bluuebunny/crossref_metadata_2025_split huggingface dataset:
Area Deprivation Index and Magnitude of Scoliosis at Presentation to a Tertiary Referral Scoliosis Clinic in Massachusetts
Authors: Nezwek Teron A. , Braun Stuart V. , Menendez Mariano E. , Grussing Emily D. , Shabin Zabrina M. 
Published: August 2021

Background:
There is growing interest in identifying predictors of large scoliosis curves at initial presentation, but few data to guide such preventive efforts. The association of neighborhood socioeconomic deprivation with curve magnitude in this context has not been previously evaluated. The purpose of our study was to determine the correlation of socioeconomic deprivation with scoliosis curve magnitude at initial presentation. Secondarily, we assessed the correlation of body mass index (BMI) with curve severity.

Methods:
We retrospectively identified 202 patients presenting with adolescent idiopathic scoliosis to a single tertiary care center in Massachusetts from January 2015 to August 2018. The Area Deprivation Index (ADI), a validated composite measure of neighborhood socioeconomic deprivation, was calculated for each patient. Curve magnitude, age, sex, BMI, race, and insurance status were recorded. Pearson correlation was used to determine the association of the ADI and BMI with scoliosis severity.

Results:
There was no correlation between the ADI and the magnitude of scoliosis at presentation (r=0.055; P=0.43). Greater BMI was moderately correlated with increased scoliosis curve magnitude (r=0.28; P<0.001). There was no association between curve magnitude and patient age, sex, race, or insurance status.

Conclusions:
The finding that neighborhood socioeconomic deprivation did not correlate with greater scoliosis severity at presentation may be suggestive of equitable access to specialized scoliosis care. Future research should determine whether this reassuring finding is unique to Massachusetts––a state with high rates of health insurance coverage––or generalizable to other US states. In addition, our study further corroborates the notion that greater BMI is associated with larger scoliosis curves, and calls for targeted interventions to facilitate early scoliosis detection in the growing childhood obese population.

Level of Evidence:
Level II—prognostic study and retrospective study.
Use of Vancomycin Powder in the Surgical Treatment of Early Onset Scoliosis Is Associated With Different Microbiology Cultures After Surgical Site Infection
Authors: Dumaine Anne M. , Du Jerry Y. , Parent Stefan , Sturm Peter , Sponseller Paul , Glotzbecker Michael P. 
Published: August 2021

Background:
The use of vancomycin powder has been shown to decrease risk of surgical site infection (SSI) in early onset scoliosis (EOS). While there is potential benefit in SSI reduction, there is also theoretical risk in creating increased bacterial resistance to standard treatment regimens. However, the effects of topical vancomycin powder on microbiology in these patients has not been studied.

Methods:
A multicenter database for EOS patients was retrospectively analyzed. All patients that underwent surgical treatment with traditional growing rods, magnetically controlled growing rods, vertical expandable prosthetic titanium rib, and Shilla for EOS performed after 2010 were identified (n=1115). Patients that sustained at least 1 SSI after guided growth surgery were assessed (n=104, 9.3%). Patients with culture and antibiotic details were included (n=55). Patients that received vancomycin powder at index surgery were compared with patients that did not. A multivariate regression model was used to control for potential confounders.

Results:
There were 55 patients included in this study, including 26 males (47%) and 29 females (53%). Mean age at index surgery was 7.2±6.9 years. Vancomycin powder was utilized in 18 cases (33%). Mean time from index surgery to SSI was 2.0±1.3 years. There were 2 cases of wound dehiscence (4%), 7 cases of superficial infection (13%), and 46 cases of deep infection (84%).
There were significant differences in overall microbiology results between vancomycin and no vancomycin cohorts (P=0.047). On univariate analysis, the vancomycin powder cohort had a significantly high incidence of cultures without growth (n=7, 39% vs. n=4, 11%, relative risk: 2.063, 95% confidence interval: 0.927-4.591, P=0.028). This association remained significant on multivariate analysis (adjusted odds ratio: 9.656, 95% confidence interval: 1.743-53.494, P=0.009).

Conclusions:
In EOS patients undergoing procedures complicated by SSI, the use of vancomycin powder was independently associated with increased risk of no culture growth. Surgeons and infectious disease physicians should be aware and adjust diagnostic and treatment strategies appropriately.

Level of Evidence:
Level III—retrospective cohort study.
Risk of Scoliosis Progression in Nonoperatively Treated Adolescent Idiopathic Scoliosis Based on Skeletal Maturity
Authors: Johnson Mitchell A. , Flynn John M. , Anari Jason B. , Gohel Shivani , Cahill Patrick J. , Winell Jennifer J. , Baldwin Keith D. 
Published: August 2021

Background:
Hand radiographs for skeletal maturity staging are now frequently used to evaluate remaining growth potential for patients with adolescent idiopathic scoliosis (AIS). Our objective was to create a model predicting a patient’s risk of curve progression based on modern treatment standards.

