bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Point-of-Care Serum Lactate Level and Mortality in Adult Sepsis Patients: A Community Hospital Setting
Authors: Charoentanyarak Suraphan , Sawunyavisuth Bundit , Deepai Sansanee , Sawanyawisuth Kittisak 
Published: March 2021

Introduction: Sepsis is a serious and emergency condition that may lead to acute circulatory failure associated with infection. Serum lactate level of over 4 mmol/L is associated with sepsis mortality. However, there is limited data on using a point of care (POC) for fingertip lactate level on sepsis mortality in community hospital setting. This study aimed to evaluate roles of POC for serum lactate with combination of clinical factors on mortality prediction in sepsis patients. Methods: This was a retrospective cohort study conducted at 7 community hospitals. The inclusion criteria were adult patients with diagnosis of sepsis who were tested for POC lactate level. Electronic chart reviews of eligible patients were performed. Predictors for mortality were computed using clinical factors and POC lactate level. Results: There were 1641 patients met the study criteria. The mortality rate was 8.96% (147 patients). There were 3 independent factors associated with mortality: age, co-morbid diseases, and POC lactate level. The adjusted odds ratio (95% CI) of POC lactate level was 1.025 (1.002, 1.048). The cut point of serum lactate was 1.6 mmol/L gave sensitivity of 79.59% and specificity of 32.10%. Conclusion: POC serum lactate level may be associated with mortality in sepsis patients at community hospitals. Lactate level of 1.6 mmol/L may be an indicator for mortality with good sensitivity. Physicians may consider more aggressive and prompt management in individuals with sepsis and POC serum lactate of 1.6 mmol/L or over.
Is Routine Use of Drain Really Necessary for Posterior Lumbar Interbody Fusion Surgery? A Retrospective Case Series with a Historical Control Group
Authors: Jang Hae-Dong , Park Seong San , Kim Kyungbum , Kim Eung-Ha , Lee Jae Chul , Choi Sung-Woo , Shin Byung-Joon 
Published: March 2021

Study Design: A retrospective case-control study. Objectives: The usefulness of a drain in spinal surgery has always been controversial. The purposes of this study were to determine the incidence of hematoma-related complications after posterior lumbar interbody fusion (PLIF) without a drain and to evaluate its usefulness. Methods: We included 347 consecutive patients with degenerative lumbar disease who underwent single- or double-level PLIF. The participants were divided into 2 groups by the use of a drain or not; drain group and no-drain group. Results: In 165 cases of PLIF without drain, there was neither a newly developed neurological deficit due to hematoma nor reoperation for hematoma evacuation. In the no-drain group, there were 5 (3.0%) patients who suffered from surgical site infection (SSI), all superficial, and 17 (10.3%) patients who complained of postoperative transient recurred leg pain, all treated conservatively. Days from surgery to ambulation and length of hospital stay (LOS) of the no-drain group were faster than those of the drain group ( P < 0.001). In a multiple regression analysis, a drain insertion was found to have a significant effect on the delayed ambulation and increased LOS. No significant differences existed between the 2 groups in additional surgery for hematoma evacuation, or SSI. Conclusions: No hematoma-related neurological deficits or reoperations caused by epidural hematoma and SSI were observed in the no-drain group. The no-drain group did not show significantly more frequent postoperative complications than the drain use group, hence the routine insertion of a drain following PLIF should be reconsidered carefully.
Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis
Authors: De Vega Brigita , Navarro Aida Ribera , Gibson Alexander , Kalaskar Deepak M. 
Published: March 2021

Study Design: Systematic review and meta-analysis. Objective: Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery. Methods: A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool. Results: Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001, I2 = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), P < .00 001, I2 = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), P = .33, I2 = 0%). Conclusions: Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.
Improvements After Arthroscopic Treatment for Femoroacetabular Impingement Syndrome in High-Level Ice Hockey Players: 2-Year Outcomes by Player Position
Authors: Lindman Ida , Abrahamsson Josefin , Öhlin Axel , Wörner Tobias , Eek Frida , Ayeni Olufemi R. , Senorski Eric Hamrin , Sansone Mikael 
Published: March 2021

