bluuebunny/crossref_metadata_2025_split huggingface dataset:
How the Implementation of a Battlefield Clinical Practice Guideline Affects Documentation Practice and Informs Future Research Initiatives: Spinal Injuries and Cervical Collars
Authors: Graham Brock , Johnson Grant M , Gurney Jennifer M , Shackelford Stacy A , Howard Jeffrey T , Janak Jud C 
Published: March 2020

Abstract

Introduction
In 2010, the Joint Trauma System published a clinical practice guideline (CPG) for providing care to patients with suspicion of spinal cord injury. The CPG advocated for liberal use of cervical collars and adequate documentation of the practice. This performance improvement project examined C-spine CPG adherence in both the prehospital and military treatment facility (MTF) settings. Understanding challenges in CPG adherence facilitates evaluation of future CPGs and their success at implantation of the clinical guidance.

Materials and Methods
The Department of Defense Trauma Registry was used to identify US Military casualties meeting the criteria for cervical collar placement between January 1, 2007 and December 31, 2018. Criteria for cervical collar placement were defined as any patient who experienced a mechanism of injury relating to an explosion, fall, or motor-vehicle-related injury. Any patients with an AIS severity score greater than 1 to the head or having any ICD injury codes related to either upper spinal cord or head injury were also considered for inclusion. Adherence of cervical collar placement was defined by documented ICD codes or prehospital documentation of cervical collar placement as captured in the registry.

Results
A total of 14,837 patients were identified for possible cervical collar placement and 3,317 had verifiable documentation of having a C-collar placed. Documented C-collar placement was higher after the publication of the clinical practice guideline in 2010 (29% vs. 15%, p &lt; 0.0001). CPG publication was associated with cervical collar application (odds ratio: 2.50, 95% CI: 2.29–2.72).

Conclusion
Application of cervical collars has increased significantly, since the initial publication of the spine injury CPG. Current gaps include valid and reliable identification of patients warranting specific clinical interventions and documentation of patient care. Currently, lack of documentation is reported as nonadherence, but it remains unknown if these missing clinical data accurately portray nonadherence or adherence with lack of documentation. Future research and resources would benefit and expand the results collected in this paper, and cement the importance of CPG publication and adherence.
Utilization of Health Care Resources by Long-term Care Residents as a Function of Pain Status
Authors: Guliani Harminder , Hadjistavropoulos Thomas , Jin Shan , Lix Lisa 
Published: March 2020

Objective:
We estimated the association between the presence of pain and health care utilization among older adults residing in long-term care (LTC) facilities.

Materials and Methods:
Using administrative health data maintained by the Saskatchewan ministry of health and time-to-event analyses with multivariable frailty models, we tested for differences in health care use (hospitalization, physician and specialist visits, and prescription drug dispensations) as a function of pain status among LTC residents after admission to an LTC. Specifically, we contrasted LTC residents with daily pain or less than daily pain but with moderate or severe intensity (ie, clinically significant pain group; CSP) to residents with no pain or nondaily mild pain (NP/NDMP group).

Results:
Our cohort consisted of 24,870 Saskatchewan LTC residents between 2004 and 2015 with an average age of 85 years (63.2% female; 63.0% in urban facilities). Roughly one third had CSP at their LTC admission date. Health care use after admission to LTC was strongly associated with pain status, even after adjusting for residents’ demographic and facility characteristics, prior comorbidities and health care utilization 1 year before the study index date. In any given quarter, compared with NP/NDMP residents, those with CSP had an increased risk of hospitalization, specialist visit, follow-up general practitioner visit, and onset of polypharmacy (ie, 3 or more medication classes).

Discussion:
To our knowledge, this is the first large-scale project to examine the utilization of health care resources as a function of pain status among LTC facility residents. Improved pain management in LTC facilities could lead to reduced health care use.
Management of systemic sclerosis: the first five years
Authors: Roofeh David , Khanna Dinesh 
Published: March 2020

Purpose of review
This review provides a risk-stratified and evidence-based management for subsets of systemic sclerosis (SSc) patients in the first five years from disease onset.

