bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Effectiveness of an Outpatient Multidisciplinary Chronic Pain Management Telementoring Service
Authors: Gersch William D. , Delate Thomas , Bergquist Karly M. , Smith Karen 
Published: July 2021

Objective:
The objective of this study was to assess the effectiveness of a Pain E-Consult Program (PEP), a multidisciplinary telementoring service based on the Extension for Community Healthcare Outcomes (ECHO) model to reduce opioid use in the outpatient setting.

Materials and Methods:
This was a retrospective matched cohort study conducted in an integrated health care delivery system. Adult patients without cancer and with a 90-day morphine milligram equivalent (MME) ≥30 mg/d between April 1, 2016, and June 30, 2017, were included. Patients whose primary care clinician received the PEP (observation) were compared with usual care (control) patients. Observation patients were matched up to 1:5 to control patients. Outcomes included change in MME and initiation of nonopioid alternative medications. Multivariable regression analyses were performed.

Results:
A total of 665 patients were matched: 125 and 540 in the observation and control groups, respectively. Patients were primarily female, white, and Medicare beneficiaries. The observation group had a statistically significantly greater decrease in median MME/day during the 6-month (−7.4 vs. 1.5 mg, P=0.002) and 12-month (−15.1 vs. −2.8 mg, P<0.001) follow-up and rates of ≥20% decrease (6 mo: 41.6% vs. 24.6%, P=0.003; 12 mo: 48.0% vs. 32.6%, P=0.017). There were no differences in the rates of initiation of nonopioid alternative medications.

Conclusions:
A PEP was associated with greater reductions in MME/day compared with usual care despite similar rates of nonopioid alternative medication initiation. A prospective randomized study of this program should be undertaken to confirm these findings.
Is severe COVID-19 a cytokine storm syndrome: a hyperinflammatory debate
Authors: Mehta Puja , Fajgenbaum David C. 
Published: July 2021

Purpose of review
The COVID-19 pandemic is a global public health crisis with considerable mortality and morbidity. A role for cytokine storm and therapeutic immunomodulation in a subgroup of patients with severe COVID-19 was proposed early in the pandemic. The concept of cytokine storm in COVID-19 has been criticised, given the lack of clear definition and relatively modest cytokinaemia (which may be necessary for viral clearance) compared with acute respiratory distress syndrome and bacterial sepsis. Here we consider the arguments for and against the concept of cytokine storm in COVID-19.

Recent findings
Several criteria have been proposed to identify the subgroup of COVID-19 patients exhibiting a cytokine storm. The beneficial effects of corticosteroids and interleukin-6 inhibition suggest that inflammation is a modifiable pathogenic component of severe COVID-19. The presence of genetic polymorphisms and pathogenic auto-autoantibodies in severe COVID-19 also suggests a significant contribution of immune dysregulation to poor outcomes.

Summary
Hyperinflammation is a key component of severe COVID-19, residing underneath the cytokine storm umbrella term, associated with poor outcomes. Better understanding of the aetiopathogenesis, with identification of biomarkers to predict treatment responses and prognosis, will hopefully enable a stratified and ultimately precision medicine approach.
Analysis of Factors Associated with Return-to-Work After Lumbar Surgery up to 2-Years Follow-up
Authors: Macki Mohamed , Anand Sharath Kumar , Hamilton Travis , Lim Seokchun , Mansour Tarek , Bazydlo Michael , Schultz Lonni , Abdulhak Muwaffak M. , Khalil Jad G. , Park Paul , Aleem Ilyas , Easton Richard , Schwalb Jason M. , Nerenz David , Chang Victor 
Published: July 2021

Study Design.
Michigan Spine Surgery Improvement Collaborative (MSSIC) prospectively collects data on all patients undergoing operations for degenerative and/or deformity indications.

Objective.
We aimed to identify which factors are significantly associated with return-to-work after lumbar surgery at long-term follow-up.

Summary of Background Data.
Prior publications have created a clinically relevant predictive model for return-to-work, wherein education, gender, race, comorbidities, and preoperative symptoms increased likelihood of return-to-work at 3 months after lumbar surgery. We sought to determine if these trends 1) persisted at 1 year and 2 years postoperatively; or 2) differed among preoperatively employed versus unemployed patients.

