bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Factors on Initial in-brace Correction in Idiopathic Scoliosis
Authors: Peeters Charles Marcelis Maria , van Hasselt Arthur Justus , Wapstra Frits Hein , Jutte Paulus Christiaan , Kempen Diederik Hendrik Ruth , Faber Christopher 
Published: December 2021

Study Design.
Systematic literature review.

Objective.
The aim of this study was to systematically review the literature and provide an overview of reported predictive factors on initial in-brace correction in patients with idiopathic scoliosis (IS).

Summary of Background Data.
Brace therapy is the best proven non-surgical treatment for IS. There is strong evidence that lack of initial in-brace correction is associated with brace treatment failure. To improve initial in-brace corrections and subsequently long-term brace treatment success, knowledge about factors influencing initial in-brace correction is a prerequisite.

Methods.
A systematic literature search was performed in Pubmed, Embase, Web-of-Science, Scopus, Cinahl, and Cochrane in November 2020. Studies which reported factors influencing initial in-brace correction in IS patients treated with brace therapy were considered eligible for inclusion.

Results.
Of the 4562 potentially eligible articles identified, 28 studies fulfilled the inclusion criteria and were included in this systematic review. Nine studies (32%) were classified as high quality studies and the remaining 19 studies (68%) as low quality. Thirty-four different reported factors were collected from the included studies. Strong evidence was found for increased curve flexibility as favorable predictive factor for initial in-brace correction. Moderate evidence was found for thoracolumbar or lumbar curve pattern as favourable predictive factor, and double major curve pattern as unfavourable predictive factor for initial in-brace correction. Also moderate evidence was found that there is no significant difference on initial in-brace correction between computer-aided design and manufacturing systems (CAD/CAM) braces with or without finite element models (FEM) simulation, and braces fabricated using the conventional plaster-cast.

Conclusion.
The results of this systematic review indicate that increased curve flexibility is strongly associated with increased initial in-brace correction.

Level of Evidence: 1
Occupational Heat Stress: An Overview for Nurse Practitioners
Authors: Sabo Kathryn , Starodub R. , Smoller Sara , Quinn Lisa , Kelly Debra , Flaherty Karen , Nicholas Patrice K. 
Published: December 2021

ABSTRACT
The health impacts of climate change are pervasive and complex. The role of nurse practitioners is a key in addressing these emerging health challenges. However, few health care providers are aware of the extensive signs and symptoms that accompany climate-related health sequelae. This article explores the increasing prevalence of occupational heat stress and best practices for nurse practitioners in addressing this problem. The A CLIMATE mnemonic is a clinical tool applied to occupational heat stress and aims to address a comprehensive health assessment and proactive management. Two clinical case studies will be offered as exemplars of occupational heat stress. The cases are framed within the A CLIMATE mnemonic for health assessment and physical examination for nurse practitioner practice.
Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study
Authors: Arnold Dirk , Schneider Fritz , Volk Gerd Fabian , Ossmann Steffen , Neudert Marcus , Hirt Bernhard , Löwenheim Hubert , Guntinas-Lichius Orlando 
Published: December 2021

Hypothesis:
Despite the complete embodiment of the stapedius muscle (SM) into the pyramidal eminence, it is possible to safely gain access to the SM belly via a retrofacial approach. This presents a novel approach to directly measure the electrically evoked stapedius reflex threshold (eSRT).

Background:
Objective fitting of maximum comfortable loudness levels for cochlear implant users can improve the benefit introduced by the device. Sensing SM activity via direct surgical access represents a potential tool for objective eSRT fitting.

Methods:
Eighteen human temporal bones (TBs) were used. Micro-computed tomography was performed for six TBs. Standard computed tomography for six TBs. Manual 3D-segmentation of the relevant middle and inner ear anatomy was performed on 12 TBs. Mastoidectomy and posterior tympanotomy allowed the access to middle ear of all 18 the TBs. Once identified the mastoidal segment of the facial nerve (FN), the retrofacial access to the SM was drilled.

Results:
The total access rate was 72.2%. Only in the first three cases the posterior semi-circular canal was hit. The SM access was identified posterior to the FN at a 4 ± 0.78 mm distance from the stapes’ head, almost halfway to the chorda tympani's branching point along the FN direction. The drilling depth to access the SM posterior to the external surface of FN on average was 2 ± 0.30 mm. The exposure took on average of 5 to 8 minutes.

