasing, but reimbursement in the inpatient setting is decreasing regardless of CON status. Both are increasing in the outpatient setting. CON states had higher utilization increases than non-CON states. There was no correlation with CON status and overall reimbursement. Surgeons should be aware of these trends in a value-based healthcare environment.

Level of Evidence:
Level III.
Cyclops lesions after ACL reconstruction using either bone-tendon-bone autograft or hamstring autograft: A retrospective cohort study
Authors: Pharr Zachary K. , Mascioli Anthony A. , Dickerson Andrew B. , Throckmorton Thomas W. , Azar Frederick M. 
Published: November 2019

Background:
ACL reconstruction is commonly performed with either bone-patellar tendon-bone (BPTB) autograft or hamstring autograft, each of which has inherent advantages and disadvantages; to our knowledge, no study has compared the frequency of cyclops lesions between the two autografts. By focusing on cyclops lesions, a source of knee extension loss after ACL reconstruction, we aimed to expand the comparison between these two autograft options.

Methods:
A single-center, retrospective chart review identified 1,902 patients between the ages of 8 and 66 yr who had ACL reconstruction between January 1, 2000, and October 31, 2015. Of these, 1534 received a BPTB autograft and 368 a hamstring autograft. Cyclops lesions were confirmed by a second arthroscopy in patients treated for loss of full knee extension, and the occurrences with BPTB and hamstring autograft were compared.

Results:
Cyclops lesions occurred in 14 (0.91%) of 1,534 reconstructions with BPTB autografts and five (1.35%) of 368 with hamstring autografts (P=0.39); this difference was not statistically significant. Cyclops lesions occurred in five (0.44%) of 1125 males and 14 (1.44%) of 777 females (P=0.004). This was statistically significant, illustrating a more frequent occurrence of cyclops lesions in female patients than in male patients with a relative risk of 4 (CI 1.4-11).

Conclusions:
Bone-patellar tendon-bone and hamstring autografts both are viable options for ACL reconstruction. The occurrence of cyclops lesions is a potential complication that has not been previously compared between these two graft options. We found no statistically significant difference in the frequency of cyclops lesions between the two groups, minimizing any concern for an increased risk of a cyclops lesion when choosing BPTB autograft or hamstring autograft. Surgeons should be cognizant that the relative risk of a cyclops lesion is four times higher in female patients than in male patients with either graft.

Level of Evidence:
Level III.
Corticosteroids as Adjunctive Therapy in the Treatment of Influenza: An Updated Cochrane Systematic Review and Meta-analysis
Authors: Lansbury Louise E. , Rodrigo Chamira , Leonardi-Bee Jo , Nguyen-Van-Tam Jonathan , Shen Lim Wei 
Published: November 2019

Objectives:
Corticosteroids may be beneficial in sepsis, but uncertainty remains over their effects in severe influenza. This systematic review updates the current evidence regarding corticosteroids in the treatment of influenza and examines the effect of dose on outcome.

Data Sources:
Electronic databases (MEDLINE, EMBASE, CINAHL, LILACS, CENTRAL, and Web of Science) and trial registries were searched to October 2018 for randomized controlled trials, quasi-experimental designs, and observational cohort studies reporting corticosteroid versus no corticosteroid treatment in individuals with influenza.

Study Selection and Data Extraction:
Two researchers independently assessed studies for inclusion. Risk of bias was assessed using the Cochrane Risk of Bias tool (randomized controlled trials) or Newcastle-Ottawa Scale (observational studies). Where appropriate, we estimated the effect of corticosteroids by random-effects meta-analyses using the generic inverse variance method. Meta–regression analysis was used to assess the association of corticosteroid dose and mortality.

Data Synthesis:
We identified 30 eligible studies, all observational apart from one randomized controlled trial. Twenty-one observational studies were included in the meta-analysis of mortality, which suggested an adverse association with corticosteroid therapy (odds ratio, 3.90; 95% CI, 2.31–6.60; 15 studies; adjusted hazard ratio, 1.49; 95% CI, 1.09–2.02; six studies). Risk of bias assessment was consistent with potential confounding by indication. Pooled analysis of seven studies showed increased odds of hospital-acquired infection in people treated with corticosteroids (unadjusted odds ratio, 2.74; 95% CI, 1.51–4.95). Meta-regression of the effect of dose on mortality did not reveal an association, but reported doses of corticosteroids in included studies were high (mostly > 40 mg methylprednisolone [or equivalent] per day).