Background: Ice hockey players often undergo arthroscopic treatment for femoroacetabular impingement syndrome (FAIS); however, only a few studies have reported postoperative patient-reported outcomes. It has been debated whether player position is related to FAIS. Purpose: To evaluate the change in patient-reported outcome measures (PROMs) in high-level ice hockey players from presurgery to 2 years after arthroscopic treatment for FAIS. The secondary aim was to evaluate differences in outcomes among player positions and whether stick handedness is related to the side of the symptomatic hip. Study Design: Case series; Level of evidence, 4. Methods: Ice hockey players undergoing treatment for FAIS between 2011 and 2019 were prospectively included. Preoperative and 2-year follow-up scores were collected for the following PROMs: HAGOS (Copenhagen Hip and Groin Outcome Score), iHOT-12 (12-item International Hip Outcome Tool), EQ-5D (EuroQol–5 Dimensions) and EQ-VAS (EuroQol–Visual Analog Scale), Hip Sports Activity Scale, and visual analog scale for overall hip function. Player position and stick handedness were collected from public sources. Preoperative and follow-up outcomes were compared for the entire cohort and among player positions. Results: The cohort included 172 ice hockey players with a mean age of 28 years, a mean body mass index of 25.6, and a mean symptom duration of 46.3 months. In the 120 players with 2-year follow-up data, there was significant improvement in all PROMs as compared with presurgery: HAGOS subscales (symptoms, 47.5 vs 68.0; pain, 57.0 vs 75.8; activities of daily living, 62.5 vs 81.0; sports, 40.0 vs 64.7; physical activity, 30.9 vs 57.2; quality of life, 32.5 vs 57.8), iHOT-12 (45.2 vs 66.7), EQ-5D (0.59 vs 0.75), EQ-VAS (68.3 vs 73.2), and visual analog scale for overall hip function (49.6 vs 69.2) ( P < .0001 for all). At 2-year follow-up, 83% reported satisfaction with the procedure. There was no difference in the improvement in PROMs among player positions. Further, there was no significant relationship between stick handedness and side of symptomatic hip; however, because of the number of bilateral procedures and large number of left-handed shooters, no conclusions could be drawn. Conclusion: High-level ice hockey players undergoing arthroscopic treatment for FAIS reported improvements in PROMs 2 years after surgery, regardless of player position.
Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain
Authors: Matsuura Tetsuya , Takata Yuki , Iwame Toshiyuki , Iwase Jyoji , Yokoyama Kenji , Takao Shoichiro , Nishio Susumu , Arisawa Kokichi , Sairyo Koichi 
Published: March 2021

Background: Reducing the number of pitches thrown is regarded as the most effective way to prevent throwing injuries in youth baseball pitchers. However, few studies have compared the effectiveness of limiting the pitch count versus the limiting the number of innings pitched in terms of elbow injuries. Hypothesis: We hypothesized that, compared with inning limits, pitch count limits would lead to greater decreases in elbow pain, range of motion deficits, positive moving valgus stress test results, and the risk of capitellar osteochondritis dissecans (OCD). Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed baseball pitchers aged 8 to 12 years in 2017 and 2018. Inning and pitch count limits in games were set to a daily maximum of 7 innings in 2017 and 70 pitches in 2018. Elbow pain, range of motion, and moving valgus stress test results were evaluated. The presence of capitellar OCD was assessed on ultrasonographic and radiographic images. Results: A total of 352 pitchers in 2017 and 367 pitchers in 2018 participated. The mean pitch count per game was lower in the pitch count limit (CL) group (52.5 ± 16.0) than in the inning limit (IL) group (98.2 ± 19.5) ( P < .001). Compared with the IL group, the CL group had significantly lower rates of elbow pain (40.9% vs 31.9%, respectively; P = .01) and reduced flexion (19.0% vs 10.6%, respectively; P = .001). Multivariate analysis revealed a significant association between elbow pain and age in both the IL and the CL groups ( P < .0001 and P = .02, respectively) and between OCD and elbow pain in the CL group ( P = .04). Conclusion: A pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.
Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump
Authors: Englander Zoë A. , Lau Brian C. , Wittstein Jocelyn R. , Goode Adam P. , DeFrate Louis E. 
Published: March 2021