Recent findings
Cardiopulmonary disease remains the primary cause of mortality in SSc patients. Morbidity and mortality in SSc-associated pulmonary arterial hypertension have improved with combination treatment, in either an upfront or sequential treatment pattern. Traditional therapies for interstitial lung disease (SSc-ILD) have targeted those with clinically significant and progressive ILD with immunosuppression. New data suggest a possible paradigm shift, introducing immunosuppressive therapy to patients before they develop clinically significant or progressive ILD. The year 2019 saw the approval of the first FDA-approved therapy for SSc-associated interstitial lung disease, using an antifibrotic agent previously approved for idiopathic pulmonary fibrosis. To date, only autologous hematopoietic stem cell transplant has demonstrated a mortality benefit for SSc-ILD, albeit in a narrow spectrum of SSc-ILD patients.

Summary
SSc is a highly heterogeneous autoimmune disease typified by varying clinical trajectories. Its management may be stratified within the first five years by subclassifying patients based on factors that have important prognostic significance: skin distribution and autoantibody status.
Image Distortion in Biplanar Slot Scanning: Patient-specific Factors
Authors: Welborn Michelle C. , Bouton Daniel , Baksh Nikolas , Degan Timothy , Sienko Susan 
Published: March 2020

Background:
Error within imaging measurements can be due to processing, magnification, measurement performance, or patient-specific factors. Previous length measurement studies based on radiographs have shown good intraclass correlation coefficients (ICCs) on single images; but have not assessed interimage distortion. In our study, “image distortion in biplanar slot scanning: technology-specific factors” we determined that there is minimal image distortion due to the image acquisition when using biplanar slot scanning. In this study, we aim to determine the role of patient-specific factors in image distortion, specifically evaluating interimage distortion.

Methods:
Digital radiographs and biplanar slot scanner images were reviewed in 43 magnetically controlled growing rod (MCGR) patients. Fifty-five postoperative anteroposterior digital radiographs, 184 follow-up biplanar slot-scanner scanner posteroanterior and 76 biplanar slot-scanner scanner laterals were measured by 2 residents and 1 attending. The manufacturer reported average actuator diameter of 9.02 mm was used as our reference width.

Results:
Overall, within image interobserver ICC were moderate to excellent (0.635 to 0.983), but the interimage ICCs were poor (0.332). Digital radiographs consistently overestimated the MCGR actuator width (mean=9.655) and biplanar slot-scanner scanner images underestimated it (mean=8.935). The measurement range was large with biplanar slot-scanner scanner posteroanterior (up to 15%) and lateral (22%) measurements and with digital radiographs (39%). Patients with abnormal muscle tone had higher degrees of measurement variability.

Conclusions:
We found that neither biplanar slot scanning nor digital radiography was precise or accurate. Digital radiographs consistently overestimated MCGR actuator width and biplanar slot scanning underestimated it. The poor ICC’s within and between image subtypes and large standard error of measurement reflected a magnitude of distortion that needs to be accounted for when using length measurements clinically. Unlike the clinically insignificant error that we noted in our previous study “image distortion in biplanar slot scanning: technology-specific factors” (0.5% to 1.5% of the measurement), the error noted in this study (0.2% to 38.5% of the measurement) has the potential to be clinically significant. Patients who have abnormal muscle tone had larger measurement errors, likely stemming from motion during the slot scanning process.

Level of Evidence:
Level III.
C5 Palsy After Cervical Spine Decompression: Topographic Correlation With C6 Chassaignac Tubercle?
Authors: Rajabian Ali , Quraishi Nasir A. 
Published: March 2020

Study Design.
Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens, which has not previously been reported.

Objective.
Our aim was to explore the possible topographic correlation of the C5 nerve root with regards to its course and regional relation to C6 Chassaignac tubercle.

Summary of Background Data.
C5 palsy is reported amongst the most frequent postoperative complications of cervical spinal procedures. We hypothesized that etiologic mechanisms proposed thus far in the current literature, although with some plausible explanation, still cannot explain why the C5 nerve root and not any other level suffer a postoperative palsy.

Methods.
Six fresh cadavers had extensive layer by layer dissection performed by two surgeons (one of whom has experience as an anatomy demonstrator and dissector). Roots of brachial plexus were exposed in relation to cervical transverse processes. Photographs were taken at each stage of the exposure.

Results.
We observed a close relation of the path of the C5 nerve root with the C6 tubercle bilaterally. Moreover, we noted a steeper descent of C5 in comparison with the other adjacent roots.