Conclusions:
The retrofacial approach seems to offer a feasible and reproducible access to the SM belly opening an avenue to electromyographic sensing of eSRT.
Calcium Channel Blockers and the Risk of Sensorineural Hearing Loss
Authors: Sutton S. Scott , Magagnoli Joseph , Cummings Tammy H. , Hardin James W. 
Published: December 2021

Objective:
To evaluate calcium channel blockers as a potential prophylactic agent for sensorineural hearing loss (SNHL).
Patients: We used a retrospective cohort of US veterans treated by the Veteran's Affairs healthcare system. Patients were included in the study if 1) they were diagnosed with high blood pressure; 2) had no previous diagnosis of SNHL; 3) were prescribed a calcium channel blocker after diagnosis or as a control cohort, patients who had no antihypertensive medication use.

Intervention:
Patients were categorized into mutually exclusive cohorts by their antihypertensive medication exposure: calcium channel blocker exposed and no antihypertensive medication exposure.

Main Outcome Measure:
Incident SNHL was defined as an inpatient or outpatient record with diagnosis codes international classification of diseases (ICD)-9-CM 389.1 or ICD-10-CM H90, H90.41, H90.42, H90.A21, H90.A22. An audiology or otolaryngology clinic visit was required for patients with an outpatient diagnosis of SNHL.

Results:
A total of 1,338,409 patients met the inclusion criteria consisting of 292,981 patients with CCBs (25,614 with verapamil and 267,367 with other CCBs) and 1,045,428 patients with no antihypertensive medication. On average, patients were middle-aged, White men with a body mass index (BMI) of 30+. Cox proportional hazards model estimates from propensity score matched data revealed CCB users had a 23.6% decreased risk of SNHL compared with those with no antihypertensive medication use (hazard ratios [HR] = 0.764; 95% confidence interval = [0.752–0.777]).

Conclusion:
This analysis found evidence supporting the theory that calcium channel blockers might be a potential prophylactic agent for sensorineural hearing loss. Additional research is warranted.
Usefulness of Cervical Vestibular-Evoked Myogenic Potentials for Diagnosing Patients With Superior Canal Dehiscence Syndrome: A Meta-Analysis
Authors: Kim Do Hyun , Kim Sung Won , Kim So-hyun , Jung Jae hoon , Hwang Se Hwan 
Published: December 2021

Objectives:
To compare the diagnostic accuracy of cervical vestibular-evoked myogenic potential (cVEMP) for detecting superior canal dehiscence (SCD) syndrome to that of computed tomography (CT) and surgical findings.

Databases Reviewed:
PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database.

Methods:
Databases were searched up to July 2021. True positives, true negatives, false positives, and false negatives were extracted. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.

Results:
Our search yielded nine studies with 721 patients. Including all cVEMP thresholds, the diagnostic odds ratio (DOR) was 32.8483 (95% confidence interval [CI]: 19.6577, 54.8900; I
2 = 49.9%). The area under the summary receiver operating characteristic curve (AUC) was 0.879. Sensitivity and specificity were 0.8278 (95% CI: 0.7517, 0.8842; I
2 = 76.4%) and 0.8824 (95% CI: 0.7859, 0.9387; I
2 = 92.8%), respectively. However, there was a high degree of heterogeneity (I
2 ≥ 70%) due to the different VEMP threshold values used among the studies. In subgroup analysis, higher cVEMP threshold values showed higher sensitivity (threshold ≤ 85: 0.9568; threshold ≤ 65: 0.7691) but lower specificity (threshold ≤ 85: 0.5879; threshold ≤ 65: 0.8913). The threshold ≤75 subgroup showed moderate sensitivity of 0.7455, high specificity of 0.9526, and the highest DOR of 38.9062. The AUC of this subgroup was 0.894.

Conclusions:
cVEMP is a reliable adjunctive tool for the clinical diagnosis of SCD. Taking the balance between sensitivity and specificity into consideration, a cVEMP threshold value of 75 showed good diagnostic accuracy.
Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension
Authors: Egbe Alexander C. , Miranda William R. , Shaik Likhita , Katta Renuka Reddy , Goda Sakr Ahmed , Devara Janaki , Connolly Heidi M. 
Published: December 2021

Background
The relationship between office vs. ambulatory blood pressure (BP) indices are well-studied in patients with essential hypertension and based on these data, it is known that the average 24-h ambulatory BP is typically lower than office BP. However, emerging data show that office SBP underestimates arterial afterload in patients with coarctation of aorta (COA), and a minimal increase in stroke volume during low-intensity exercise results in an exaggerated rise in SBP as compared to those with essential hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with essential hypertension.