Conclusions:
Corticosteroid treatment in influenza is associated with increased mortality and hospital-acquired infection, but the evidence relates mainly to high corticosteroid doses and is of low quality with potential confounding by indication a major concern.
Alive and Ventilator Free: A Hierarchical, Composite Outcome for Clinical Trials in the Acute Respiratory Distress Syndrome*
Authors: Novack Victor , Beitler Jeremy R. , Yitshak-Sade Maayan , Thompson B. Taylor , Schoenfeld David A. , Rubenfeld Gordon , Talmor Daniel , Brown Samuel M. 
Published: November 2019

Objectives:
Survival from acute respiratory distress syndrome is improving, and outcomes beyond mortality may be important for testing new treatments. The “ventilator-free days” score, is an established composite that equates ventilation on day 28 to death. A hierarchical outcome treating death as a worse than prolonged ventilation would enhance face validity, but performance characteristics and reporting of such an outcome are unknown. We therefore evaluated the performance of a novel hierarchical composite endpoint, the Alive and Ventilator Free score.

Design:
Using data from four Acute Respiratory Distress Syndrome Network clinical trials, we compared Alive and Ventilator Free to the ventilator-free days score. Alive and Ventilator Free compares each patient with every other patient in a win-lose-tie for each comparison. Duration of mechanical ventilation is only compared if both patients survived. We evaluated power of Alive and Ventilator Free versus ventilator-free days score under various circumstances.

Setting:
ICUs within the Acute Respiratory Distress Syndrome Network.

Patients:
Individuals enrolled in four Acute Respiratory Distress Syndrome Network trials.

Interventions:
None for this analysis.

Measurements and Main Results:
Within the four trials (n = 2,410 patients), Alive and Ventilator Free and ventilator-free days score had similar power, with Alive and Ventilator Free slightly more powerful when a mortality difference was present, and ventilator-free days score slightly more powerful with a difference in duration of mechanical ventilation. Alive and Ventilator Free less often found in favor of treatments that increased mortality and increased days free of ventilation among survivors.

Conclusions:
A hierarchical composite endpoint, Alive and Ventilator Free, preserves statistical power while improving face validity. Alive and Ventilator Free is less prone to favor a treatment with discordant effects on survival and days free of ventilation. This general approach can support complex outcome hierarchies with multiple constituent outcomes. Approaches to interpretation of differences in Alive and Ventilator Free are also presented.
Family Care Rituals in the ICU to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members—A Multicenter, Multinational, Before-and-After Intervention Trial*
Authors: Amass Timothy H. , Villa Gianluca , OMahony Sean , Badger James M. , McFadden Rory , Walsh Thomas , Caine Tanis , McGuirl Don , Palmisciano Amy , Yeow Mei-Ean , De Gaudio Raffaele , Curtis J. Randall , Levy Mitchell M. 
Published: November 2019

Objectives:
To assess the feasibility and efficacy of implementing “Family Care Rituals” as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family members.

Design:
Prospective, before-and-after intervention evaluation.

Setting:
Two U.S. academic medical ICU’s, and one Italian academic medical/surgical ICU.

Subjects:
Family members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission.

Interventions:
A novel intervention titled “Family Care Rituals” during which, following a baseline observation period, family members enrolled in the intervention phase were given an informational booklet outlining opportunities for engagement in care of the patient during their ICU stay.

Measurements and Main Results:
Primary outcome was symptoms of post-traumatic stress disorder in family members 90 days after patient death or ICU discharge. Secondary outcomes included symptoms of depression, anxiety, and family satisfaction. At 90-day follow-up, 131 of 226 family members (58.0%) responded preintervention and 129 of 226 family members (57.1%) responded postintervention. Symptoms of post-traumatic stress disorder were significantly higher preintervention than postintervention (39.2% vs 27.1%; unadjusted odds ratio, 0.58; p = 0.046). There was no significant difference in symptoms of depression (26.5% vs 25.2%; unadjusted odds ratio, 0.93; p = 0.818), anxiety (41.0% vs 45.5%; unadjusted odds ratio, 1.20; p = 0.234), or mean satisfaction scores (85.1 vs 89.0; unadjusted odds ratio, 3.85; p = 0.052) preintervention versus postintervention 90 days after patient death or ICU discharge.