Methods:
We retrospectively reviewed all AIS patients presenting with a major curve <50 degrees, available hand radiographs, and complete follow up through skeletal maturity at our institution over a 3-year period. Patients with growth remaining underwent rigid bracing of curves >25 degrees, whereas patients between 10 and 25 degrees were observed. Treatment success was defined as reaching skeletal maturity with a major curve <50 degrees. Four risk categories were identified based on likelihood of curve progression.

Results:
Of 609 AIS patients (75.4% female) presenting with curves over 10 degrees and reaching skeletal maturity at most recent follow up, 503 (82.6%) had major thoracic curves. 16.3% (82/503) of thoracic curves progressed into surgical treatment range. The highest risk group (Sanders 1 to 6 and curve 40 to 49 degrees, Sanders 1 to 2 and curve 30 to 39) demonstrate a 30% success rate with nonoperative treatment. This constitutes an 111.1 times (95% confidence interval: 47.6 to 250.0, P<0.001) higher risk of progression to surgical range than patients in the lowest risk categories (Sanders 1 to 8 and curve 10 to 19 degrees, Sanders 3 to 8 and curve 20 to 29 degrees, Sanders 5 to 8 and curve 30 to 39 degrees).

Conclusions:
Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient’s risk of progression and ultimate surgical risk.

Level of Evidence:
Level III—retrospective cohort study.
Evaluation of an Extended-duration Chemoprophylaxis Regimen for Venous Thromboembolism after Microsurgical Breast Reconstruction
Authors: Pittelkow Eric M. , DeBrock Will C. , Mailey Brian , Ballinger Tarah J. , Socas Juan , Lester Mary E. , Hassanein Aladdin H. 
Published: August 2021

Background:
Patients undergoing free flap breast reconstruction are at a high risk for venous thromboembolism based upon Caprini scores. Guidelines for venous thromboembolism prophylaxis recommend high-risk groups receive extended chemoprophylaxis for several weeks after gynecological, orthopedic, and surgical oncology cases. Extended prophylaxis has not been studied in free flap breast reconstruction. The purpose of this study was to compare outcomes of free flap breast reconstruction patients who received extended venous thromboembolism (VTE) prophylaxis with those who received standard inpatient-only prophylaxis.

METHODS:
Patients undergoing microsurgical breast reconstruction were divided into two groups: standard VTE prophylaxis (Group I) and extended prophylaxis (Group II). Both groups received prophylactic subcutaneous heparin or enoxaparin preoperatively and enoxaparin 40 mg daily postoperatively while inpatient. Group II was discharged with a home regimen of enoxaparin 40 mg daily for an additional 14 days.

RESULTS:
In total, 103 patients met inclusion criteria (36 patients in Group I, 67 patients in Group II). The incidence of VTE was 1.5% in Group II compared with 2.8% in Group I (P = 0.6). There was no difference in reoperative hematoma between Group I (n = 0) and Group II (n = 1) (P = 0.7). Total flap loss was 2.2%.

Conclusions:
Although this retrospective pilot study did not show statistical significance in VTE between those receiving extended home chemoprophylaxis (1.5% incidence) compared with inpatient-only chemoprophylaxis (2.8%), the risk of bleeding complications was similar. These results indicate that a larger, higher powered study is justified to assess if an extended home chemoprophylaxis protocol should be standard of care post free flap breast reconstruction.
Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial
Authors: Lane Elizabeth , Magel John S. , Thackeray Anne , Greene Tom , Fino Nora F. , Puentedura Emilio J. , Louw Adriaan , Maddox Daniel , Fritz Julie M. 
Published: August 2021

Abstract
Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: −0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to −6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
Forces Required for Isolated Malleus Shaft Fractures
Authors: Rönnblom Anton , Niklasson Anders , Werner Mimmi , Stål Per , Tano Krister 
Published: August 2021

Background and Hypothesis:
Isolated malleus shaft fractures are rare cases. A commonly reported cause is a finger pulled out from a wet outer ear canal after a shower or bath. The objective was to investigate experimentally the mechanism and forces needed to establish an isolated malleus shaft fracture.

Methods:
Ten fresh-frozen human temporal bones were adapted to allow visual inspection of the structures involved while negative pressure trauma was applied. Thirty malleus bones were broken and the required forces were measured. Measurements from 60 adult test subjects were used to create mathematical and physical models to calculate and measure the forces necessary for generating trauma. To calculate the maximum muscle force developed by the tensor tympani muscle, the muscle area and fiber type composition were determined.