Conclusion.
Steeper angle of the C5 nerve root and close proximity to C6 Chassaignac tubercle may play a role in predisposing it to neuropraxia. Detailed anatomical photographs on fresh unprocessed cadaveric specimens are novel. Peculiar anatomical features and recent experimental evidence discussed do highlight a postganglionic extraforaminal etiology corresponding well to the demographic meta-analysis data on clinical features of postoperative C5 palsy. Exploring an alternative unified “neurophysiologic stress and critical tipping point” etiological model that encompasses current theories and correlates known metanalyses observations, we believe further studies would be prudent to ascertain/refute these findings.

Level of Evidence: 3
Cervical Canal Morphology: Effects of Neck Flexion in Normal Condition
Authors: Sudres Patrice , Evin Morgane , Arnoux Pierre-Jean , Callot Virginie 
Published: March 2020

Study Design.
Continuous measurements and computation of absolute metrics of cervical subarachnoid space (CSS) and spinal cord (SC) geometries proposed are based on in vivo magnetic resonance imaging and 3D reconstruction.

Objective.
The aim of the study is to offer a new methodology to continuously characterize and to quantify the detailed morphology of the CSS and the cervical SC in 3D for healthy subjects in both neutral supine and flexion.

Summary of Background Data.
To the best of our knowledge, no study provides a morphological quantification by absolute indices based on the 3D reconstruction of SC and CSS thanks to in vivo magnetic resonance imaging. Moreover, no study provides a continuous description of the geometries.

Methods.
Absolute indices of SC (cross-sectional area, compression ratio, position in the canal, length) and of CSS (cross-sectional area, occupational ratio, lengths) were computed by measures from 3D semi-automatic reconstructions of high resolution in vivo magnetic resonance images (3D T2-SPACE sequence) on healthy subjects (N = 11) for two postures: supine neutral and flexion neck positions. The variability induced by the semi-automatic reconstruction and by the landmarks positioning were investigated by preliminary sensitivity analyses. Inter and intra-variability were also quantified on a randomly chosen part of our population (N = 5).

Results.
The length and cross-sectional area of SC are significantly different (P < 0.05) in flexion compared with neutral neck position. Spinal cord stays centered in the canal for both postures. However, the cross-sectional area of CSS is submitted to low variation after C3 vertebra for both postures. Occupational ratio (OR) and compression ratio (CR) after C3 are significantly lower in flexion.

Conclusion.
This study presented interpretations of morphological measures: (1) left–right stability (described by the Left–Right eccentricity index) ensured by the denticulate ligaments and the nerve roots attached to the dural sheaths, (2) a Poisson effect of the SC was partially notified through its axial (antero-posterior [AP] diameter, OR, CR) and its longitudinal geometrical descriptions (length of spinal cord [LSC]). Such morphological data can be useful for geometrical finite element modeling and could now be used to compare with injured or symptomatic subjects.

Level of Evidence: 3
Identification of Predictive Factors for Mechanical Complications After Adult Spinal Deformity Surgery
Authors: Kawabata Atsuyuki , Yoshii Toshitaka , Sakai Kenichiro , Hirai Takashi , Yuasa Masato , Inose Hiroyuki , Utagawa Kurando , Hashimoto Jun , Matsukura Yu , Tomori Masaki , Torigoe Ichiro , Kusano Kazuo , Otani Kazuyuki , Mizuno Koichi , Satoshi Sumiya , Kazuyuki Fukushima , Tomizawa Shoji , Arai Yoshiyasu , Shindo Shigeo , Okawa Atsushi 
Published: March 2020

Study Design.
A retrospective multicenter observational study.

Objective.
To investigate correction surgeries that were performed in relatively aged patients in terms of mechanical complications (MCs) and their predictive factors.

Summary of Background Data.
The risk factors associated with MCs have not yet been well examined, especially in aged populations.

Methods.
We retrospectively reviewed 230 surgically treated ASD patients with an average age of 72.2 years. Twenty-eight patients with ASD caused by vertebral fractures were excluded. The minimum follow-up was 2 years. Postoperative MCs were defined as proximal junction kyphosis, distal junction kyphosis, pseudoarthrosis, rod breakage, and vertebral fractures. We divided all the ASD patients into two groups: patients with MC (the MC (+) group) and patients without MC (the MC (−) group). Radiographic parameters were evaluated before and immediately after surgery. The SRS-Schwab ASD classification and global alignment and proportion (GAP) score were also evaluated.

