bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing the Injury Severity of Subaxial Cervical Spine Trauma
Authors: Schroeder Gregory D. , Canseco Jose A. , Patel Parthik D. , Divi Srikanth N. , Karamian Brian A. , Kandziora Frank , Vialle Emiliano N. , Oner F. Cumhur , Schnake Klaus J. , Dvorak Marcel F. , Chapman Jens R. , Benneker Lorin M. , Rajasekaran Shanmuganathan , Kepler Christopher K. , Vaccaro Alexander R. 
Published: December 2020

Study Design.
Global cross-sectional survey.

Objective.
The aim of this study was to validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience.

Summary of Background Data.
Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: injury morphology, facet injury involvement, neurologic status, and case-specific modifiers.

Methods.
A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience.

Results.
A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, P = 0.04), N3 (incomplete spinal cord injury, P = 0.03), and M2 (critical disk herniation, P = 0.04). When stratified by surgeon experience, pairwise comparison showed only two morphological subtypes, B1 (bony posterior tension band injury, P = 0.02) and F2 (unstable facet fracture, P = 0.03), and one neurologic subtype (N3, P = 0.02) exhibited a significant difference in injury severity score.

Conclusion.
The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience, and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.

Level of Evidence: 4
Clinically Meaningful Improvement Following Cervical Spine Surgery: 30% Reduction Versus Absolute Point-change MCID Values
Authors: Khan Inamullah , Pennings Jacquelyn S. , Devin Clinton J. , Asher Anthony M. , Oleisky Emily R. , Bydon Mohamad , Asher Anthony L. , Archer Kristin R. 
Published: December 2020

Study Design.
Retrospective analysis of prospectively collected registry data.

Objective.
The aim of this study was to compare the performance of 30% reduction to established absolute point-change values for measures of disability and pain in patients undergoing elective cervical spine surgery.

Summary of Background Data.
Recent studies recommend using a proportional change from baseline instead of an absolute point-change value to define minimum clinically important difference (MCID).

Methods.
Analyses included 13,179 patients who underwent cervical spine surgery for degenerative disease between April 2013 and February 2018. Participants completed a baseline and 12-month follow-up assessment that included questionnaires to assess disability (Neck Disability Index [NDI]), neck and arm pain (Numeric Rating Scale [NRS-NP/AP], and satisfaction [NASS scale]). Participants were classified as met or not met 30% reduction from baseline in each of the respective measures. The 30% reduction in scores at 12 months was compared to a wide range of established absolute point-change MCID values using receiver-operating characteristic curves, area under the receiver-operating characteristic curve (AUROC), and logistic regression analyses. These analyses were conducted for the entire patient cohort, as well as for subgroups based on baseline severity and surgical approach.

Results.
Thirty percent reduction in NDI and NRS-NP/AP scores predicted satisfaction with more accuracy than absolute point-change values for the total population and ACDF and posterior fusion procedures (P < 0.05). The largest AUROC differences, in favor of 30% reduction, were found for the lowest disability (ODI 0–20%: 16.8%) and bed-bound disability (ODI 81%–100%: 16.6%) categories. For pain, there was a 1.9% to 11% and 1.6% to 9.6% AUROC difference for no/mild neck and arm pain (NRS 0–4), respectively, in favor of a 30% reduction threshold.

Conclusion.
A 30% reduction from baseline is a valid method for determining MCID in disability and pain for patients undergoing cervical spine surgery.

Level of Evidence: 3
Risk Factors for Facial Pressure Ulcers in Patients Who Underwent Prolonged Prone Orthopedic Spine Surgery
Authors: Techanivate Anchalee , Athibai Nutwara , Siripongsaporn Suvimol , Singhatanadgige Weerasak 
Published: December 2020

Mini
This study evaluated incidence and risk factors associated with the development of facial pressure ulcers (FPU) in patients who underwent spine surgery in prone position. A total of 300 cases were studied. The incidence of FPU after prone spine surgery using head padded device >3 hours was 27.3%. Hypotension, higher temperature, prolonged operation time, and much crystalloid therapy were the independent risk factors

Study Design.
Retroprospective study.