Methods.
MSSIC was queried for all patients undergoing lumbar operations (2014–2019). All patients intended to return-to-work postoperatively. Patients were followed for up to 2 years postoperatively. Measures of association were calculated with multivariable generalized estimating equations.

Results.
Return-to-work increased from 63% (3542/5591) at 90 days postoperatively to 75% (3143/4147) at 1 year and 74% (2133/2866) at 2 years postoperatively. Following generalized estimating equations, neither clinical nor surgical variables predicted return-to-work at all three time intervals: 90 days, 1 year, and 2 years postoperatively. Only socioeconomic factors reached statistical significance at all follow-up points. Preoperative employment followed by insurance status had the greatest associations with return-to-work. In a subanalysis of patients who were preoperatively employed, insurance was the only factor with significant associations with return-to-work at all three follow-up intervals. The return-to-work rates among unemployed patients at baseline increased from 29% (455/1100) at 90 days, 44% (495/608) at 1 year, and 46% (366/426) at 2 years postoperatively. The only two significant factors associated with return-to-work at all three follow-up intervals were Medicaid, as compared with private insurance, and male gender.

Conclusion.
In patients inquiring about long-term return-to-work after lumbar surgery, insurance status represents the important determinant of employment status.

Level of Evidence: 2
Upper Quadrant Pain and Disability Associated with a Cross-Sectional Area of Deep and Superficial Neck Muscles
Authors: Radosher Avital , Kalichman Leonid , Moshe Shlomo , Ezra David , Simonovich Azaria , Droujin Jonathan , Alperovitch-Najenson Deborah 
Published: July 2021

Study Design.
An analytical cross-sectional computed tomography (CT) study.

Objective.
To investigate the association of the cross-sectional area (CSA) and density of neck muscles (sternocleidomastoid, upper trapezius, levator scapulae, anterior scalene, longus coli, longus capitis) with upper quadrant pain and disability.

Summary of Background Data.
Neck pain, a common condition, causes substantial disability to individuals. The deep cervical flexor muscles are impaired in persons with neck pain. These muscles play a greater role in maintaining stable head postures, whereas, superficial muscles are responsible for peak exertions and reinforcing spinal stability at terminal head postures.

Methods.
Two hundred thirty consecutive individuals suffering from neck pain were referred to CT scans; 124/230 complied with the inclusion and exclusion criteria. Subjects were interviewed and the measurements of the CSA and muscle density were extracted from the scans.

Results.
Muscles associated with quick disability of the arms, shoulders, and hand questionnaire (QDASH) were the lateral posterior group (LPG) CSA C3–C4 on the right side (beta = –0.31, P = 0.029); the sternocleidomastoid (SCM) CSA C3–C4 on the left side (beta = 0.29, P = 0.031); the LPG CSA C3–C4 on the left side (beta = –0.49, P = 0.000); the LCM CSA C5–C6 on the right side (beta = –0.19, P = 0.049); the LPG CSA C5–C6 on the right side (beta = –0.36, P = 0.012); and the LPG CSA C5–C6 on the left side (beta = –0.42, P = 0.002). Further analyses with radiculopathy acting as an augmenting/enhancing variable (moderator), showed an increase in the model strength (r
2 = 0.25) with a stronger prediction of pain and disability. Muscle measurements did not predict neck disability index (NDI) scores.

Conclusion.
By using an accurate measuring tool, we found an association of the deep and superficial neck muscles’ CSA with upper extremities’ pain and disability. When performing manual work, a special load is placed on the shoulders and neck muscles. Future research should focus on examining the effectiveness of exercise-type intervention programs to strengthen the deep neck and upper extremities’ muscles in order to prevent muscle fatigue.

Level of Evidence: 2
Epidemiology of Spine-Related Neurologic Injuries in Professional Baseball Players
Authors: Makhni Melvin C. , Curriero Frank C. , Yeung Caleb M. , Leung Eric , Kvit Anton , Mroz Tom , Ahmad Christopher S. , Lehman Ronald A. 
Published: July 2021

Study Design.
A retrospective case series study.