Methods
Case-control study of 118 COA patients and 118 patients with essential hypertension matched by age, sex, BMI and office SBP.

Results
Although both groups had similar office SBP (132 ± 17 mmHg) by design, the COA group had paradoxical increases in 24-h ambulatory SBP (135 ± 14 vs. 126 ± 13; P < 0.001) and daytime ambulatory SBP (142 ± 16 vs. 130 ± 13; P < 0.001), and less nocturnal dipping (−3 ± 5 vs. −9 ± 4; P < 0.001). The COA group also had a higher prevalence of masked hypertension [36 (31%) vs 14 (12%); P < 0.001), and worse arterial function indices.

Conclusion
These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating essential hypertension guidelines recommendations to the treatment of COA. It also provides the rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.
The Role of Cerebral CT Angiogram in Subacute Ischemic Cerebrovascular Events
Authors: Alshumrani Ghazi , Alzahrani Fares , Alamri Ahmad , Al-Khani Abdullah Murhaf , Shehata Shehata , Alsabaani Abdullah , Alhazzani Adel 
Published: December 2021

Background:
Stroke is a spectrum of medical emergencies resulting from a direct insult to the cerebral blood flow. Cerebral computed tomography angiogram (CTA) plays an important role in the diagnostic algorithm of acute stroke. However, the role of CTA in the subacute phase is not well-established. This study aimed to assess the diagnostic role of CTA in subacute ischemic stroke and transient ischemic attack (TIA) in identifying underlying etiology. It also aimed to describe the commonly encountered CTA findings in the subacute phase of ischemic events.

Methods:
This is a retrospective study in which we evaluated the radiologic records of all patients who had a cerebral CTA for subacute stroke and TIA during the period from January 1, 2010 to May 30, 2018.

Results:
The study included 104 cases diagnosed with subacute ischemic stroke or TIA. Patients’ ages ranged from 8 to 96 years with a mean age of 52.9 (18.1) years. Most of the patients were males (68.3%; 71). CTA findings were abnormal in 86 cases (82.7%). Stenosis was diagnosed in 34 (32.7%) cases, followed by acute arterial thrombosis (25; 24%) and chronic occlusion (17; 16.3%). The internal carotid artery was the most affected (57.6%), followed by the vertebrobasilar arteries.

Conclusion:
The current study revealed that CTA has a high diagnostic yield in the subacute phase of ischemic cerebrovascular events, with an important role in detecting clinically relevant findings in this group of patients.
Adrenal Crisis Presenting as Recurrent Encephalopathy Mimicking Autoimmune, Infectious Encephalitis, and Common Variable Immune Deficiency
Authors: Poon Jason T. , Salzman Karen , Clardy Stacey L. , Paz Soldan M. Mateo 
Published: December 2021

Introduction:
Adrenal crisis can present with life-threatening complications and mimic autoimmune or infectious encephalitis, and common variable immune deficiency (CVID). The literature regarding the neurological complications of adrenal crisis is limited and focuses on patients who present with hypotension and electrolyte abnormalities.

Case Report:
A 30-year-old man presented 3 times to our hospital with encephalopathy, fever, and left sided weakness with a history of multiple autoimmune diseases and prior hospitalizations for encephalopathy. During his first 2 admissions, he was normotensive and without electrolyte abnormalities. Extensive workup for infectious, paraneoplastic, seizure, metabolic, toxic, and vascular etiologies, and autoimmune encephalitis was negative. His exam returned to baseline with empiric steroid treatment, and he was discharged. He re-presented 2 months later with encephalopathy for a third admission. During this subsequent presentation, he had hyponatremia, low serum osmolality, elevated urine sodium, undetectable morning cortisol, and 21-α hydroxylase autoantibodies. A diagnosis of autoimmune adrenal insufficiency was established, he was treated with physiological doses of hydrocortisone and fludrocortisone, and improved rapidly to near baseline function. He has remained relapse-free at 4-year follow up. During all admissions, he was also found to have low immunoglobulin G levels and met criteria for CVID; however, his immunoglobin levels recovered with steroid replacement.