Objectives.
The aim of this study was to identify the incidence and the risk factors associated with the development of facial pressure ulcers (FPU) in patients who underwent spine surgery in prone position for at least 3 hours.

Summary of Background Data.
FPU is a serious complication that can occur after prolonged surgery in the prone position.

Methods.
A total of 300 cases were studied (160 retrospective cases and 140 prospective cases). Preoperative, intraoperative, and postoperative data were collected using a structured record form. Patients were divided into FPU group and normal group. A univariate and multivariate logistic regression was used to determine the association of predictor variables.

Results.
FPU occurred in 82 patients (27.3%), 129 zones, and 151 lesions. The average age was 61.9 years (11–89), the average operating time was 3.8 hours (3–8.3). The locations of FPU were the forehead, maxillary, and chin zone (33.3%, 34.1%, and 32.5%, respectively). The severity was mostly stage I or II except one patient who developed stage III on the entire face. Patients in the FPU group had significant difference in: operation time (4.4 vs. 3.6 hours), anesthetic time (5.2 vs. 4.0 hours), hypotension (79% vs. 56%), lowest blood pressure, total blood loss, total crystalloid, colloid and blood replacement, highest temperature (36.5 C° vs. 36.2 C°) compared to the normal group (P < 0.05). Factors related to FPU were hypotension odds ratio (OR) 2.75 (95% confidence interval [CI] 1.4–5.2, P = 0.002), highest temperature OR 1.95 (95% CI 1.1–3.3, P = 0.013), operation time OR 1.44 (95% CI 1.0–1.9, P = 0.014), and total crystalloid therapy OR 1.07 (95% CI 1.0–1.1, P = 0.042).

Conclusion.
The incidence of FPU after prone spine surgery using head padded device >3 hours was 27.3%. The risk factors of developing FPU included: hypotension, higher temperature, prolonged operation time, and much crystalloid therapy.

Level of Evidence: 4
Effects of Inhaled Epoprostenol and Prone Positioning in Intubated Coronavirus Disease 2019 Patients With Refractory Hypoxemia
Authors: Li Jie , Fink James B. , Augustynovich Ashley E. , Mirza Sara , Kallet Richard H. , Dhand Rajiv 
Published: December 2020

Objectives:
To evaluate the effects of inhaled epoprostenol and prone positioning, individually and in combination in mechanically ventilated patients with coronavirus disease 2019 and refractory hypoxemia.

Design:
Retrospective study.

Setting:
Academic hospital adult ICUs.

Patients:
Adult patients who received inhaled epoprostenol and prone positioning during invasive ventilation were enrolled. Patients were excluded if inhaled epoprostenol was initiated: 1) at an outside hospital, 2) after prone positioning was terminated, 3) during extracorporeal membrane oxygenation or cardiopulmonary resuscitation, and 4) with Pao
2/Fio
2 greater than 150 mm Hg.

Interventions:
Inhaled epoprostenol and prone positioning.

Results:
Of the 43 eligible patients, 22 and seven received prone positioning and inhaled epoprostenol alone, respectively, prior to their use in combination, Pao
2/Fio
2 was not different pre- and post-prone positioning or inhaled epoprostenol individually (89.1 [30.6] vs 97.6 [30.2] mm Hg; p = 0.393) but improved after the combined use of inhaled epoprostenol and prone positioning (84.0 [25.6] vs 124.7 [62.7] mm Hg; p < 0.001). While inhaled epoprostenol and prone positioning were instituted simultaneously in 14 patients, Pao
2/Fio
2 was significantly improved (78.9 [27.0] vs 150.2 [56.2] mm Hg, p = 0.005) with the combination. Twenty-seven patients (63%) had greater than 20% improvement in oxygenation with the combination of inhaled epoprostenol and prone positioning, and responders had lower mortality than nonresponders (52 vs 81%; p = 0.025).

