bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain
Authors: Lemes Ítalo Ribeiro , Pinto Rafael Zambelli , Turi Lynch Bruna Camilo , Codogno Jamile Sanches , Oliveira Crystian Bitencourt , Ross Leanna M. , Araújo Fernandes Rômulo , Monteiro Henrique Luiz 
Published: February 2021

Study Design.
Observational cross-sectional.

Objective.
To investigate the association between leisure-time physical activity (LTPA) and low back pain (LBP) in adults from primary care settings, and to explore how sedentary behavior influences this association.

Summary of Background Data.
LTPA is inversely associated with LBP. However, there is no study investigating this association in primary care settings from a middle-income country. Moreover, the influence of sedentary behavior in this association is unknown.

Methods.
Cross-sectional analysis of an ongoing longitudinal study with adults from Bauru, Brazil (n = 557). Data on physical activity, sedentary behavior (sitting time), LBP, body mass index (BMI), and chronic diseases were assessed by face-to-face interviews, physical evaluation, and medical records. Binary logistic regression was used to test the association of LTPA with the presence of LBP. Sociodemographic, behavioral, and health variables were used as covariables in the multivariable models.

Results.
The fully adjusted model showed that active participants were 33% less likely to have LBP when compared with those insufficiently active (odds ratios [OR]: 0.67 [95% CI: 0.46–0.98]). A significant association was found for active participants who spent less than 3 h/day sitting (OR: 0.45 [95% CI: 0.23–0.89]) but not for those who spent 3 h/day or more in sedentary activities (OR: 0.78 [95% CI: 0.48–1.27]). An inverse association of LTPA with LBP was observed in obese participants (OR = 0.49 [95% CI: 0.25–0.94]), but not in those with normal BMI and overweight.

Conclusion.
LTPA was inversely associated with the prevalence of LBP in adults from primary care. This association was influenced by sedentary behavior and BMI.

Level of Evidence: 4
Does Patient Body Mass Index Affect the Outcome of Multimodal Rehabilitation in Chronic Mechanical Low Back Pain?
Authors: Shetty Gautam M. , Jain Shikha , Shah Nidhi , Ram C.S. , Thakur Harshad 
Published: February 2021

Study Design.
Retrospective.

Objective.
The aim of this study was to investigate the effect of body mass index (BMI) on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation.

Summary of Background Data.
Despite being a well-known risk factor for developing LBP, there is minimal data on the effect of BMI on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation.

Methods.
Data from patients with chronic mechanical LBP who underwent multimodal rehabilitation treatment at a chain of spine rehabilitation outpatient clinics in one of the three BMI groups—1564 patients in normal body weight (BMI ≥18.5–24.9), 1990 patients in overweight (BMI ≥25–29.9), and 891 patients in obese (BMI ≥ 30) groups—were retrospectively analyzed. Pre- and post-treatment Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores, and final treatment outcomes were compared between the three groups. Multivariate analysis was used to determine the association between pre-treatment covariates and post-treatment clinical outcomes.

Results.
Post-treatment, the mean NPRS (P = 0.005) and mean ODI (P < 0.001) scores were significantly higher with a significantly lower percentage of full success outcome (P = 0.009) in the obese group when compared to normal and overweight groups. However, multivariate analysis showed a significant correlation between age, the number of treatment sessions, pre-treatment NPRS and ODI scores, and post-treatment NPRS and ODI scores and treatment failure, and no correlation with patient BMI.

Conclusion.
Patient BMI may not affect pain and disability outcomes in patients undergoing a multimodal rehabilitation treatment for chronic LBP. In contrast to BMI, other covariates such as age, treatment sessions, and pre-treatment NPRS and ODI scores may be associated with increased risk for poor treatment outcome. Obese individuals can expect clinical outcomes similar to normal or overweight individuals with multimodal physical rehabilitation for chronic LBP.

Level of Evidence: 3
Obesity in Patients Undergoing Lumbar Degenerative Surgery—A Retrospective Cohort Study of Postoperative Outcomes
Authors: Varshneya Kunal , Wadhwa Harsh , Stienen Martin N. , Ho Allen L. , Medress Zachary A. , Aikin Jessica , Li Gordon , Desai Atman , Ratliff John K. , Veeravagu Anand 
Published: February 2021

Study Design.
Retrospective cohort studying using a national, administrative database.

