bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the Position of the Junctional Vertebrae After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: Implication in Risk Assessment of Proximal Junctional Kyphosis Development
Authors: Homans Jelle F. , Kruyt Moyo C. , Schlösser Tom P.C. , Colo Dino , Rogers Kenneth , Shah Suken A. , Flynn John M. , Castelein René M. , Pasha Saba 
Published: May 2019

Background:
The development of proximal junctional kyphosis (PJK) after posterior spinal fusion in adolescent idiopathic scoliosis is a major problem. Changes in the global sagittal parameters as they relate to PJK have been reported after surgery, however, the relationships between the changes in the upper-instrumented vertebra (UIV) during and after surgery as they relate to development of PJK have not been quantified. We hypothesize that the compensatory changes in the unfused segments of the spine over time are correlated with the surgically induced changes in the UIV position.

Methods:
Sixty adolescent idiopathic scoliosis patients (with at least 1-year follow-up) who underwent posterior spinal surgery were included retrospectively. Global spinal parameters were calculated using 3-dimensional models of the spine, additional parameters [proximal junctional kyphosis angle (PJKA), cervical lordosis angle] were measured manually before surgery and at 3 postoperative follow-ups. The 3-dimensional position of the vertebral body centroids was calculated for T1, UIV, and lower-instrumented vertebra at all timepoints. The sagittal position of T1, UIV, and lower-instrumented vertebra were correlated to the cervical lordosis, PJKA, lumbar lordosis, and pelvic tilt.

Results:
The position of T1 and UIV were significantly more anterior at first erect for patients who developed PJK. The posterior shift of UIV at the most recent follow-up as compared with the preoperative position was significant in both the PJK and non-PJK cohort. A larger anterior shift in UIV at first erect correlated with a larger T1 and UIV posterior shift at the most recent follow-up. At the most recent follow-up, a more posterior position of the UIV correlated with a larger angle of PJKA (P<0.05).

Conclusion:
Both a larger anterior shift of UIV between preoperative and first erect and a more posterior position of UIV at the most recent follow-up was correlated with a higher PJKA. A larger anterior shift in the position of the UIV after surgery was associated with a higher posterior shift of UIV at the last follow-up. The surgically induced changes in the UIV are an important parameter associated with the development of PJK.

Level of Evidence:
Level IV.
Obese Children Have Different Forearm Fracture Characteristics Compared With Normal-weight Children
Authors: Li Ying , James Chrystina , Byl Nicole , Sessel Jordyn , Caird Michelle S. , Farley Frances A. , Robbins Christopher 
Published: May 2019

Background:
Current estimates suggest that one third of children and adolescents are overweight and 1 in 5 are obese. Obese children are at increased risk of sustaining more complex fractures, failing nonoperative treatment, and experiencing more complications during treatment. The purpose of this study was to compare forearm fracture characteristics, treatment, and complications in grouped overweight and obese [OW+OB; body mass index-for-age percentile (BMI%) ≥85] pediatric patients compared with normal-weight (NW; BMI%≤84) patients.

Methods:
This was a retrospective comparative study of patients aged 2 to 17 years old who presented with a forearm fracture resulting from low-energy trauma between January 2010 and September 2017. Patients with incomplete height and weight data; an underlying condition that predisposes to fractures or altered fracture healing; and torus, greenstick, pathologic, and high-energy fractures were excluded. Demographics, fracture characteristics, treatment, and complications were recorded. Descriptive and inferential analyses were conducted.

Results:
A total of 565 patients (403 NW, 162 OW+OB) met the inclusion criteria. NW children sustained open fractures nearly twice as frequently as the OW+OB children but this was not statistically significant (9.7% vs. 4.9%; P=0.065). Subanalysis showed that NW children were 4.1 times more likely to sustain an open fracture compared with obese (BMI%≥95) children (9.7% vs. 2.4%; P=0.029). A significant relationship was found between BMI% and location of the fracture, the bones involved, and fracture type. The OW+OB children sustained more distal forearm fractures than midshaft and proximal forearm fractures. Isolated radial shaft fractures were more common in the OW+OB group, whereas isolated ulnar shaft fractures were more common in the NW group. There was no difference in associated neurovascular injury, initial nonoperative versus operative management, failure of nonoperative treatment, and treatment complications.