Conclusions:
In critically ill, mechanically ventilated patients with coronavirus disease 2019 who had refractory hypoxemia, oxygenation improved to a greater extent with combined use of inhaled epoprostenol and prone positioning than with each treatment individually. A higher proportion of responders to combined inhaled epoprostenol and prone positioning survived compared with nonresponders. These findings need to be validated by randomized, prospective clinical trials.
Racial Differences in a Detroit, MI, ICU Population of Coronavirus Disease 2019 Patients
Authors: Lazar Michael H. , Fadel Raef , Gardner-Gray Jayna , Tatem Geneva , Caldwell Martina T. , Swiderek Jennifer , Jennings Jeffrey H. 
Published: December 2020

OBJECTIVES:
To investigate the potential influence of racial differences in outcomes of patients infected by coronavirus disease 2019-positive patients who require intensive care in an urban hospital.

DESIGN:
Retrospective cohort study.

SETTING:
Henry Ford Health System Multidisciplinary ICU, a total of 156 beds spread throughout the hospital in Detroit, MI.

PATIENTS:
We obtained data from the electronic medical record of all adult severe acute respiratory syndrome coronavirus-2-positive patients managed in the ICU of Henry Ford Hospital in Detroit, MI, between March 13, 2020, and July 31, 2020. Included patients were divided into two groups: people of color (including Black, Asian, Hispanic/Latino, and Arab) and White.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 365 patients were evaluated: 219 were Black (60.0%), 129 were White (35.3%), two were Asian (0.6%), eight were Hispanic/Latino (2.2%), and seven were Arab (1.9%). People of color were younger (62.8 vs 67.1; p = 0.007), with equal distribution of sex. People of color had less coronary artery disease (34 [14.4%] vs 35 [27.1%]; p =0.003) and less self-reported use of regular alcohol consumption (50 [21.2%] vs 12 [9.3%]; p = 0.004) than Whites, with no differences in diabetes (125 [53.0%] vs 66 [51.2%]; p = 0.742), hypertension (188 [79.7%] vs 99 [76.8%]; p = 0.516), congestive heart failure (41 [17.4%] vs 32 [24.8%]; p = 0.090), or chronic kidney disease (123 [54.1%] vs 55 [42.6%]; p = 0.083).
There was no difference in ICU length of stay between people of color (18 d [CI, 7–47 d]) and Whites (18 d [CI, 6–48 d]; p = 0. 0.979). Neither frequency (72.5% vs 71.3%; p = ns) nor median time to mechanical ventilation between people of color (9 d [CI, 6–15 d]) and Whites (10 d [CI, 5–16 d]; p = 0.733) was different. Overall, 188 patients (51.5 %) died in the hospital. The 28-day mortality was lower in people of color (107/236; 45.3%) versus Whites (73/129; 56.6%) (adjusted odds ratio 0.60; p = 0.034), and there was an increased median survival time in people of color (20 d) versus Whites (13.5 d; hazard ratio 0.62; p = 0.002). The inhospital mortality was lower in people of color versus White, but the difference was not statistically significant (113 [47.9%] vs 75 [58.1%], respectively; p = 0.061). Finally, there was no significant difference in days of symptoms prior to admission, frequency of presenting symptoms, or frequency or severity of acute respiratory distress syndrome between the two groups.

CONCLUSIONS:
In critically ill patients infected with coronavirus disease 2019, people of color had a lower 28-day mortality than Whites with no difference in hospital mortality, ICU length of stay, or rates of intubation. These findings are contrary to previously held beliefs surrounding the pandemic.
The Association of Platelet Decrease Following Continuous Renal Replacement Therapy Initiation and Increased Rates of Secondary Infections
Authors: Griffin Benjamin R. , Wu Chaorong , O’Horo John C. , Faubel Sarah , Jalal Diana , Kashani Kianoush 
Published: December 2020

Objectives:
Thrombocytopenia is common in critically ill patients treated with continuous renal replacement therapy and decreases in platelets following continuous renal replacement therapy initiation have been associated with increased mortality. Platelets play a role in innate and adaptive immunity, making it plausible that decreases in platelets following continuous renal replacement therapy initiation predispose patients to development of infection. Our objective was to determine if greater decreases in platelets following continuous renal replacement therapy correlate with increased rates of secondary infection.