Objective.
The aim of this study was to determine the postoperative complications and quality outcomes of patients with and without obesity undergoing surgical management for lumbar degenerative disease (LDD).

Summary of Background Data.
Obesity is a global epidemic that negatively impacts health outcomes. Characterizing the effect of obesity on LDD surgery is important given the growing elderly obese population.

Methods.
This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether the patient had a concurrent diagnosis of obesity at time of surgery. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between patients with and without obesity. Patients who underwent three or more levels surgical correction, were under the age of 18 years, or those with any previous history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.

Results.
A total of 67,215 patients underwent primary lumbar degenerative surgery, of which 22,405 (33%) were obese. After propensity score matching, baseline covariates of the two cohorts were similar. The complication rate was 8.3% in the nonobese cohort and 10.4% in the obese cohort (P < 0.0001). Patients with obesity also had longer lengths of stay (2.7 days vs. 2.4 days, P < 0.05), and higher rates of reoperation and readmission at all time-points through the study follow-up period to their nonobese counterparts (P < 0.05). Including payments after discharge, lumbar degenerative surgery in patients with obesity was associated with higher payments throughout the 2-year follow-up period ($68,061 vs. $59,068 P < 0.05).

Conclusion.
Patients with a diagnosis of obesity at time of LDD surgery are at a higher risk for postoperative complications, reoperation, and readmission.

Level of Evidence: 4
Relief of Low Back Pain After Posterior Decompression for Lumbar Spinal Stenosis
Authors: Kakiuchi Masaaki , Wada Eiji , Harada Takeo , Yamasaki Ryoji , Fukushima Wakaba 
Published: February 2021

Study Design.
A retrospective study.

Objective.
The aim of this study was to confirm that decompression for lumbar spinal stenosis (LSS) relieves low back pain (LBP) as adequately as it relieves leg pain and to identify predictors for inadequate LBP relief.

Summary of Background Data.
Although decompression for LSS is generally thought to yield worse results for LBP than for leg pain, some studies have reported similar improvements in pain scores between LBP and leg pain. To treat LBP or take measures to prevent inadequate LBP relief, reliable predictors for LBP relief should be identified.

Methods.
We retrospectively reviewed 175 patients who underwent posterior element-preserving decompression and evaluated the relief of LBP and leg pain using numeric rating scales (NRSs). Associations between demographic, clinical, or imaging parameters and LBP relief at 1 and 4 years were analyzed by stepwise linear regression analyses. The imaging parameters included Modic change type 1, disc degeneration, foraminal stenosis, vertebral slipping (within Grade 1), scoliosis (<15°) and lordosis.

Results.
The mean improvements in LBP and leg pain NRS scores from baseline were 5.22 and 4.70 points (P = 0.064, paired t test) at 1 year and 5.12 and 4.62 points (P = 0.068) at 4 years, respectively. Poor LBP scores at 4 years were significantly associated with long-lasting LBP (beta = 0.31, P < 0.0001) and moderate or severe arm symptoms with cervical spinal cord compression or intramedullary hyperintense signal on T2-weighted MRI (beta = 0.22, P = 0.0014). The imaging parameters of the lumbar spine failed to show clear associations with poor LBP scores at 4 years, although Modic change type 1 showed a significant association with poor LBP scores at 1 year (beta = 0.28, P < 0.0001).

Conclusion.
Posterior decompression relieves LBP as well as leg pain. Long-lasting LBP and concurrent symptomatic cervical myelopathy are important predictors for inadequate LBP relief. There were no reliable imaging parameters predictive of inadequate LBP relief.

Level of Evidence: 4
Comparison of Mechanical Power During Adaptive Support Ventilation Versus Nonautomated Pressure-Controlled Ventilation—A Pilot Study
Authors: Buiteman-Kruizinga Laura A. , Mkadmi Hassan E. , Schultz Marcus J. , Tangkau Peter L. , van der Heiden Pim L. J. 
Published: February 2021

Objectives:
The aim of this pilot study was to compare the amount of “mechanical power of ventilation” under adaptive support ventilation with nonautomated pressure-controlled ventilation.

