bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Body Mass Index in Obese and Morbidly Obese Patients on Complications and 30- and 90-day Readmissions Following Lumbar Spine Fusion
Authors: Chen Xiao T. , Shahrestani Shane , Ballatori Alexander M. , Ton Andy , Buser Zorica , Wang Jeffrey C. 
Published: January 2021

Study Design.
Retrospective cohort study using the 2013–2017 National Readmission Database.

Objective.
The aim of this study was to quantify the influence of body mass index (BMI) on complication and readmission rates following lumbar spine fusion.

Summary of Background Data.
Compared to controls, patients with BMI ≥35 had greater odds of readmission, infection, and wound complications following lumbar spine fusion.

Methods.
Patients who underwent elective lumbar spine fusion within the population-based sample were considered for inclusion. Exclusion criteria included nonelective lumbar spine fusions, malnourished, anorexic, or underweight patients, and surgical indications of trauma or neoplasm. Patients were grouped by BMI: 18.5 to 29.9 (controls), 30 to 34.9 (obesity I), 35 to 39.9 (obesity II), and ≥40 (obesity III). Multivariate regression was performed to analyze differences in complications and readmissions between groups. Predictive modeling was conducted to estimate the impact of BMI on 30- and 90-day infection, wound complication, and readmissions rates.

Results.
A total of 86,697 patients were included for analysis, with an average age of 58.9 years and 58.9% being female. The obesity II group had significantly higher odds of infection (odds ratio [OR]: 1.82, 95% confidence interval [CI]: 1.28–2.62, P = 0.001), wound dehiscence (OR: 3.08, 95% CI: 1.70–6.18, P = 0.0006), and 30-day readmission (OR: 1.32, 95% CI: 1.11–1.58, P = 0.002), whereas the obesity III group had significantly higher odds of acute renal failure (OR: 2.14, 95% CI: 1.20–4.06, P = 0.014), infection (OR: 2.43, 95% CI: 1.72–3.48, P < 0.0001), wound dehiscence (OR: 3.76, 95% CI: 2.08–7.51, P < 0.0001), 30-day readmission (OR: 1.62, 95% CI: 1.36–1.93, P < 0.0001), and 90-day readmission (OR: 1.53, 95% CI: 1.31–1.79, P < 0.0001) compared with controls. Predictive modeling showed cumulative increases of 6.44% in infection, 3.69% in wound dehiscence, and 1.35% in readmission within 90-days for each successive BMI cohort.

Conclusion.
Progressively higher risks for infection, wound complications, and hospital readmission were found with each progressive BMI level.

Level of Evidence: 3
Cost-Effectiveness of Bariatric Surgery Prior to Posterior Lumbar Decompression and Fusion in an Obese Population with Degenerative Spondylolisthesis
Authors: Paranjape Chinmay S. , Gentry Ryan D. , Regan Conor M. 
Published: January 2021

Study Design.
Cost-effectiveness analysis.

Objective.
To determine if bariatric surgery prior to posterior lumbar decompression and fusion (PLDF) for degenerative spondylolisthesis (DS) is a cost-effective strategy.

Summary of Background Data.
Obesity poses significant perioperative challenges for DS. Treated operatively, obese patients achieve worse outcomes relative to non-obese peers. Concomitantly, they fare better with surgery than with nonoperative measures. These competing facts create uncertainty in determining optimal treatment algorithms for obese patients with DS. The role of bariatric surgery merits investigation as a potentially cost-effective optimization strategy prior to PLDF.

Methods.
We simulated a Markov model with two cohorts of obese individuals with DS. 10,000 patients with body mass index (BMI) more than or equal to 30 in both arms were candidates for both bariatric surgery and PLDF. Subjects were assigned either to (1) no weight loss intervention with immediate operative or nonoperative management (“traditional arm”) or (2) bariatric surgery 2 years prior to entering the same management options (“combined protocol”).
Published costs, utilities, and transition probabilities from the literature were applied. A willingness to pay threshold of $100,000/QALY was used. Sensitivity analyses were run for all variables to assess the robustness of the model.