Conclusions:
OW+OB children have different forearm fracture characteristics compared with their NW peers. The thick soft tissue envelope in obese children may be protective against an open forearm fracture. In contrast to previous studies, obesity was not associated with failure of nonoperative treatment or a higher rate of complications.

Level of Evidence:
Level III—prognostic.
Collection of Common Knee Patient-reported Outcome Instruments by Automated Mobile Phone Text Messaging in Pediatric Sports Medicine
Authors: Mellor Xochitl , Buczek Matthew J. , Adams Alexander J. , Lawrence J. Todd R. , Ganley Theodore J. , Shah Apurva S. 
Published: May 2019

Background:
Patient-reported outcome (PRO) instruments measure health status in a variety of domains. With the proliferation of mobile phones, delivering PROs across patient-friendly platforms (eg, apps, text messaging) may increase completion rates, particularly among children. The purpose of this study was to validate the collection of common knee PROs in sports medicine with text messaging by correlating text-messaging responses with paper delivery in adolescents.

Methods:
Patients presenting to a hospital-based pediatric orthopaedic sports medicine clinic with a knee injury were enrolled prospectively. Paper versions of the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and the Pediatric Functional Activity Brief Scale (Pedi-Fab Scale) were completed during initial clinic visits. Over the next 72 hours, patients completed the text message delivery of the Pedi-IKDC and Pedi-Fab Scale. Correlations between paper and text message delivery of the 2 PROs were assessed.

Results:
Ninety-one patients (mean age: 16.0±2.0 y; 48% females) enrolled in the text-messaging study, with 55 (60.4%) completing the Pedi-Fab Scale, 48 (52.7%) completing the Pedi-IKDC, and 39 (42.9%) completing both PROs. The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-Fab Scale was 0.95 (P<0.001; 95% confidence interval, 0.91-0.97). The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-IKDC was 0.96 (P<0.001; 95% confidence interval, 0.93-0.98). Average Pedi-Fab scores on paper (M=12.7) and mobile phone (M=12.3) were not significantly different (P=0.52). Similarly, average Pedi-IKDC scores on paper (M=68.8) and mobile phone (M=67.7) were not significantly different (P=0.41). Average completion time for the text delivered Pedi-Fab and Pedi-IKDC were 102±224 and 159±155 minutes, respectively. High school enrollment (P=0.025), female sex (P=0.036), and race (P=0.002) were significantly associated with text completion of Pedi-IKDC.

Conclusions:
Text message delivery using mobile phones permits valid assessment of Pedi-IKDC and Pedi-Fab scores in adolescents. Questionnaire delivery by automated text messaging allows asynchronous response and may increase compliance and reduce the labor cost of collecting PROs.

Level of Evidence:
Level III—prospective cohort study.
Delayed Penetration of the Thoracic Aorta by Pedicle Screws
Authors: Schermann Haggai , Mirovsky Yigal , Chechik Yigal 
Published: May 2019

Study Design.
A case report.

Objective.
Presentation of a patient diagnosed with perforation of the aorta by pedicle screws at levels T6 and T9 2 years after spinal fusion, who was advised no intervention. Review of other reported cases that did not undergo excision of the penetrating screws.

Summary of Background Data.
More than 30 cases of aortic penetration by pedicle screws were described. Gradual penetration of the screws into the aorta rarely causes symptoms other than backache. However, only two cases were treated conservatively.

Methods.
A 65-year-old female patient underwent spinal decompression and T5-T10 posterior fusion following a spinal abscess. Two years and 8 months postoperatively, she underwent a computed tomography scan for suspicion of spinal hardware infection, which showed T6 and T10 screws penetrating the thoracic aorta.