Design:
Retrospective
cohort analysis.

Setting:
This study uses a continuous renal replacement therapy database from Mayo Clinic (Rochester, MN), a tertiary academic center.

Participants:
Adult patients who survived until ICU discharge and were on continuous renal replacement therapy for less than 30 days were included. A subgroup analysis was also performed in patients with thrombocytopenia (platelets < 100 × 103/µL) at continuous renal replacement therapy initiation.

Measurements and Main Results:
The primary predictor variable was a decrease in platelets from precontinuous renal replacement therapy levels of greater than 40% or less than or equal to 40%, although multiple cut points were analyzed. The primary outcome was infection after ICU discharge, and secondary endpoints included post-ICU septic shock and post-ICU mortality. Univariable, multivariable, and propensity-adjusted analyses were used to determine associations between the predictor variable and the outcomes.

Results:
Among 797 eligible patients, 253 had thrombocytopenia at continuous renal replacement therapy initiation. A greater than 40% decrease in platelets after continuous renal replacement therapy initiation was associated in the multivariable-adjusted models with increased odds of post-ICU infection in the full cohort (odds ratio, 1.49; CI, 1.02–2.16) and in the thrombocytopenia cohort (odds ratio, 2.63; CI, 1.35–5.15) cohorts.

Conclusions:
Platelet count drop by greater than 40% following continuous renal replacement therapy initiation is associated with an increased risk of secondary infection, particularly in patients with thrombocytopenia at the time of continuous renal replacement therapy initiation. Further research is needed to evaluate the impact of both continuous renal replacement therapy and platelet loss on subsequent infection risk.
The Practice and Complications of Midline Catheters: A Systematic Review
Authors: Tripathi Sandeep , Kumar Shruti , Kaushik Shubhi 
Published: December 2020

OBJECTIVE:
Midline catheters are considered “midway” regarding vascular access. The objective of this systematic review was to explore the current practice, dwell time, and complication rates of midline catheters.

DESIGN:
Systematic review.

SETTING:
Search on four databases, PubMed, CINAHL, Scopus, and Embase, were conducted for English language articles published after the year 2000.

MEASUREMENTS AND MAIN RESULTS:
A total of 987 articles were identified, of which 31 manuscripts met the inclusion criteria and were selected for review. Quality assurance was performed based on the Newcastle-Ottawa score. Average dwell time and complication rates were calculated for studies involving adult patients and adjusted for sample size. This analysis included data from the placement of 18,972 midline catheters across five countries. Aside from two randomized control trials, most of the studies analyzed were cohort studies. One pediatric and two neonatal studies were included. The average dwell time was 16.3 days (n = 4,412). The adjusted mean infection rate was 0.28/1,000 catheter days, with 64% of studies not reporting any infection with midline catheter. The failure rate of midline catheters was 12.5%. Adjusted average rates of other significant complications included the following: deep vein thrombosis (4.1%), dislodgement (5.0%), occlusion (3.8%), phlebitis (3.4%), and infiltration (1.9%).

Conclusions:
The dwell times and failure rates of midline catheters compare favorably against published data on other types of catheters. Their infection rates are also lower than the reported rates of central venous catheters; however, they have a higher rate of mechanical complications. Active surveillance of infections due to midline catheters is recommended. More data are needed from pediatric and neonatal populations.
Brief Educational Video Improves Patient Understanding of Mohs Surgery: A Randomized Controlled Trial
Authors: Lin Matthew J. , Dubin Danielle P. , Younessi Shannon , Khorasani Hooman 
Published: December 2020

BACKGROUND
Patient's retention and recall of material discussed in a medical consultation is often inadequate.

OBJECTIVE
To assess patient's knowledge, anxiety, and understanding of Mohs surgery after viewing a brief educational video.

METHOD
A prospective, investigator-blinded, randomized controlled trial of 120 consecutive patients before the first Mohs surgery procedure. Sixty subjects viewed an instructional video and 60 subjects did not. A survey was administered to both groups, measuring knowledge, anxiety, and understanding of Mohs surgery.