Background: There is little in vivo data that describe the relationships between patellar tendon orientation, patellar tendon strain, and anterior cruciate ligament (ACL) strain during dynamic activities. Quantifying how the quadriceps load the ACL via the patellar tendon is important for understanding ACL injury mechanisms. Hypothesis: We hypothesized that flexion angle, patellar tendon orientation, and patellar tendon strain influence ACL strain during a single-leg jump. Specifically, we hypothesized that patellar tendon and ACL strains would increase concurrently when the knee is positioned near extension during the jump. Study Design: Descriptive laboratory study. Methods: Models of the femur, tibia, ACL, patellar tendon, and quadriceps tendon attachment sites of 8 male participants were generated from magnetic resonance imaging (MRI). High-speed biplanar radiographs during a single-leg jump were obtained. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones, ligament, and tendon attachment sites. Flexion angle, patellar tendon orientation, patellar tendon strain, and ACL strain were measured from the registered models. ACL and patellar tendon strains were approximated by normalizing their length at each knee position to their length at the time of MRI. Two separate bivariate linear regression models were used to assess relationships between flexion angle and patellar tendon orientation and between ACL strain and patellar tendon strain. A multivariate linear regression model was used to assess whether flexion angle and patellar tendon strain were significant predictors of ACL strain during the inflight and landing portions of the jump. Results: Both flexion angle and patellar tendon strain were significant predictors ( P < .05) of ACL strain. These results indicate that elevated ACL and patellar tendon strains were observed concurrently when the knee was positioned near extension. Conclusion: Concurrent increases in patellar tendon and ACL strains indicate that the quadriceps load the ACL via the patellar tendon when the knee is positioned near extension. Clinical Relevance: Increased ACL strain when the knee is positioned near extension before landing may be due to quadriceps contraction. Thus, landing with unanticipated timing on an extended knee may increase vulnerability to ACL injury as a taut ligament is more likely to fail.
Refining contextual inquiry to maximize generalizability and accelerate the implementation process
Authors: Davis Molly , Beidas Rinad S 
Published: March 2021

Background: While contextual inquiry, or in-depth mixed-methods work to study the implementation context, is critical for understanding the setting in which a behavioral health evidence-based practice (EBP) will be implemented, current methods to determine potential barriers and facilitators to implementation are often conducted in a single setting and/or for a single EBP per study, often taking 1–2 years to complete. To maximize generalizability and reduce the research-to-practice gap efficiently, it is important to move toward cross-sector and/or cross-EBP contextual inquiry. Methods: In this viewpoint, we argue for (a) collaborative research studies that seek to identify determinants of implementation that are similar and unique across different settings and EBPs, using rapid approaches when possible; (b) enhanced synthesis of existing research on implementation determinants to minimize duplication of contextual inquiry efforts; and (c) clear rationale for why additional in-depth or rapid contextual inquiry is needed before it is conducted. Throughout this viewpoint, the need to balance scientific rigor and speed are considered. Conclusions: Overall, this viewpoint seeks to encourage researchers to consolidate and share knowledge on barriers and facilitators to implementation to prepare for the scaling out of much needed implementation strategies and interventions for improving health. Plain language summary: Significant time and resources are often devoted to understanding what makes it easier or harder to use best practices for behavioral health concerns in health care settings. The goal of the current viewpoint is to offer ways to streamline this process so that high-quality behavioral health services can reach the patients that need them more quickly. In particular, we advocate for ways to share knowledge among researchers and learn from prior findings to more efficiently identify what makes it easier or harder to use best practices for addressing behavioral health problems in a given setting (e.g., primary care, schools, specialty mental health).
VE-cadherin cleavage in sleep apnoea: new insights into intermittent hypoxia-related endothelial permeability
Authors: Harki Olfa , Tamisier Renaud , Pépin Jean-Louis , Bailly Sébastien , Mahmani Anissa , Gonthier Brigitte , Salomon Aude , Vilgrain Isabelle , Faury Gilles , Briançon-Marjollet Anne 
Published: March 2021