Results.
Of the 202 patients, 91 (45.0%) had MCs. The age at surgery was significantly higher in the MC (+) group than in the MC (−) group. Regarding radiographic parameters, postoperative global tilt (GT), pre- and postoperative thoracolumbar kyphosis (TLK), and postoperative thoracic kyphosis were significantly higher in the MC (+) group than in the MC (−) group. Other parameters, such as the proposed ideal alignment target of PI-LL<10, did not significantly affect MC rates. The GAP score was high in both groups and not significantly related to a higher rate of MC. Forward stepwise logistic regression indicated that the age at surgery, postoperative GT, and preoperative TLK were significant risk factors for MCs.

Conclusion.
Older age, higher postoperative GT, and higher pre and postoperative TLK can be risk factors for MCs. The GAP score was high in both groups and not significantly related to a higher rate of MC.

Level of Evidence: 4
Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace
Authors: Dolan Lori A. , Donzelli Sabrina , Zaina Fabio , Weinstein Stuart L. , Negrini Stefano 
Published: March 2020

Study Design.
Comparative effectiveness study

Objective.
To evaluate factors leading to higher percentage of brace failures in a cohort of North American patients with adolescent idiopathic scoliosis relative to their peers in Italy.

Summary of Background Data.
Studies of bracing in United States have shown worse outcomes than studies from European centers, possibly due to sample characteristics or treatment approaches.

Methods.
Sample: Braced patients, aged 10 to 15, Risser <3, Cobb 20°- to 40°, observed to Cobb ≥40° and/or ≥Risser 4 selected from prospective databases. Comparators: Bracing per Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) (TLSO) and Italian Scientific Spine Institute (ISICO) protocol (SPoRT braces with or without SEAS exercises). Baseline characteristics (sex, age, BMI, Risser, Cobb, curve type) and average hours of brace wear/day. Differences in programs (e.g., SEAS, type of brace, weaning protocol) were captured by a variable named “SITE.” Outcome: Treatment failure (Cobb ≥40 before Risser 4). Statistics: Comparison of baseline characteristics, analyses of risk factors, treatment components, and outcomes within and between cohorts using logistic regression.

Results.
A total of 157 BrAIST and 81 ISICO subjects were included. Cohorts were similar at baseline but differed significantly in terms of average hours of brace wear: 18.31 in the ISICO versus 11.76 in the BrAIST cohort. Twelve percent of the ISICO and 39% of the BrAIST cohort had failed treatment. Age, Risser, Cobb, and a thoracic apex predicted failure in both groups. SITE was related to failure (odds ratio [OR] = 0.19), indicating lower odds of failure with ISICO versus BrAIST approach. With both SITE and wear time in the model, SITE loose significance. In the final model, the adjusted odds of failure were higher in boys (OR = 3.34), and those with lowest BMI (OR = 9.83); the odds increased with the Cobb angle (OR = 1.23), and decreased with age (OR = 0.41) and hours of wear (OR = 0.86).

Conclusion.
Treatment at the ISICO resulted in a lower failure rate, primarily explained by longer average hours of brace wear.

Level of Evidence: 3
Anatomic Features of Head and Neck Keratinocyte Cancer in Virginia
Authors: Karlin Justin , Engelhard Stephanie , Russell Mark , Kirzhner Maria 
Published: March 2020

BACKGROUND
Keratinocyte cancer (KC) patients benefit from early diagnosis. We describe here the anatomy of head/neck KCs to help guide screening efforts.

OBJECTIVE
To examine lesion frequency and anatomic distribution of head and neck KC.

METHODS
This retrospective cohort study of 4,770 consecutive pathology reports, 1998 to 2015, analyzes 5,463 head and neck KCs (3,664 basal cell carcinoma [BCC], 1,259 squamous cell carcinoma [SCC], and 540 SCC in situ) from 3,581 patients.

RESULTS
Basal cell carcinoma relative tumor density (RTD) was highest on the nose; SCC RTD was highest on the cheek. Basal cell carcinoma-to-SCC ratio was highest on eyelid and lowest on scalp. Temple, ear, and neck SCC predominated in men; nose and cheek SCC in women. Scalp, temple, and ear BCC showed male predominance, while cheek, nose, and chin predominated in women. Left-sided ear SCC in situ and BCC were more common than right-sided ear lesions.