Objective.
To analyze the epidemiology of diagnoses of degenerative cervical and lumbar spinal conditions among Major League Baseball (MLB) and Minor League Baseball (MiLB) players.

Summary of Background Data.
Repetitive high-energy forces in professional baseball players may predispose them to degenerative cervical and lumbar spinal conditions. There is a lack of data concerning the epidemiology of these injuries in professional baseball.

Methods.
Deidentified data on spine injuries were collected from all MLB and MiLB teams from 2011 to 2016 from the MLB-commissioned Health and Injury Tracking System database. Rates of diagnoses of common degenerative spinal conditions as well as their impact on days missed due to injury, necessitation of surgery, and player participation and career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete-exposures in concordance with prior studies.

Results.
Over 2011 to 2016, 4246 days of play were missed due to 172 spine-related injuries. 73.3% were related to the lumbar spine and 26.7% to the cervical spine. There were similar rates of surgery required for these injuries (18.3% of lumbar injuries vs. 13.0% of cervical injuries, P = 0.2164). Mean age of players with cervical injuries was higher compared with the lumbar group (27.5 vs. 25.4, P = 0.0119). Average number of days missed due to lumbar injuries was significantly higher than those due to cervical injuries (34.1 vs. 21.6 d, P = 0.0468). Spine injury rates for pitchers were significantly higher than those of other position players (0.086 per 1000 athlete-exposures vs. 0.037, P < 0.0001).

Conclusion.
Neurologic diagnoses relating to the cervical and lumbar spine lead to substantial disability among MLB and MiLB players as well as days missed from play. Pitchers have over double the rates of injury compared with other position players. Lumbar conditions were associated with significantly higher numbers of days missed from play.

Level of Evidence: 4
Protein Supplement and Enhanced Recovery After Posterior Spine Fusion Surgery
Authors: Khalooeifard Razieh , Oraee-Yazdani Saeed , Keikhaee Mohsen , Shariatpanahi Zahra Vahdat 
Published: July 2021

Study Design:
This was a randomized, double-blind clinical trial study.

Objective:
The objective of this study was to evaluate the effect of protein supplementation on vertebral fusion and enhanced recovery after posterior spine fusion (PSF) surgery.

Summary of Background Data:
Nonfusion is one of the most common complications of lumbar spine surgery. It has been shown that protein plays an important role in bone repair; however, its correlation to vertebral fusion following PSF surgery is unknown.

Patients and Methods:
In this randomized, double-blind clinical trial study, the intervention group received a diet with 1.2 g of protein plus high-protein supplement (36 g whey protein), and the control group received a similar diet, except for starch as a placebo from 48 hours before to 1 month after surgery.

Results:
The intervention group showed a significantly higher rate of vertebral fusion compared with the control group (P=0.019). Surgical site infection and pain were significantly lower in the intervention group. A significant difference was found in the wound healing rate in favor of the intervention group. The rates of decrease in serum high-sensitivity C-reactive protein levels and increase in serum levels of insulin-like growth factor 1, albumin, total protein, and alkaline phosphatase were greater in the intervention group than in the control group (P<0.001).

Conclusions:
Increased protein intake improves vertebral fusion and enhances recovery in patients undergoing PSF. This was the first study to investigate the effect of protein on fusion and healing factors; as a result, further clinical trials are needed to confirm the current results.
Achieving the Most Effective Hanging Points at the Lower End of the Face for Thread Lifting: Quantitative Measurement of Tissue Resistance in Different Facial Layers
Authors: Rungsawang Chalermquan , Tansatit Tanvaa , Fasunloye Liz Kenny , Uruwan Sukanya 
Published: July 2021