BackgroundObstructive sleep apnoea (OSA) causes intermittent hypoxia that in turn induces endothelial dysfunction and atherosclerosis progression. We hypothesised that VE-cadherin cleavage, detected by its released extracellular fragment solubilised in the blood (sVE), may be an early indicator of emergent abnormal endothelial permeability. Our aim was to assess VE-cadherin cleavage in OSA patients and inin vivoandin vitrointermittent hypoxia models to decipher the cellular mechanisms and consequences.MethodsSera from seven healthy volunteers exposed to 14 nights of intermittent hypoxia, 43 OSA patients and 31 healthy control subjects were analysed for their sVE content. Human aortic endothelial cells (HAECs) were exposed to 6 h of intermittent hypoxiain vitro, with or without an antioxidant or inhibitors of hypoxia-inducible factor (HIF)-1, tyrosine kinases or vascular endothelial growth factor (VEGF) pathways. VE-cadherin cleavage and phosphorylation were evaluated, and endothelial permeability was assessed by measuring transendothelial electrical resistance (TEER) and fluorescein isothiocyanate (FITC)–dextran flux.ResultssVE was significantly elevated in sera from healthy volunteers submitted to intermittent hypoxia and OSA patients before treatment, but conversely decreased in OSA patients after 6 months of continuous positive airway pressure treatment. OSA was the main factor accounting for sVE variations in a multivariate analysis. Inin vitroexperiments, cleavage and expression of VE-cadherin increased upon HAEC exposure to intermittent hypoxia. TEER decreased and FITC–dextran flux increased. These effects were reversed by all of the pharmacological inhibitors tested.ConclusionsWe suggest that in OSA, intermittent hypoxia increases endothelial permeability in OSA by inducing VE-cadherin cleavage through reactive oxygen species production, and activation of HIF-1, VEGF and tyrosine kinase pathways.
Reference equations for tidal breathing parameters using structured light plethysmography
Authors: Motamedi-Fakhr Shayan , Iles Richard , Barker Nicki , Alexander John , Cooper Brendan G. 
Published: March 2021

Tidal breathing measurements can be used to identify changes in respiratory status. Structured light plethysmography (SLP) is a non-contact tidal breathing measurement technique. Lack of reference equations for SLP parameters makes clinical decision-making difficult. We have developed a set of growth-adjusted reference equations for seven clinically pertinent parameters of respiratory rate (fR), inspiratory time (tI), expiratory time (tE), duty cycle (tI/total breath time), phase (thoraco-abdominal asynchrony (TAA)), relative thoracic contribution (RTC) and tidal inspiratory/expiratory flow at 50% volume (IE50).Reference equations were developed based on a cohort of 198 seated healthy subjects (age 2–75 years, height 82–194 cm, 108 males). We adopted the same methodological approach as the Global Lung Function Initiative (GLI) report on spirometric reference equations. 5 min of tidal breathing was recorded per subject. Parameters were summarised with their medians. The supplementary material provided is an integral part of this work and a reference range calculator is provided therein.We found predictedfRto decrease with age and height rapidly in the first 20 years and slowly thereafter. ExpectedtI,tEand RTC followed the opposite trend. RTC was 6.7% higher in females. Duty cycle increased with age, peaked at 13 years and decreased thereafter. TAA was high and variable in early life and declined rapidly with age. Predicted IE50 was constant, as it did not correlate with growth.These reference ranges for seven key measures ensure that clinicians and researchers can identify tidal breathing patterns in disease and better understand and interpret SLP and tidal breathing data.
Nailing femoral shaft fracture with postless distraction technique: a new technique enabled by shape-conforming pad
Authors: Aprato Alessandro , Secco Davide Carlo , D’Amelio Andrea , Grosso Elena , Massè Alessandro 
Published: March 2021

Abstract
Background
Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications.

Methods
We reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications.

Results
Median age was 53 years, and median weight was 70 kg (range 50–103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% “excellent” reduction for subtrochanteric fractures, while 81 versus 79% “excellent” reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique.

Conclusions
Our results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail.
Level of evidence:
IV