Conclusions:
Offering opportunities such as family care rituals for family members to be involved with providing care for family members in the ICU was associated with reduced symptoms of post-traumatic stress disorder. This intervention may lessen the burden of stress-related symptoms in family members of ICU patients.
A Case of Triple-Negative Myasthenia Gravis Lambert-Eaton Overlap Syndrome With Negative Agrin and LRP-4 Antibodies
Authors: Maturana Miguel A. , Bertorini Tulio E. , Mei Lin , Pandhi Abhi , Mays William H. 
Published: November 2019

Abstract
A case of triple-negative myasthenia gravis Lambert-Eaton overlap syndrome with negative Agrin and LRP-4 antibodies. Myasthenia gravis (MG) is an autoimmune disorder that shares similar features with Lambert-Eaton myasthenic syndrome. The combined clinical and electrophysiological findings of MG and Lambert-Eaton myasthenic syndrome have been reported, these cases represent the so-called “myasthenia gravis Lambert-Eaton overlap syndrome” (MLOS). A total of 55 MLOS cases have been identified, 13 cases were reported before the acetylcholine receptor (AChR) antibody (ab) testing era, 14 during the AChR-ab era, 26 during the voltage-gated calcium channel (VGCC)-ab era, and 2 cases have been reported during the muscle-specific kinase (MuSK)-ab era, of these; only 1 patient tested negative for all 3 antibodies. New immunological markers have been identified in the study of MG [Agrin and the low-density lipopro-tein receptor-related protein 4 (LRP-4)]. We present a patient with MLOS who tested negative for all 5 (AChR, MuSK, VGCC, Agrin, and LRP-4) serologic markers.
What Is in the Literature
Authors: Bromberg Mark B. 
Published: November 2019

Abstract
This installment of what is in the literature is on amyotrophic lateral sclerosis (ALS). The pathophysiology of ALS remains open and the role of genes, a foothold into pathophysiology, but there are >22 genes identified, and the mechanisms are not known for any. Despite the lack of a firm understanding of pathophysiology, drug trials continue based on possible mechanisms, but no new drugs beyond riluzole and edaravone have been positive in phase 3 trials. There are a number of formal stem cell trials underway, and the results of a phase 2 trial are described. Major efforts to make trials more sensitive are being considered. There are a number of articles with helpful and practical findings for the diagnosis and management of ALS.
Monozygotic Twins Discordant for Kennedy Disease: A Case Report
Authors: Popescu Cyprian 
Published: November 2019

Abstract
Spinal and bulbar muscular atrophy or Kennedy disease (KD) is an X-linked recessive disorder caused by a pathogenic CAG expansion in the first exon of the androgen receptor. Proximal muscle atrophy, weakness, contraction fasciculations, bulbar involvement, and sensory disturbances are part of the clinical picture of KD. We report the unusual genetic and phenotypic expression in 2 monozygotic twins. Genetic analysis has shown abnormal expansion of CAG repeat in the first exon of the androgen receptor gene on chromosome X different between the twin brothers (44, respectively, 46) but with large phenotypical differences including onset age, evolution, and clinical features. Disease began at age 31 for the first brother, respectively, and at 56 years for the second one and consisted of muscle wasting and progressive impairment of walking. In addition, the second brother did not manifest bulbar involvement 3 years after clinical onset and has more sensory features. Besides classical EMG testing, we evaluate sensory participation in spinal and bulbar muscular atrophy with sudoscan device and confirmed the sensory deficit. We discussed epigenetic factors potentially involved in KD that could play a role in the phenotypical differences. To the best of our knowledge, this is the first case describing CAG trinucleotide repeats in monozygotic twins and also the first sudoscan diagnostic of sensory disturbances in Kennedy syndrome.
Distal Cervical Spondylotic Amyotrophy: Case Reports Demonstrating Clinical/Imaging Segmental Discrepancy
Authors: Bourque Pierre R. , Mobach Theo , Warman-Chardon Jodi , Breiner Ari 
Published: November 2019

AbstractMonomelic pure motor amyotrophy may seem to be an ominous syndrome as it leads to consideration of motor neuron disease. We present a series of 3 very similar cases where unilateral pure distal lower motor neuron paresis and atrophy was limited to the C8-T1 myotomes, without long-tract signs. Electrodiagnostic studies were in keeping with a restricted anterior horn cell disorder. Neuroimaging showed very focal spinal cord compression at the C6-7 level. Two patients underwent surgical decompression. All 3 patients were improved or stable at follow-up. Distal spondylotic amyotrophy is characterized by equal involvement of thenar and hypothenar muscles, in contrast to amyotrophic lateral sclerosis or Hirayama disease. We discuss the striking 2-level discrepancy between imaging and clinical localization. Proposed explanations are arterial or venous compromise caudal to the site of compression. Anatomical variation such as a prefixed brachial plexus is unlikely. A similar imaging/clinical discrepancy has been documented in Hirayama disease and spondylotic myelopathy.
Significance of Asymptomatic Hyper Creatine-Kinase Emia
Authors: Finsterer Josef , Scorza Fulvio A. , Scorza Carla A. 
Published: November 2019

Abstract

Objectives:
Whether asymptomatic hyper-CKemia (AHCE) should prompt a thorough work-up for muscle disease or not is controversially discussed. This review aims at summarizing and discussing recent findings concerning the cause, frequency, evolution, and work-up of conditions manifesting as AHCE and normal or abnormal electromyography (EMG) respectively muscle biopsy.