Design:
Single-center, observational prospective pilot study adjoining unitwide implementation of adaptive support ventilation in our department.

Setting:
The ICU of a nonacademic teaching hospital in the Netherlands.

Patients:
Twenty-four passive invasively ventilated critically ill patients expected to need of invasive ventilation beyond the following calendar day.

Measurements and Main Results:
In patients under adaptive support ventilation, only positive end-expiratory pressure and Fio
2 were set by the caregivers—all other ventilator settings were under control of the ventilator; in patients under pressure-controlled ventilation, maximum airway pressure (Pmax), positive end-expiratory pressure, Fio
2, and respiratory rate were set by the caregivers. Mechanical power of ventilation was calculated three times per day. Compared with pressure-controlled ventilation, mechanical power of ventilation with adaptive support ventilation was lower (15.1 [10.5–25.7] vs 22.9 [18.7–28.8] J/min; p = 0.04). Tidal volume was not different, but Pmax (p = 0.012) and respiratory rate (p = 0.012) were lower with adaptive support ventilation.

Conclusions:
This study suggests adaptive support ventilation may have benefits compared with pressure-controlled ventilation with respect to the mechanical power of ventilation transferred from the ventilator to the respiratory system in passive invasively ventilated critically ill patients. The difference in mechanical power of ventilation is not a result of a difference in tidal volume, but the reduction in applied pressures and respiratory rate. The findings of this observational pilot study need to be confirmed in a larger, preferably randomized clinical trial.
Prior Exposure to Angiotensin II Receptor Blockers in Patients With Septic Shock to Individualize Mean Arterial Pressure Target? A Post Hoc Analysis of the Sepsis and Mean Arterial Pressure (SEPSISPAM) Trial*
Authors: Demiselle Julien , Seegers Valérie , Lemerle Marie , Meziani Ferhat , Grelon Fabien , Megarbane Bruno , Anguel Nadia , Mira Jean-Paul , Dequin Pierre-François , Gergaud Soizic , Weiss Nicolas , Legay François , Le Tulzo Yves , Conrad Marie , Robert René , Gonzalez Frédéric , Guitton Christophe , Tamion Fabienne , Tonnelier Jean-Marie , Bédos Jean-Pierre , Van Der Linden Thierry , Vieillard-Baron Antoine , Mariotte Eric , Pradel Gaël , Lesieur Olivier , Ricard Jean-Damien , Hervé Fabien , du Cheyron Damien , Guerin Claude , Teboul Jean-Louis , Helms Julie , Radermacher Peter , Asfar Pierre 
Published: February 2021

OBJECTIVES:
Individualizing a target mean arterial pressure is challenging during the initial resuscitation of patients with septic shock. The Sepsis and Mean Arterial Pressure (SEPSISPAM) trial suggested that targeting high mean arterial pressure might reduce the occurrence of acute kidney injury among those included patients with a past history of chronic hypertension. We investigated whether the class of antihypertensive medications used before the ICU stay in chronic hypertensive patients was associated with the severity of acute kidney injury occurring after inclusion, according to mean arterial pressure target.

DESIGN:
Post hoc analysis of the SEPSISPAM trial.

SETTING:
The primary outcome was the occurrence of severe acute kidney injury during the ICU stay defined as kidney disease improving global outcome stage 2 or higher. Secondary outcomes were mortality at day 28 and mortality at day 90.

PATIENTS:
All patients with chronic hypertension included in SEPSISPAM with available antihypertensive medications data in the hospitalization report were included.

MEASUREMENTS AND MAIN RESULTS:
We analyzed 297 patients. Severe acute kidney injury occurred in 184 patients, without difference according to pre-ICU exposure to antihypertensive medications. Patients with pre-ICU exposure to angiotensin II receptor blockers had significantly less severe acute kidney injury in the high mean arterial pressure target group (adjusted odd ratio 0.24 with 95% CI [0.09–0.66]; p = 0.006). No statistically significant association was found after adjustment for pre-ICU exposure to antihypertensive medications and survival.