Conclusion:
The reported patient demonstrated some of the neurological complications of adrenal crisis which can mimic other autoimmune conditions such as CVID. The neurologist should be aware that recurrent encephalopathy from adrenal insufficiency can occur regardless of hemodynamic or electrolyte changes on typical hospital metabolic panels.
Retrospective Evaluation of Acute Headache in Pediatric Emergency Department
Authors: Güngör Ali , Göktuğ Aytaç , Bodur İlknur , Öztürk Betül , Güneylioğlu Muhammed M. , Yaradilmiş Raziye M. , Tekeli Aysun , Karacan Can D. , Tuygun Nilden 
Published: December 2021

Background:
The aims of this study were to describe the etiologies of acute headache presenting to the pediatric emergency department, determine their clinical characteristics, the prevalence of red flag findings and neuroimaging and identify predictors of headaches because of serious intracranial diseases.

Materials and Methods:
Patients from 2 to 18 years of age who visited pediatric emergency department with a chief complaint of headache between January 1, 2016 and August 31, 2020 were retrospectively evaluated.

Results:
The mean age of the 558 patients included in the study was 11.17±3.78 years, and 290 (52%) were female. The most common cause of acute headache was head and neck area infections (except central nervous system infections) in 355 (63.6%) patients. Forty patients (7.2%) had a headache because of serious intracranial diseases. According to binary logistic regression analysis, the findings that predicted a serious intracranial diseases were abnormal neurological physical examination [odds ratio (OR): 187.57; 95% confidence interval (CI): 32.67-1076.64], recent onset or suddenly severe headache (OR: 14.41; 95% CI: 3.14-65.91), and vomiting (OR: 9.42; 95% CI: 1.90-46.63). Neuroimaging was performed in 63 (11.3%) patients, and 7 (1.25%) had a pathology requiring emergency treatment.

Conclusions:
The majority of acute headaches were evaluated as secondary headache. The most common cause of acute headache was head and neck area infections. Abnormal neurological physical examination, recent onset or suddenly severe headache, and vomiting were the most useful red flags for predicting serious intracranial diseases. The requirement for neuroimaging should be evaluated individually for each patient.
Isolated Abducens Nerve Palsy in a Patient With COVID-19
Authors: Manolopoulos Apostolos , Katsoulas Georgios , Kintos Vasileios , Koutsokera Maria , Lykou Christina , Lapaki Konstantina-Maria , Acquaviva Pascua T. 
Published: December 2021

Introduction:
The pandemic of coronavirus disease 2019 (COVID-19) stands as a major global health and social burden. As cases are growing, several other symptoms, besides the typical respiratory ones, are emerging. The involvement of the nervous system is increasingly recognized with manifestations ranging from hyposmia to meningoencephalitis and cranial neuropathies.

Case Report:
We report the case of a 41-year-old female patient who presented to the emergency department complaining of diplopia and headache over the last 2 days. She denied any medical history, as well as any other neurological or respiratory symptom. A detailed neurological and ophthalmological examination revealed a limitation to the abduction of the right eye due to palsy of the right lateral rectus muscle causing painless, horizontal diplopia in the right gaze. The computed tomography of the brain was normal. Based on the detected lymphopenia, she was tested for COVID-19 and was positive. The cerebrospinal fluid analysis showed no abnormalities, while also a repeated head computed tomography was similarly normal. The patient received no specialized medical treatment, and after 6 days, she was discharged home having a minimal degree of persistent diplopia. Two weeks later, brain magnetic resonance imaging was performed that was similarly unrevealing.

Conclusions:
Isolated abducens nerve palsy can be the only presenting symptom in COVID-19. Although several pathophysiological mechanisms have been proposed, the exact nature of this manifestation has not been clarified yet. Vigilance is required by neurologists to detect and manage patients with such subtle clinical presentations.
Reversible Cerebral Vasoconstriction Syndrome in the Setting of COVID-19 and Pleomorphic Sarcoma
Authors: Harahsheh Ehab , Gritsch David , Mbonde Amir , Apolinario Michael , Hoxworth Joseph M. , Demaerschalk Bart M. 
Published: December 2021

Introduction:
Reversible cerebral vasonstriction syndrome (RCVS) is an increasingly recognized clinical and radiologic syndrome. However, it has been rarely reported in the setting of the novel coronavirus disease-2019 (COVID-19) infection or sarcomatous tumors. RCVS might be the initial manifestations of COVID-19 infection or noncatecholamine producing masses including sarcoma.