Results:
The temporal bone experiments showed that applied negative pressure in a wet ear canal could not fracture the malleus shaft with only passive counterforce from supporting structures, although the forces exceeded what was required for a malleus shaft fracture. When adding calculated counteracting forces from the tensor tympani muscles, which consisted of 87% type II fibers, we estimate that a sufficient force is generated to cause a malleus fracture.

Conclusion:
The combination of a negative pressure created by a finger pulling outward in a wet ear canal and a simultaneous counteracting reflexive force by the tensor tympani muscle were found to be sufficient to cause an isolated malleus fracture with an intact tympanic membrane.
Comparison of the Effects of Matching and Normalization on the Cervical Vestibular Evoked Myogenic Potential
Authors: Hudson Hannah , Govender Sendhil , Parlane Rengen M. , Rosengren Sally M. 
Published: August 2021

Hypothesis:
We compared two means of mitigating the effect of sternocleidomastoid (SCM) contraction strength on the cervical vestibular evoked myogenic potential (cVEMP): contraction matching and amplitude normalization.

Background:
SCM muscle contraction strength affects the amplitude of the cVEMP which can impact measures of inter-side asymmetry and diagnostic outcomes.

Methods:
In 19 normal subjects, we investigated the effect of muscle contraction variation within a cVEMP recording. We then compared cVEMP recordings on the right and left sides with matched and unmatched muscle contraction strength using raw amplitudes and amplitude ratios (i.e., normalized amplitudes).

Results:
Contraction variability had significant effects on small sections of a cVEMP recording, but there was no significant effect on overall cVEMP amplitude, suggesting that the cVEMP is relatively unaffected by variable effort during a recording. Matching the contraction across the two sides (d = 0.53, p = 0.016) and amplitude normalization (d = 0.43, p = 0.004) both significantly reduced inter-side asymmetry, but normalization had no additional benefit once the sides were matched (interaction effect, p = 0.019). cVEMPs recorded with matched contractions had the smallest range of asymmetry values.

Conclusion:
The study shows that controlling the background contraction during a cVEMP recording, either by using similar contractions for each trial or by normalizing the amplitude, reduces cVEMP asymmetry and can prevent incorrect results in the minority of subjects who make asymmetric muscle contractions.
What is the role of remdesivir in patients with COVID-19?
Authors: Beigel John H. 
Published: August 2021

Purpose of review
COVID-19 represents an unprecedented public health crisis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The antiviral remdesivir is one component of treating COVID-19. Unfortunately, the trials evaluating remdesivir have reported mixed results, leading to uncertainty on when to use remdesivir. This review discusses the trials evaluating the efficacy of remdesivir for COVID-19 and other supporting data to help inform the role of remdesivir in patients with COVID-19.

Recent findings
Since the start of the pandemic, there have been four randomized trials of remdesivir in treating patients hospitalized with COVID-19. More recently, extensive observational studies have provided supportive data.

Summary
The majority of trials evaluating remdesivir suggest that remdesivir is effective in the treatment of patients hospitalized with COVID-19. Although there may be a benefit in some subgroups more than others, there is insufficient data to make definitive statements about benefits or lack of benefits in particular groups. Remdesivir has demonstrated clinical benefits such as decreased time in the hospital, lower progression to mechanical ventilation, and decreased utilization of other hospital resources; it is unclear if it reduces mortality, but one randomized controlled trial suggested possible survival benefits. Based on the data available, remdesivir has been approved (or authorized for early use) in 48 countries.
The treatment of chronic low back pain using annuloplasty with percutaneous endoscopic discectomy
Authors: Komatsu Jun , Muta Tomoya 
Published: August 2021

Abstract

Introduction:
Percutaneous endoscopic discectomy (PED) is often used to treat patients with chronic discogenic low back pain (LBP) (DLBP). In this technique, after selective discectomy of the degenerated disc, the posterior annulus fibrosus and tear site are modulated by thermal annuloplasty (TA) using a bipolar radiofrequency coagulator (PED/TA). PED/TA has been shown to be effective for treating DLBP.

Patient Concerns:
The patient was a 40-year-old man who visited our hospital with complaints of chronic LBP (CLBP) and buttock pain, left-sided sciatica, and sensory disturbance affecting his left thigh.

Diagnoses and interventions:
He was diagnosed as having discogenic LBP with a high intensity zone in the L4–5 disc, so discography was performed combined with steroid and lidocaine injection at the affected site. He recovered from LBP with 80% effective rate. He again reported concordant LBP with leg pain and numbness, which was treated effectively by intradiscal injection. However, the pain gradually recurred, so we decided to perform PED/TA.

Outcomes:
After PED, the high intensity zone site was ablated with a coagulator. Following surgery, the patient's severe LBP in the seated position resolved, his leg pain and sensory disturbance improved, and has experienced no difficulties in carrying out activities of daily living.