Results.
Due to high morbidity, the patient was not offered an operation for screw excision.

Conclusion.
This case report adds to the only two previous reports of patients who did not undergo revision of pedicle screws penetrating thoracic aorta.

Level of Evidence: 5
Cardiac Arrest Prior to Venoarterial Extracorporeal Membrane Oxygenation: Risk Factors for Mortality
Authors: Fux Thomas , Holm Manne , Corbascio Matthias , van der Linden Jan 
Published: May 2019

Objectives:
Mortality after cardiac arrest remains high despite initiation of venoarterial extracorporeal membrane oxygenation. We aimed to identify pre-venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality in patients with witnessed cardiac arrest and with greater than or equal to 1 minute of cardiopulmonary resuscitation before venoarterial extracorporeal membrane oxygenation. The association between preimplant variables and all-cause mortality at 90 days was analyzed with multivariable logistic regression.

Design:
Retrospective observational cohort study.

Setting:
Tertiary medical center.

Patients:
Seventy-two consecutive patients with cardiac arrest prior to venoarterial extracorporeal membrane oxygenation cannulation.

Interventions:
None.

Measurements and Main Results:
Median age was 56 years (interquartile range, 43–56 yr), 75% (n = 54) were men. Out-of-hospital cardiac arrest occurred in 12% (n = 9) of the patients. Initial cardiac rhythm was nonshockable in 57% (n = 41) and shockable in 43% (n = 31) of patients. Median cardiopulmonary resuscitation duration was 21 minutes (interquartile range, 10–73 min; range, 1–197 min]. No return of spontaneous circulation was present in 64% (n = 46) and postarrest cardiogenic shock in 36% (n = 26) of the patients at venoarterial extracorporeal membrane oxygenation cannulation. Median duration of venoarterial extracorporeal membrane oxygenation was 5 days (interquartile range, 2–12 d). The 90-day overall mortality and in-hospital mortality were 57% (n = 41), 53% (n = 38) died during venoarterial extracorporeal membrane oxygenation, and 43% (n = 31) were successfully weaned. All survivors had Cerebral Performance Category score 1–2 at discharge to home. Multivariable logistic regression analysis identified initial nonshockable cardiac arrest rhythm (odds ratio, 12.2; 95% CI, 2.83–52.7; p = 0.001), arterial lactate (odds ratio per unit, 1.15; 95% CI, 1.01–1.31; p = 0.041), and ischemic heart disease (7.39; 95% CI, 1.57–34.7; p = 0.011) as independent risk factors of 90-day mortality, whereas low-flow duration, return of spontaneous circulation, and age were not.

Conclusions:
In 72 patients with cardiac arrest before venoarterial extracorporeal membrane oxygenation initiation, nonshockable rhythm, arterial lactate, and ischemic heart disease were identified as independent pre-venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality. The novelty of this study is that the metabolic state, expressed as level of lactate just before venoarterial extracorporeal membrane oxygenation initiation seems more predictive of outcome than cardiopulmonary resuscitation duration or absence of return of spontaneous circulation.
Sexual Dysfunction in Breast Cancer Survivors
Authors: Gandhi Christy , Butler Elizabeth , Pesek Sarah , Kwait Rebecca , Edmonson David , Raker Christina , Clark Melissa A. , Stuckey Ashley , Gass Jennifer 
Published: May 2019

Objectives:
Sexual dysfunction is common in breast cancer survivors. Our survey study aimed to delineate the relative associations between sexual dysfunction and breast cancer treatment including surgical modalities and adjuvant therapies.

Methods:
Women in surveillance following breast cancer surgery were eligible for our survey incorporating the Female Sexual Function Index. Analysis involved multiple log-binomial regression to evaluate the association between sexual dysfunction (Female Sexual Function Index≤26.55) and treatment modality.