Results.
Over a 10-year horizon, the combined protocol was dominant ($13,500 cheaper, 1.15 QALY more effective). Changes in utilities of operative and nonoperative treatments in non-obese patients, the obesity cost-multiplier, cost of bariatric surgery, and the probability of success of nonoperative treatment in obese patients led to decision changes. However, all thresholds occurred outside published bounds for these variables.

Conclusion.
The combined protocol was less costly and more effective than the traditional protocol. Results were robust with thresholds occurring outside published ranges. Bariatric surgery is a viable, cost-effective preoperative strategy in obese patients considering elective PLDF for DS.

Level of Evidence: 3
Exceptional Conditions for Favorable Neurological Recovery After Laminoplasty in Cases with Cervical Myelopathy Caused by K-line (−) Ossification of Posterior Longitudinal Ligament
Authors: Tsujimoto Takeru , Endo Tsutomu , Menjo Yusuke , Kanayama Masahiro , Oda Itaru , Suda Kota , Fujita Ryo , Koike Yoshinao , Hisada Yuichiro , Iwasaki Norimasa , Takahata Masahiko 
Published: January 2021

Study Design.
A retrospective observational study.

Objective.
To clarify the exceptional conditions for a favorable neurological recovery after laminoplasty (LMP) for cervical myelopathy caused by K-line (−) ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data.
The K-line-based classification of cervical OPLL was developed to predict insufficient neurological recovery after LMP. For patients with K-line (−) OPLL, LMP generally yields the least improvement because of inadequate decompression of the spinal cord; however, there are some exceptional cases wherein LMP promotes favorable neurological recoveries.

Methods.
We retrospectively reviewed the medical records of 106 consecutive patients who underwent LMP for cervical OPLL to determine the demographic data, radiographic findings, and neurological recoveries of the patients as assessed preoperatively and 2 years postoperatively by their Japanese Orthopedic Association (JOA) scores. The factors associated with favorable outcomes after LMP in patients with K-line (−) were then investigated.

Results.
Of 106 total patients, 31 were classified as K-line (−), of whom 21 achieved the least neurological recovery after LMP (JOA recovery rate <50%), while the remaining 10 patients achieved favorable outcomes (JOA recovery rate ≥50%). Among the K-line (−) group patients, those with ext-K-line (+), which changed to K-line (+) in the neck-extended position, and the patients with up-K-line (−), in whom the lesion responsible for myelopathy in the upper cervical spine (C3 or above), showed favorable neurological recoveries after LMP.

Conclusion.
Our data shows that, even for patients with K-line (−) OPLL, a favorable neurological recovery can be expected after LMP in cases in which the OPLL is in the upper cervical spine or the K-line changes to (+) in the neck-extended position. This means that K-line-based predictions of surgical outcomes after LMP should be indicated for patients with OPLL in the middle and lower cervical spine with limited extension mobility.

Level of Evidence: 4
The Feasibility of Anterior Spinal Access
Authors: Ng Julia Poh-Hwee , Scott-Young Matthew , Chan Daniel Nim-Cho , Oh Jacob Yoong-Leong 
Published: January 2021

Study Design.
Cross-sectional study.

Objective.
To analyze the feasibility of anterior spinal access to the vascular corridor at the L5–S1 junction, by evaluating three crucial anatomical landmarks. This provides a framework for risk-stratification for the clinician during preoperative evaluation.

Summary of Background Data.
The anterior lumbar interbody fusion (ALIF) offers many advantages for fusion at the L5–S1 junction. However, the variant iliac vasculature may preclude safe anterior access.

Methods.
Five hundred magnetic resonance imaging (MRI) images of the L5–S1 level were identified, with 379 meeting inclusion criteria. We graded the anterior access into three grades, namely, easy, advanced, or difficult by looking at three important anatomical landmarks—the vascular corridor (narrow if ≤25 mm, medium if 25–35 mm [inclusive], and wide if >35 mm), the left common iliac vein (LCIV) location (grades A–D based on the relative position of the LCIV to the L5–S1 disc space), and the presence or absence of a fat plane.