Methods:
Systematic PubMed search.

Results:
There are numerous primary (hereditary) and acquired myopathies that manifest with permanent, recurrent, or temporary AHCE with/without myopathic EMG or muscle biopsy. AHCE particularly occurs at onset of these conditions, which include dystrophinopathies, myotilinopathies, calpainopathy, caveolinopathy, dysferlinopathy, central core disease, multicore disease, desminopathy, MD1, MD2, hypoPP, malignant hyperthermia susceptibility, Pompe disease, McArdle disease, myoadenylate deaminase-deficiency, CPT2-deficiency, mitochondrial disorders, or myopathy with tubular aggregates. Most likely, other primary myopathies manifest with AHCE as well, without having been reported. Patients with AHCE should be taken seriously and repeated CK determination must be conducted. If hyper-CKemia is persisting or recurrent, these patients should undergo an EMG and eventually muscle biopsy. If noninformative, genetic work-up by a panel or whole exome sequencing should be initiated, irrespective of the family history. Patients with AHCE should avoid excessive exercise, require sufficient hydration, require counseling with regard to the risk of malignant hyperthermia, and should inform anesthesiologists and surgeons about their condition before elective surgery.

Conclusions:
Recurrent AHCE should be taken seriously and managed with conventional work-up. If noninformative, genetic work-up should follow irrespective of the family history.
Oculopharyngeal Muscular Dystrophy, an Often Misdiagnosed Neuromuscular Disorder: A Southern California Experience
Authors: Goyal Namita A. , Mozaffar Tahseen , Chui Luis A. 
Published: November 2019

Abstract

Objective:
Oculopharyngeal muscular dystrophy (OPMD) is a rare neuromuscular disorder characterized by late-onset development of bilateral eyelid ptosis, ophthalmoparesis and dysphagia with further progression to proximal limb muscle weakness that is an under recognized condition. The mode of inheritance is usually autosomal dominant, but a recessive form has been reported. OPMD is caused by a short expansion of the alanine repeat (GCN trinucleotide) in the poly(adenylate)-binding protein nuclear1 (PABPN1) gene.

Methods:
We performed a retrospective review of undiagnosed cases that initially presented with ptosis, diplopia, dysphagia, muscle weakness, muscular dystrophy and/or myasthenia gravis from 2000 to 2015 at two institutions in Southern California.

Results:
Twenty-five patients were identified to have OPMD with genetic confirmation.

Conclusions:
Even though a rare condition, the prevalence is disproportionally frequent in certain ethnic groups and in certain regions; thus, we report our experience of OPMD patients in Southern California.
Mohs Micrographic Surgery for the Treatment of External Ear Melanoma: an Outcome Study
Authors: Puyana Carolina , Ham Paula , Tsoukas Maria M. 
Published: November 2019

BACKGROUND
The external ear is composed of thin skin overlying cartilage making melanoma on the external ear difficult to resect while preserving the intricate anatomy. Although surgeons have achieved robust clinical outcomes for nonmelanoma and most recently melanoma skin cancers with Mohs micrographic surgery (MMS), there is still not enough evidence on the MMS application for external ear melanoma treatment.

OBJECTIVE
The authors examined survival outcomes in patients treated with MMS, narrow margin excision (NME), and wide margin excision (WME) for melanoma on the external ear.

METHODS
Data from the NCI SEER program was retrospectively analyzed. Patients who received surgical treatment on the external ear and had microscopically confirmed diagnosis of cutaneous melanoma were included in the study. The effect of different surgery types: MMS, NME, and WME, on melanoma survival was evaluated.

RESULTS
A total of 8,212 melanoma cases of the external ear performed during the years 2000 to 2015 were considered for analysis. There were no significant differences in survival comparing NME and WME with MMS.

CONCLUSION
Mohs micrographic surgery is at least equivalent to WME for the treatment of melanoma of the external ear.