CONCLUSIONS:
Our results suggest that patients with septic shock and chronic hypertension treated with angiotensin II receptor blocker may benefit from a high mean arterial pressure target to reduce the risk of acute kidney injury occurrence.
Comparison of Sepsis Definitions as Automated Criteria
Authors: Yu Sean C. , Betthauser Kevin D. , Gupta Aditi , Lyons Patrick G. , Lai Albert M. , Kollef Marin H. , Payne Philip R. O. , Michelson Andrew P. 
Published: February 2021

OBJECTIVES:
Assess the impact of heterogeneity among established sepsis criteria (Sepsis-1, Sepsis-3, Centers for Disease Control and Prevention Adult Sepsis Event, and Centers for Medicare and Medicaid severe sepsis core measure 1) through the comparison of corresponding sepsis cohorts.

DESIGN:
Retrospective analysis of data extracted from electronic health record.

SETTING:
Single, tertiary-care center in St. Louis, MO.

PATIENTS:
Adult, nonsurgical inpatients admitted between January 1, 2012, and January 6, 2018.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
In the electronic health record data, 286,759 encounters met inclusion criteria across the study period. Application of established sepsis criteria yielded cohorts varying in prevalence: Centers for Disease Control and Prevention Adult Sepsis Event (4.4%), Centers for Medicare and Medicaid severe sepsis core measure 1 (4.8%), International Classification of Disease code (7.2%), Sepsis-3 (7.5%), and Sepsis-1 (11.3%). Between the two modern established criteria, Sepsis-3 (n = 21,550) and Centers for Disease Control and Prevention Adult Sepsis Event (n = 12,494), the size of the overlap was 7,763. The sepsis cohorts also varied in time from admission to sepsis onset (hr): Sepsis-1 (2.9), Sepsis-3 (4.1), Centers for Disease Control and Prevention Adult Sepsis Event (4.6), and Centers for Medicare and Medicaid severe sepsis core measure 1 (7.6); sepsis discharge International Classification of Disease code rate: Sepsis-1 (37.4%), Sepsis-3 (40.1%), Centers for Medicare and Medicaid severe sepsis core measure 1 (48.5%), and Centers for Disease Control and Prevention Adult Sepsis Event (54.5%); and inhospital mortality rate: Sepsis-1 (13.6%), Sepsis-3 (18.8%), International Classification of Disease code (20.4%), Centers for Medicare and Medicaid severe sepsis core measure 1 (22.5%), and Centers for Disease Control and Prevention Adult Sepsis Event (24.1%).

CONCLUSIONS:
The application of commonly used sepsis definitions on a single population produced sepsis cohorts with low agreement, significantly different baseline demographics, and clinical outcomes.
The Lived Experience of ICU Clinicians During the Coronavirus Disease 2019 Outbreak: A Qualitative Study
Authors: Kentish-Barnes Nancy , Morin Lucas , Cohen-Solal Zoé , Cariou Alain , Demoule Alexandre , Azoulay Elie 
Published: February 2021

OBJECTIVES:
During the coronavirus disease 2019 pandemic, frontline healthcare professionals were asked to reorganize the provision of critical care in unprecedented ways. Our aim was to gain insight into the lived experience of clinicians who worked in ICUs during the surge.

DESIGN:
Qualitative study using semistructured, in-depth interviews.

SETTING:
Clinicians who worked in three ICUs in Paris (France) during the peak of the pandemic (April and May 2020).

Participants:
Twenty-seven ICU clinicians (12 physicians, 11 nurses, three nursing assistants, and one respiratory therapist).

MEASUREMENTS AND MAIN RESULTS:
Interviews were audio recorded and analyzed using thematic analysis. Six themes emerged: coping with initial disorganization and creating new routines, the intensification of professional relationships and the development of unexpected collaborations, losing one’s reference points and recreating meaningful interactions with patients, working under new constraints and developing novel interactions with family members, compensating for the absence of family members and rituals at the end of life, and the full engagement of ICU clinicians during the coronavirus disease 2019 crisis.