Results.
Our results showed that 43.27% of the patients had wide corridor for the anterior access, 19.26% of patients had no fat plane, and 7.65% had a LCIV that extended past the midline of the disc (Grade C, D: >50%). By combining these three factors, 37.20% would have easy anterior access, while a minority (1.85%) would have a difficult anterior access.

Conclusion.
The ALIF at L5–S1 offers significant benefits to the patient. The surgeon should be aware of the dangers in an anterior access by looking at three crucial factors to determine whether the access is easy, advanced, or difficult. Patients with a difficult access should be attempted by experts, vascular access surgeons, or consider an alternative approach to L5–S1.

Level of Evidence: 3
Effects of the Level and Duration of Mobilization Therapy in the Surgical ICU on the Loss of the Ability to Live Independently: An International Prospective Cohort Study
Authors: Scheffenbichler Flora T. , Teja Bijan , Wongtangman Karuna , Mazwi Nicole , Waak Karen , Schaller Stefan J. , Xu Xinling , Barbieri Silvia , Fagoni Nazzareno , Cassavaugh Jessica , Blobner Manfred , Hodgson Carol L. , Latronico Nicola , Eikermann Matthias 
Published: January 2021

OBJECTIVES:
It is unclear whether early mobilization in the surgical ICU helps improve patients’ functional recovery to a level that enables independent living. We assessed dose of mobilization (level + duration). We tested the research hypotheses that dose of mobilization predicts adverse discharge and that both duration of mobilization and maximum mobilization level predict adverse discharge.

DESIGN:
International, prospective cohort study.

SETTING:
Study conducted in five surgical ICUs at four different institutions.

PATIENTS:
One hundred fifty patients who were functionally independent before admission (Barthel Index ≥ 70) and who were expected to stay in the ICU for greater than or equal to 72 hours.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Mobilization was quantified daily, and treatments from all healthcare providers were included. We developed and used the Mobilization Quantification Score that quantifies both level and duration of mobilization. We assessed the association between the dose of mobilization (level + duration; exposure) and adverse discharge disposition (loss of the ability to live independently; primary outcome). There was wide variability in the dose of mobilization across centers and patients, which could not be explained by patients’ comorbidity or disease severity. Dose of mobilization was associated with reduced risk of adverse discharge (adjusted odds ratio, 0.21; 95%CI, 0.09–0.50; p < 0.001). Both level and duration explained variance of adverse discharge (adjusted odds ratio, 0.28; 95% CI, 0.12–0.65; p = 0.003; adjusted odds ratio, 0.14; 95% CI, 0.06–0.36; p < 0.001, respectively). Duration compared with the level of mobilization tended to explain more variance in adverse discharge (area under the curve duration 0.73; 95% CI, 0.64–0.82; area under the curve mobilization level 0.68; 95% CI, 0.58–0.77; p = 0.10).

CONCLUSIONS:
We observed wide variability in dose of mobilization treatment applied, which could not be explained by patients’ comorbidity or disease severity. High dose of mobilization is an independent predictor of patients’ ability to live independently after discharge. Duration of mobilization sessions should be taken into account in future quality improvement and research projects.
Faculty Perceptions: A Qualitative Study of the Perceived Need, Opportunities, and Challenges of Developing “One Health-One Medicine” in the Medical, Veterinary, and Public Health Curricula
Authors: Roopnarine Rohini , Regan Julie-Anne 
Published: January 2021

Introduction:
The conceptual framework of One Health (OH) provides a strategy for promoting collaboration across the nexus of animal, human, and environmental health, which is essential for tackling emerging disease threats, such as COVID-19. However, there is no accreditation requirement for OH to prepare students across the professions for collaborative practice. This study aimed to explore the perspectives of faculty across the medical, veterinary, and public health programs about the need, opportunities, and challenges of developing OH in the curricula.

Methods:
In this qualitative study, faculty across the three disciplines were invited to participate in audio-recorded, focus group interviews. Recordings were transcribed verbatim and analyzed using inductive and deductive thematic analysis.

Results:
All participants recognized the need for OH as a critical concept for preparing students for collaborative practice. Opportunities were identified for shared learning and research across the disciplines, particularly through the use of interprofessional education. The lack of an accreditation mandate for OH in the medical curriculum was perceived to be the greatest challenge, leading to an anticipation of significant resistance among medical educators and students.