CONCLUSION
This study demonstrates gender- and laterality-specific differences that comport with patterns of solar exposure.
Exercise training delays renal disorders with decreasing oxidative stress and increasing production of 20-hydroxyeicosatetraenoic acid in Dahl salt-sensitive rats
Authors: Ogawa Yoshiko , Takahashi Junta , Sakuyama Akihiro , Xu Lusi , Miura Takahiro , Muroya Yoshikazu , Ito Daisuke , Kohzuki Masahiro , Ito Osamu 
Published: March 2020

Objective:
Exercise training has antihypertensive and renoprotective effects in humans and rats. However, the effects of exercise training on renal disorders that occur with salt-sensitive hypertension remains unclear. The study aim was to investigate the effects and mechanisms of exercise training on renal function in a rat model of salt-sensitive hypertension.

Methods:
Six-week-old male Dahl salt-sensitive rats were divided into normal-salt (0.6% NaCl) diet, high-salt (8% NaCl) diet, and high-salt diet with exercise training groups. The high-salt diet with exercise training group underwent daily treadmill running for 8 weeks.

Results:
The high-salt diet induced severe hypertension and renal dysfunction. Exercise training significantly improved high-salt diet-induced urinary protein, albumin, and l-type fatty acid-binding protein excretion, and glomerulosclerosis but not renal interstitial fibrosis without changing blood pressure. Exercise training significantly attenuated high-salt diet-induced oxidative stress in the kidneys and decreased high-salt diet-stimulated xanthine oxidoreductase activity but not nicotinamide adenine dinucleotide phosphate oxidase activity. The high-salt diet did not change urinary excretion of 20-hydroxyeicosatetraenoic acid and decreased cytochrome P450 4A protein expression in the kidneys. Exercise training increased urinary 20-hydoroxyeicosatetraenoic acid excretion and renal cytochrome P450 4A protein expression.

Conclusion:
Exercise training improved renal disorders without lowering blood pressure in Dahl salt-sensitive rats. Exercise training also decreased oxidative stress and increased 20-hydroxyeicosatetraenoic acid production in the kidneys. These results suggest that improvements in oxidative stress and 20-hydroxyeicosatetraenoic acid production may be potential mechanisms by which exercise training improved renal disorders in Dahl salt-sensitive rats.
Change in Lower Eyelid Contour Following Ectropion Repair With Lateral Tarsal Strip
Authors: Young William , Scofield-Kaplan Stacy M. , Levy R. Evan , Keenum Zachary , Mancini Ronald 
Published: March 2020

Purpose:
To evaluate the change in lateral canthal angle (LCA), inferior ocular surface exposed (IOSE), lower eyelid curvature, and margin-to-reflex distance 2 in those undergoing lower eyelid ectropion repair using a lateral tarsal strip technique.

Methods:
This is an Institutional Review Board-approved retrospective analysis of patients undergoing lower eyelid ectropion repair. This study included all patients from 2012 to 2018 operated on by a single surgeon at the University of Texas Southwestern Medical Center. For each patient, LCA, IOSE, and eyelid curvature were measured on preoperative and postoperative photographs using NIH Image J photographic analysis. These measurements were compared using paired 1-tail t-tests for LCA and IOSE and paired 2-tail t-tests for eyelid curvature. This study was Health Insurance Portability and Accountability Act-compliant with protection of individually identifiable information.

Results:
Fifty-one patients with lower eyelid ectropion underwent lower eyelid ectropion repair using a lateral tarsal strip technique. Forty-three of the patients underwent a bilateral lower eyelid ectropion repair. There was no statistically significant difference in the LCA. There was a reduction in IOSE among both cohorts. The fourth degree polynomial trendlines generated to assess eyelid curvature demonstrated statistical significance, suggesting a flattening of eyelid curvature. margin-to-reflex distance 2 also had a statistically significant decrease postoperatively.

Conclusions:
Lower eyelid ectropion repair using a lateral tarsal strip approach causes a reduction in IOSE, a more gradual lower eyelid curvature, and a decrease in margin-to-reflex distance 2 without causing a statistically significant change in LCA.