Conclusions:
This case suggests that PED/TA is potentially advantageous for treating DLBP, CLBP and severe sitting intolerance. Also, PED/TA may allow lumbar interbody fusion to be avoided in patients with CLBP and severe sitting intolerance.
Advances in hearing preservation in cochlear implant surgery
Authors: Tarabichi Osama , Jensen Megan , Hansen Marlan R. 
Published: August 2021

Purpose of review
Advancements in cochlear implant surgical approaches and electrode designs have enabled preservation of residual acoustic hearing. Preservation of low-frequency hearing allows cochlear implant users to benefit from electroacoustic stimulation, which improves performance in complex listening situations, such as music appreciation and speech understanding in noise. Despite the relative high rates of success of hearing preservation, postoperative acoustic hearing outcomes remain unpredictable.

Recent findings
Thin, flexible, lateral wall arrays are preferred for hearing preservation. Both shortened and thin, lateral wall arrays have shown success with hearing preservation and the optimal implant choice is an issue of ongoing investigation. Electrocochleography can monitor cochlear function during and after insertion of the electrode array. The pathophysiology of hearing loss acutely after cochlear implant may differ from that involved in delayed hearing loss following cochlear implant. Emerging innovations may reduce cochlear trauma and improve hearing preservation.

Summary
Hearing preservation is possible using soft surgical techniques and electrode arrays designed to minimize cochlear trauma; however, a subset of patients suffer from partial to total loss of acoustic hearing months to years following surgery despite evidence of residual apical hair cell function. Early investigations in robotic-assisted insertion and dexamethasone-eluting implants show promise.
When Cancer Is the Self
Authors: Stephens Jennifer M.L. , Thorne Sally 
Published: August 2021

Background
The term “cancer” is imbued with identity signals that trigger certain assumed sociocultural responses. Clinical practice with hematological cancer patients suggests the experience of these patients may be different than that of solid tumor cancer patients.

Objective
We sought to explore the research question: How are identity experiences described and elucidated by adult hematological cancer patients?

Methods
This qualitative study was guided by interpretive description as the methodological framework.

Results
Preexisting identity labels and assumptions assigned to the overarching “cancer” diagnosis were viewed by patients as entirely inadequate to fully describe and inform their experience. Instead, findings revealed the propensity of adult hematology oncology patients to co-create and enact new identities increasingly reflective of the nonlocalized nature of their cancer subtype. Three themes that arose from the data included the unique cancer-self, the invasion of cancer opposed to self, and the personification of the cancer within self.

Conclusions
Hematology oncology patients experience and claim a postdiagnosis identity that is self-described as distinct and highly specialized, and are distinct to solid tumor patients in aspects of systemic and total consumption of the self. This uniqueness is extended to the specific hematological cancer subtype down to genetics, indicating a strong “new” sense of self.

Implications for Practice
The manner in which hematology oncology patients in this study embraced notions of transformed self and isolating uniqueness provides practitioners with a lens through which new and innovative interventions can be constructed to improve patient care and psychosocial outcomes.
Remote System for Daily Symptom Monitoring During Systemic Anticancer Treatment
Authors: Coolbrandt Annemarie , Muylaert Kristof , Vandeneede Evi , Dooms Christophe , Wildiers Hans 
Published: August 2021

Background
Electronic systems for remotely monitoring symptoms during cancer treatment are increasingly being used. Most of them are intended for weekly or periodic symptom monitoring.

Objective
The aim of this study was to explore the feasibility and usability of a remote system for daily symptom monitoring during systemic anticancer treatment.

Methods
We offered a remote system for daily symptom monitoring to patients starting their first ever systemic therapy. Patient acceptance was observed as the proportion of patients showing interest in using the system. System users were invited to complete the “Health information Technology Usability Evaluation Scale,” and the number of patients’ self-reports was used to evaluate patient compliance.

Results
Of 465 patients, 239 (51.4%) showed interest in using the system; 111 system users reported a fairly good overall usability score (4 of 5), and perceived ease of use scored the highest (4.7 of 5) and perceived usefulness lowest (3.7 of 5). Their daily compliance was 68.8% (±31.1) at 3 weeks and 59.1% (±31.2) at 12 weeks after the start of treatment. Less than half of respondents (49.5%) and only one third (31.2%) perceived that their symptom reports were used by the nurses and doctors, respectively.

Conclusion
Half of patients starting their first ever systemic treatment showed interest in using a remote system for daily symptom monitoring. For these patients, daily symptom monitoring seems acceptable, and the system is well complied within the first 12 weeks of treatment.

Implication for Practice
A remote system for daily symptom monitoring is feasible and enables quick response to deteriorating symptoms. Use by healthcare professionals is a point of improvement.