RESULTS
The video group scored higher than the control group on the knowledge portion of the survey (median score 78% vs 56%, p < .01), but there were no differences in anxiety or understanding scores between groups. The percentage of subjects who answered each knowledge question correctly was greater in the video group than in the control group. In the subgroup of patients who had not previously had a consultation with a Mohs surgeon, the video group had higher median knowledge scores (67% vs 44%, p < .01), higher median understanding scores (8 vs 6, p = .05), and lower median visual analogue anxiety scores (4 vs 6, p = .01) compared with the control group.

CONCLUSION
A brief educational video increases patient's knowledge of Mohs surgery. For patients who have not yet had a consultation with a Mohs surgeon, the video may also reduce anxiety.
Fractional CO2 Laser for Transcutaneous Drug Delivery of Onabotulinum Toxin in Palmar Hyperhidrosis
Authors: Agamia Naglaa F. , Sobhy Nagat , Abd-Elraouf Amira , Tawfik Abeer 
Published: December 2020

BACKGROUND
Palmar hyperhidrosis is a common disorder of excessive sweating due to over-stimulation of cholinergic receptors on eccrine glands.

OBJECTIVE
To compare the efficacy of laser-assisted drug delivery of onabotulinum toxin A (BoNTA) and intradermal BoNTA injections in the management of palmar hyperhidrosis.

PATIENTS AND METHODS
This intrapatient comparative study was conducted on 30 adult patients with idiopathic palmar hyperhidrosis. The palms of the patients were divided into 2 groups. Group 1 was treated with intradermal injections of 50 units of BoNTA, whereas Group 2 was subjected to laser-assisted transcutaneous BoNTA delivery using fractional CO2 laser at different doses (25, 50, and 75 units). Each treatment modality was evaluated using the iodine starch test, hyperhidrosis disease severity scale, and gravimetric scoring.

RESULTS
Delivery of 75 units of BoNTA to the dermis on the right-sided palms assisted by fractional CO2 laser was clinically equivalent to 50 units of injection on the left side. Pain intensity was significantly higher on the injected side than on the other side.

CONCLUSION
Laser-assisted drug delivery of botulinum toxin can be considered an effective and safe alternative for treatment of palmar hyperhidrosis with minimal side effects and complications.
Coexistence of Meesmann Corneal Dystrophy and a Pseudo-Unilateral Lattice Corneal Dystrophy in a Patient With a Novel Pathogenic Variant in the Keratin K3 Gene: A Case Report
Authors: Abad-Morales Víctor , Barbany Miriam , Gris Oscar , Güell José Luis , Pomares Esther 
Published: December 2020

Purpose:
This study aims to clinically and genetically report a case of coexisting Meesmann corneal dystrophy (MECD) and pseudo-unilateral lattice corneal dystrophy (LCD).

Methods:
Clinical characterization was supported by a complete ophthalmological evaluation, including visual acuity measurement and slit-lamp examination. Molecular diagnosis was performed by whole-exome sequencing analyzing the gelsolin, keratin K3 (KRT3), keratin K12, and transforming growth factor-beta–induced genes.

Results:
A 57-year-old woman presented with recurrent corneal erosions over 17 years and visual impairment in both eyes. Ophthalmological evaluation revealed multiple central tiny cysts in the epithelium of both eyes and lattice linear lesions only in the right cornea. In both eyes, a corneal posterior crocodile shagreen degeneration could also be observed. These findings were compatible with a MECD and a unilateral LCD. Molecular analysis identified the novel heterozygous nucleotide substitution c.1492G>A (amino acid change p.Glu498Lys) in the KRT3 gene, in cosegregation with the MECD familial phenotype. However, no genetic evidence supported the unique LCD phenotype observed in the patient.

Conclusions:
To the best of our knowledge, this is the first report of a pseudo-unilateral LCD in a patient with coexistent MECD. Moreover, the genetic analysis showed a novel mutation in the previously MECD-associated gene KRT3.