Case Report:
A 44-year-old male who developed COVID-19–related symptoms followed by rapid onset of severe headaches in the setting of persistently elevated blood pressure (BP). Brain imaging showed multifocal arterial narrowing in the anterior and posterior circulation consistent with RCVS. Serial imaging demonstrated resolution of the arterial narrowing after BP control was achieved with improvement in the patient’s headaches. Further investigation for secondary causes of the patient’s elevated BP revealed a right renal mass, and the patient underwent right nephrectomy, and the biopsy results confirmed the diagnosis of pleomorphic sarcoma.

Conclusion:
Our case suggests a possible association between severe acute respiratory syndrome coronavirus 2 with development of RCVS, but further studies are needed to validate this observation, establish a causal relationship and define a pathophysiological mechanism. Considering tumors other than catecholamine-producing masses as a potential risk factor for developing RCVS might lead to earlier detection and treatment of any underlying malignancy in patients whom the main and sole presentation could be RCVS.
Platelet-to-Neutrophil Ratio is Related to Hemorrhagic Transformation in Patients With Acute Cerebral Infarction
Authors: Liu Fan , Jin Ming , Zhang Zhuo , Gao Jia , Wang Xiaopeng 
Published: December 2021

Background:
As a common complication of cerebral infarction, hemorrhagic transformation (HT) often indicates a worse clinical outcome. The aim of this study was to explore the relationship between the platelet-to-neutrophil ratio (PNR) and HT in patients with acute cerebral infarction.

Methods:
Patients with HT after acute cerebral infarction were enrolled in the HT group. Matched patients with acute cerebral infarction without HT were enrolled at the same time. All patients included in this study did not receive reperfusion therapy. The PNR was obtained on the second day of admission. Multivariate logistic analysis was used to evaluate the relationship between the PNR and HT.

Results:
We collected data from a total of 137 patients: 61 patients with HT and 76 patients without HT. After adjusting for confounders, the PNR was independently associated with HT (odds ratio=0.922, 95% confidence interval: 0.891-0.955, P<0.05). The receiver operating characteristic curve demonstrated that the PNR could better predict HT (area under the curve=0.808, 95% confidence interval: 0.735-0.882, P<0.05). When the cut-off value of the PNR was 50.4765, the sensitivity was 70.5%, and the specificity was 82.9%. After stratifying the PNR to 50.4765, logistic analysis was performed again. The risk of HT in patients with a low PNR was 12.995 times that of patients with a high PNR. In patients without atrial fibrillation, the PNR was still independently related to HT.

Conclusions:
The PNR is a predictor of HT, and patients with a low PNR have a higher risk of HT.
Progressive Multifocal Leukoencephalopathy Misdiagnosed as Neuropsychiatric Systemic Lupus Erythematosus With a Catastrophic Outcome
Authors: Algahtani Hussein , Shirah Bader , Othman Leen , Almarri Abdullah Khaled , Alwafi Emad , Alassiri Ali H. 
Published: December 2021

Introduction:
Progressive multifocal leukoencephalopathy (PML) is a rare infection of the central nervous system due to the reactivation of the John Cunningham polyomavirus. It is commonly a progressive fatal disease with worldwide distribution.

Case Report:
We describe a rare case of PML, which was misdiagnosed as neuropsychiatric systemic lupus erythematosus (SLE) with a catastrophic outcome due to delay in diagnosis with superadded cyclophosphamide therapy.

Conclusion:
There are several lessons taught from our case. Firstly, in patients with autoimmune disorders who are strongly immunosuppressed, the new onset of cognitive impairment and seizures should alert the treating physician to look carefully for PML. Secondly, in cases of SLE where the diagnosis of the cause of cognitive impairment and seizures is not clear, we suggest that immunosuppression should not be intensified until PML has clearly been ruled out. Lastly, multidisciplinary care in patients with suspected neuropsychiatric SLE including a neurologist, an infectious diseases consultant, a neuroradiologist, and a rheumatologist is needed.