Summary:
The thread lift procedure is a minimally invasive alternative to facelift surgery. The hanging point, which the terminal end of the thread is hooked into, is an important component. If it is loose and cannot stabilize the passage when the inserted thread is pulled, the lifting effect will fail. Therefore, the aim of this study was to elucidate the ability of the tissue to support the thread attachment in the different facial layers while performing this procedure. Twenty hemi-faces of 10 soft cadavers, which were divided into 45 blocks, were used to measure the tissue resistance in the midface area. The resistance of the soft tissue in the four facial layers in each block was measured while a 22G cannula connected with a force gauge was passed through it. The results showed that the tissue resistance in the sub-SMAS was higher than the SMAS and subcutaneous layers in the blocks located in the nasolabial and perioral regions. This was also significantly greater than the resistance in the subcutaneous layer in the three medial blocks below the oral commissure (P < 0.05). However, the low resistance of the sub-SMAS was found in the blocks located in the buccal and lower parotidomasseteric regions. Thus, it was preferable that the hanging point was based in the deep plane (sub-SMAS and SMAS layers) of the nasolabial, perioral, and upper parotidomasseteric regions. Moreover, the sub-SMAS layer within the buccal and lower parotidomasseteric regions should be avoided due to the loose attachment in the buccal capsule and subplatysmal fat.
Method for Flushing Surgical Drains Using a Butterfly Needle
Authors: Becker Hilton , Abadi Kevin , Slutsky Hanna , Vazquez Oscar Adrian 
Published: July 2021

Summary:
Surgical drains placed during breast surgery can become blocked by clots or other debris, which may lead to infection of the prosthetic and seroma or hematoma formation from improper drainage. Current methods involve stripping the drain, which does not clear the pores inside the cavity, or flushing the drain at the opposite end using a syringe with the debris going into the cavity being drained. The authors propose an easily available flushing option using a butterfly needle inserted at an angle that provides a sterile and efficient method for flushing the drain near the body cavity and clearing blockages. This creates a self-sealing valve that can be reinforced with Tegaderm and allows for the use of antibiotics or hemostatic agents through it. The primary author has performed this technique in-office in multiple patients undergoing breast augmentation, mastopexy/mammaplasty, breast reconstruction after mastectomy, and breast revision surgeries requiring implants or expanders with satisfactory results and no complications. This method is limited in that it must be performed by a health care professional, but it is easy to perform.
Utility of urinary albumin excretion as an index for stratifying the residual cardiovascular risk in patients undergoing antihypertensive agents treatment
Authors: Kikuchi Yawara , Tanaka Fumitaka , Nakamura Motoyuki , Tanno Kozo , Onoda Toshiyuki , Ohsawa Masaki , Sakata Kiyomi , Omama Shinichi , Ogasawara Kuniaki , Yonekura Yuki , Itai Kazuyoshi , Kuribayashi Toru , Ishigaki Yasushi , Okayama Akira , Asahi Koichi 
Published: July 2021

Background:
Patients treated with antihypertensive medication, even those with well controlled blood pressure (BP), are at higher risk for the development of atherosclerotic cardiovascular disease (ASCVD) in comparison to nonhypertensive individuals with optimal risk levels. We hypothesized that this residual risk could be stratified based on urinary albumin excretion (UAE).

Methods:
A total of 13 082 middle-aged and older individuals with SBP/DBP of less than 160/100 mmHg and urinary albumin-to-creatinine ratios (UACRs) of less than 300 mg/g, and who were free from ASCVD events, were followed to investigate the incidence of ASCVD. The baseline BP was classified into four categories: normal BP (BP1), high normal BP (BP2), elevated BP (BP3), and grade 1 hypertension (BP4) based on the 2019 Japanese Society of Hypertension guidelines.

Results:
After an average 10.6 ± 2.6 years of follow-up, the multivariable hazard ratio for the development of ASCVD (n = 994) was already increased in medicated hypertensive patients with BP1 in comparison with untreated individuals with BP1; however, among medicated hypertensive patients, this risk was separated between the UAE groups, which were classified according to the median UACR (male, 15.4 mg/g; female, 19.0 mg/g). In medicated hypertensive patients with any category of BP1-BP3, the adjusted risk of the development of ASCVD in those with lower and higher UACRs was comparable to that observed in untreated individuals in the BP1 and BP4 categories, respectively.