Discussion:
Successful development of OH in all three curricula is vital to prepare students for current and future threats to global health. The role of accreditation bodies in ensuring medical, veterinary, and public health curricula prepare students for these threats is crucial. Implications for practice include strategies for persuading medical educators and medical students to embrace OH in the curriculum and promote a culture of shared learning.
Cosinor-rhythmometry for 24-h urinary sodium, potassium, creatinine excretion in the Chinese adult population
Authors: Peng Ya-Guang , Feng Jing-Jing , Zhang Ying , Li Kun , Cai Si-Yu , Yan Ruo-Hua , Peng Xiao-Xia 
Published: January 2021

Abstract

Background:
The low accuracy of equations predicting 24-h urinary sodium excretion using a single spot urine sample contributed to the misclassification of individual sodium intake levels. The application of single spot urine sample is limited by a lack of representativity of urinary sodium excretion, possibly due to the circadian rhythm in urinary excretion. This study aimed to explore the circadian rhythm, characteristics, and parameters in a healthy young adult Chinese population as a theoretical foundation for developing new approaches.

Methods:
Eighty-five participants (mean age 32.4 years) completed the 24-h urine collection by successively collecting each of the single-voided specimens within 24 h. The concentrations of the urinary sodium, potassium, and creatinine for each voided specimen were measured. Cosinor analysis was applied to explore the circadian rhythm of the urinary sodium, potassium, and creatinine excretion. The excretion per hour was computed for analyzing the change over time with repeated-measures analysis of variance and a cubic spline model.

Results:
The metabolism of urinary sodium, potassium, and creatinine showed different patterns of circadian rhythm, although the urinary sodium excretion showed non-significant parameters in the cosinor model. A significant circadian rhythm of urinary creatinine excretion was observed, while the circadian rhythm of sodium was less significant than that of potassium. The circadian rhythm of urinary sodium and creatinine excretion showed synchronization to some extent, which had a nocturnal peak and fell to the lowest around noon to afternoon. In contrast, the peak of potassium was observed in the morning and dropped to the lowest point in the evening. The hourly urinary excretion followed a similar circadian rhythm.

Conclusion:
It is necessary to consider the circadian rhythm of urinary sodium, potassium, and creatinine excretion in adults while exploring the estimation model for 24-h urinary sodium excretion using spot urine.
Pandemic of the aging society — sporadic cerebral small vessel disease
Authors: Lau Alexander Yuk Lun , Ip Bonaventure Yiu Ming , Ko Ho , Lam Bonnie Yin Ka , Shi Lin , Ma Karen Ka Yan , Au Lisa Wing Chi , Soo Yannie Oi Yan , Leung Thomas Wai Hong , Wong Adrian , Mok Vincent Chung Tong 
Published: January 2021

Abstract
Age-related sporadic cerebral small vessel disease (CSVD) has gained increasing attention over the past decades because of its increasing prevalence associated with an aging population. The widespread application of and advances in brain magnetic resonance imaging in recent decades have significantly increased researchers’ understanding in the in vivo evolution of CSVD, its impact upon the brain, its risk factors, and the mechanisms that explain the various clinical manifestation associated with sporadic CSVD. In this review, we aimed to provide an update on the pathophysiology, risk factors, biomarkers, and the determinants and spectrum of the clinical manifestation of sporadic CSVD.
Unique Associations Between Specific Attention-Deficit Hyperactivity Disorder Symptoms and Related Functional Impairments
Authors: Zoromski Allison K. , Epstein Jeffery N. , Ciesielski Heather A. 
Published: January 2021

ABSTRACT:

Objective:
The purpose of this study was to explore the unique relationships between specific attention-deficit hyperactivity disorder (ADHD) symptoms and functional impairment in school-age children using parent and teacher ratings.