CONCLUSIONS:
Among ICU clinicians, there was a sense of total professional engagement during the surge. Caring for critically ill coronavirus disease 2019 patients was fraught with challenges and generated a strong feeling of responsibility, as clinicians felt they had to compensate for the absence of family members. Rethinking policies about family visits and safeguarding positive relationships among colleagues are two important priorities for future healthcare crises.
Acute Axonal Motor Neuropathy With Completely Reversible Conduction Failure—Is It Really Axonal?
Authors: Carneiro Fábio , Sequeira João , Goulart Zulmira , Pereira Pedro 
Published: February 2021

Abstract
We present the case of a 24-year-old man with a 3-day history of limb weakness and flaccid tetraparesis, hyporreflexia, and gait difficulties (Hughes grade 3) in the examination. Electromyography at presentation revealed severe amplitude reduction in distal compound muscle action potentials of several nerves without features of demyelination, fulfilling electrodiagnostic criteria for acute axonal motor neuropathy. The patient was treated with immunoglobulin and recovered completely 21 days after symptom onset. Electromyography at this timepoint showed normalization of compound muscle action potentials without increased temporal dispersion. The electroclinical recovery profile in this patient is consistent with reversible conduction failure in distal nerve segments in detriment of axonal degeneration. Thus, it is an “axonal motor neuropathy” where axonopathy is unlikely, giving strength to the concept of “nodopathies/paranodopathies.”
Treatment of Iatrogenic Saphenous Neuroma after Knee Arthroscopy with Excision and Allograft Reconstruction
Authors: Schur Mathew D. , Sochol Kristen M. , Lefebvre Rachel , Stevanovic Milan 
Published: February 2021

Background:The treatment of postoperative, painful sensory neuromas is an ongoing challenge for surgeons. Here, we describe a technique for treatment with excision and allograft reconstruction and report on early results of its use in treating painful saphenous neuromas after knee arthroscopy.Methods:A retrospective review of a single surgeon’s peripheral nerve clinic from January 1, 2013, to December 31, 2019, was conducted to identify post-knee arthroscopy saphenous neuroma cases in which reconstruction with processed human nerve allograft distally implanted into healthy muscle belly was performed. We examined the outcomes for each patient, including subjective pain self-assessment and need for further surgical treatment.Results:In total, 9 cases were identified, with patient ages ranging from 21 to 74 years. The average time to referral to peripheral nerve clinic was 31 months (range: 4–143 months). Upon exploration, all nerves were found to have a neuroma in continuity. Six of the 9 patients reported subjective improvement through final follow-up. Three of the 9 patients reported initial improvement, with recurrence of pain at/near the site of the neuroma. The average follow-up time was 9 months (range: 1–21 months).Conclusions:Here, we report on a novel technique of using a processed human nerve allograft after neuroma resection to provide an organized environment for bridging regenerated axons into muscle tissue. We also describe our early results using this technique to treat iatrogenic saphenous neuromas after knee arthroscopy. Results are encouraging, with 6 of the 9 patients experiencing subjective reduction in pain at final follow-up.
Wound Healing of Descemet Membrane After Penetrating Keratoplasty and Its Relevance for Descemet Membrane Endothelial Keratoplasty Surgeons
Authors: Steindor Friedrich A. , Clemens Amelie C. , Herwig-Carl Martina C. , Loeffler Karin U. , Menzel-Severing Johannes , Geerling Gerd 
Published: February 2021

Abstract:
Compared with penetrating keratoplasty (PK), Descemet membrane endothelial keratoplasty (DMEK) is characterized as lower risk for complications such as immunological graft reaction and faster and better postoperative visual recovery. In patients with endothelial graft failure after PK, DMEK can be used to regenerate PK graft transparency. The surgical technique for DMEK in this specific situation is still under debate, particularly regarding stripping of Descemet membrane (DM) from the failed PK and diameter of the DMEK graft. Here we report a case of a 75-year-old female patient with a failed graft 16 years after PK for Fuchs endothelial dystrophy, who underwent uneventful DMEK surgery. Stripping of DM in this particular case was performed outside the failed PK and demonstrated a biomechanically stable junction between the PK donor and the host DM. Histopathologic analysis of the excised DM showed continuous extracellular matrix connecting the host and donor DM, indicating primary intention wound healing after PK at this tissue level. This case demonstrates that after PK, a biomechanically stable and histologically continuous DM can enable Descemetorhexis outside the failed graft and transplantation of a DMEK graft larger than the previous PK. This may provide more endothelial cells for transplantation.