Conclusion:
In medicated patients with well controlled hypertension, UAE is useful for stratifying the residual risk of developing ASCVD in comparison to nonhypertensive individuals with optimal risk levels.
Cataract surgery in herpes simplex virus ocular disease
Authors: Al-Ani Haya H. , Lu Lucy M. , Meyer Jay J. , Niederer Rachael L. 
Published: July 2021

Purpose:
To investigate the outcomes and complications associated with cataract surgery in eyes with herpes simplex virus (HSV)-related anterior segment ocular disease.

Setting:
Public tertiary center in Auckland, New Zealand.

Design:
Retrospective observational cohort study.

Methods:
Clinical records of patients diagnosed with HSV-related keratitis and/or anterior uveitis who underwent subsequent cataract surgery in the affected eye were reviewed. Main outcomes measured were visual outcome, complications, and recurrence.

Results:
37 eyes of 37 patients were included. Intraoperative complications occurred in 1 patient (2.7%) with iris prolapse. Keratitis or uveitis recurred postoperatively in 17 patients (45.9%) 8 patients (22.5%); 22.5% experienced recurrences in the first year postoperatively. 1 case (2.7%) of postoperative cystoid macular edema and 1 (2.7%) postoperative endophthalmitis occurred. Corrected distance visual acuity at 3 months was >20/50 in 21 patients (70.0%), 20/50 to 20/200 in 4 patients (12.9%), and ≤20/200 in 6 patients (19.4%). Vision improved in 26 eyes (83.9%) and worsened in only 1 eye (3.2%). Risk for recurrent inflammation was associated with a greater number of recurrences prior to surgery (hazard rate [HR] 1.31), time quiescent prior to surgery (HR 0.48), and iris transillumination defect at preoperative assessment (HR 57.66).

Conclusions:
Cataract surgery in eyes with previous HSV disease may improve visual acuity for most of the eyes but, overall, carries a guarded prognosis, particularly in eyes with corneal scarring. There is a significant risk for recurrent inflammation in the first year postoperatively. If possible, surgeons should ensure a period of disease quiescence prior to surgery.
Treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients: Rationale and baseline characteristics of the TAROT-HF study
Authors: Lin Wen-Yu , Chung Fa-Po , Liao Chia-Te , Huang Jin-Long , Liang Huai-Wen , Lee Ying-Hsiang , Lin Po-Lin , Chiou Wei-Ru , Hsu Chien-Yi , Chang Hung-Yu 
Published: July 2021

Background:
This study used a real-world database to investigate the prescription patterns of sacubitril/valsartan (Sac/Val) among Taiwanese patients with heart failure with reduced ejection fraction (HFrEF).

Methods:
The Treatment with Angiotensin Receptor neprilysin inhibitor fOr Taiwan Heart Failure patients (TAROT-HF) study is a principal investigator–initiated, multicenter, observational, retrospective study on Taiwanese HFrEF patients. A total of 1772 patients with HFrEF (mean age 62.5 years, 75.3% male, mean left ventricular ejection fraction [LVEF] 29.3%) who received Sac/Val at 10 hospitals between 2017 and 2018 were enrolled at the date of Sac/Val initiation. Among these patients, 585 (33%) initially received Sac/Val during acute decompensated heart failure (HF) hospitalization (TAROT-AHF arm), whereas 1187 (67%) initially received the same at the outpatient clinic (TAROT-CHF arm).

Results:
A total of 1343 (75.8%) patients received an initial dose of 50 mg twice daily or fewer, whereas 422 (23.8%) received the standard initiation dose (100 mg twice daily). During outpatient Sac/Val initiation, the mean dosages were significantly higher than that following hospitalization (117 ± 55 mg vs 109 ± 57 mg; p = 0.014). Multivariate analysis identified younger age, higher systolic blood pressure, higher LVEF, prior use of renin-angiotensin system inhibitors, use of ivabradine, and a history of diabetes mellitus as independent factors for initiating a standard Sac/Val dose. Over a follow-up period of 18 months, incidences of cardiovascular death or first unplanned HF hospitalization were 18.69 and 33.11 per 100-person years for the TAROT-CHF and TAROT-AHF arms, respectively.

Conclusion:
The TAROT-HF study provided an opportunity to describe the clinical features of patients with HFrEF who received Sac/Val, assess the real-world utilization and efficacy of Sac/Val, and compare these patients with those included in prior registries.