Methods:
Parents and teachers rated ADHD symptoms and comorbidities (internalizing and oppositional behaviors) as well as impairments (academic, relationship, and classroom behavior) for 8689 children using the Vanderbilt ADHD Diagnostic Rating Scales. Stepwise regression was used to determine which of the 18 ADHD symptom items were most associated with specific domains of impairment with relevant demographic and clinical characteristics used as covariates (e.g., sex, comorbidities, medication status, and age).

Results:
“Careless mistakes” and “avoids tasks” significantly predicted academic impairment across content areas and across parent- and teacher-rating models. ADHD symptoms accounted for limited variance in impairment in the family and peer relationship domains or in organized activities when oppositional symptoms were entered as a covariate. Regarding teacher-rated classroom behavior, the strongest predictor of impairment was “talks too much.”

Conclusion:
The findings indicate that the symptoms that were most predictive of impairment varied by domain of impairment.
Chlorhexidine Hypersensitivity: A Case Report of Delayed Reactions Associated with Epidermal Preparations
Authors: Bhardwaj Priya , Bekeny Jenna C. , Zolper Elizabeth G. , Nigam Manas , Sher Sarah R. 
Published: January 2021

Summary:
Chlorhexidine is a topical antiseptic that is generally well tolerated in patients, making it a common preparatory substance in various surgical settings. Sparse case reports have identified immediate hypersensitivity reactions after exposure to this substance, especially in patients with a history of atopy. The purpose of this case report is to describe 3 unique presentations of delayed hypersensitivity to epidermal chlorhexidine preparation. Patients undergoing breast surgery by a single surgeon between December 2018 and January 2019 were retrospectively reviewed for incidence of dermatologic complications. Medical and surgical history of patients as well as dermatologic hypersensitivity course were collected. Three patients presented with a delayed hypersensitivity to the epidermal chlorhexidine surgical preparation, ChloraPrep. Each patient developed an erythematous, pruritic maculopapular rash in the distribution of the chlorhexidine application. This occurred beyond the immediate postoperative period—ranging from postoperative days 5 to 35. Initial treatment included the use of 1% hydrocortisone along with a systemic antihistamine. If there was no improvement in symptoms after 3 days, we transitioned patients to 0.5% triamcinolone ointment. If there was no improvement after 5 days on triamcinolone, the patient was reexamined and systemic steroids were prescribed. In each of our cases, all skin changes had resolved within 7–10 days of initial symptoms. Our findings highlight a series of delayed adverse reactions to epidermal chlorhexidine occurring beyond the intraoperative and immediate postoperative period. This case report serves to recognize a unique presentation pattern to ensure that all patients are accurately diagnosed and promptly treated via a systematic treatment algorithm.
Sternal Tumor Resection and Reconstruction Using Iliac Crest Autograft
Authors: Drinnon Kyle D. , Sherali Samir , Cox Cameron T. , MacKay Brendan J. 
Published: January 2021

Background:
Primary malignant tumors of the sternum are rare among bone tumors. Even with radical resection, the survival rate for sternal tumors remains low. Resection often results in significant bone defects in the chest wall, and reconstruction must provide adequate protection for pulmonary and respiratory structures. Flexible materials have historically been used for sternal reconstructions following failed sternotomies in cardiac surgery. Although these have had some success, they fail to provide adequate support for patients undergoing reconstruction secondary to tumor resection, who are otherwise healthy and active. Although rigid materials offer greater protection, they frequently cause chronic pain and respiratory complications. More recently, bone grafts have been used to reconstruct sternal defects, and the limited published reports are promising.

Methods:
We present the case of a patient diagnosed with an extramedullary solitary bone plasmacytoma who underwent a sternal resection and reconstruction with an autogenous bone graft taken from the iliac crest and secured in place with 5 plates (3 sternal and 2 mandibular).

Results:
At 9-month follow-up, bone marrow biopsy showed no evidence of multiple myeloma. X-ray, computed tomography, and Pulmonary Function Test (PFT) scans confirmed graft stability, and the patient has returned to normal activities.

Conclusions:
Sternal resection and reconstruction is an effective method for treating extramedullary solitary plasmacytoma when radiation is ineffective. In cases of significant segmental defects, iliac crest bone graft may be a viable option for repairing sternal defects following tumor resection.