Results:
Of the 600 completed surveys, the final eligible analytic sample included 278 sexually active respondents. Overall, 65%, 27%, and 8% underwent lumpectomy, mastectomy with reconstruction, and mastectomy alone, respectively. In total, 74.5% reported receipt of radiation; 47.8% chemotherapy; 27.3% tamoxifen, and 31.4% aromatase inhibitor (AI). No significant difference in prevalence of sexual dysfunction was observed by surgical modality, even when adjusted for adjuvant therapy. Chemotherapy or radiation was not associated with sexual dysfunction when adjusted for surgical modality. The prevalence of sexual dysfunction was 1.6 times higher for the AI group compared with the no endocrine therapy group (P=0.01), when adjusted for other treatment groups.

Conclusions:
Our study demonstrated that the highest rates of sexual dysfunction were among breast cancer survivors treated with AI. Neither surgical modality, chemotherapy, nor radiation was associated with sexual dysfunction. These data may guide clinicians in counseling sexually active breast cancer patients in treatment planning and survivorship.
First Report of Bacillary Angiomatosis by Bartonella elizabethae in an HIV-Positive Patient
Authors: Corral Julieta , Manríquez Robles Amairani , Toussaint Caire Sonia , Hernández-Castro Rigoberto , Moreno-Coutiño Gabriela 
Published: May 2019

Abstract:
We present the case of an HIV-positive patient who developed polymorphous lesions in which the evidence in the skin biopsy corresponds to the diagnosis of bacillary angiomatosis, and further tests proved the pathological agent involved in this case is not the usual Bartonella species, B. henselae and B. quintana, but B. elizabethae. As far as we know, this is the first case of bacillary angiomatosis secondary to this etiological agent.
Mid-term Outcome and Prognosis of Prediabetic Patients After Coronary Artery Bypass Graft Surgery, Regardless of the First Month After Surgery
Authors: Hosseini Kaveh , Jalali Arash , Karimi Abbasali , Sadeghian Saeed , Tajdini Masih 
Published: May 2019

Objective:
Current knowledge of the effects of prediabetes on the postsurgical outcomes of mortality and major adverse cardiovascular events (MACE) after coronary artery bypass graft surgery (CABG) is limited. The aim of this study is to evaluate the MACE and overall 1-year survival of patients with prediabetes who underwent elective isolated CABG.

Material and Methods:
After a thorough analysis of CABG database since January 2016, 3741 patients were included. Patients were categorized as follows: diabetes mellitus type 2 (n = 2695), prediabetics (fasting blood sugar = 100–125 mg/dL and hemoglobin A1c (HbA1c) = 5.7%–6.4%) (n = 471), and nondiabetics (fasting blood sugar < 100 mg/dL and HbA1c < 5.7%) (n = 575). Primary end point (MACE) was the composite death, acute coronary syndrome, coronary revascularization, and cerebrovascular events after 1 month of surgery. Event-free survival was assessed and compared between groups over a median follow-up of 1 year.

Results:
In this retrospective cohort design, 3741 patients who underwent elective isolated CABG were evaluated. One-year overall survival percent was 100% for nondiabetic and prediabetic patients and 99.9% for diabetic patients (P value = 0.56). One-year event-free survival was 97.4% for nondiabetics, 98.1% for prediabetics, and 96.8% for diabetic patients (P value = 0.08).

Conclusions:
One-year overall survival and also the event-free survival of prediabetic patients were similar to those without diabetes mellitus. Over the median follow-up of 1 year, descending trends shows the higher probability of adverse events in diabetic patients with longer follow-ups.
When an Infected Meniscus Portends a Perforated Viscus
Authors: Hannon Michelle , Zachariah Stephen , Etherington Neha Bansal , Govind Anusha , Weber Devin , Hess Bryan 
Published: May 2019

Abstract
A 59-year-old woman with a status of post–renal transplant 7 years prior for autosomal dominant polycystic kidney disease on tacrolimus and mycophenolate mofetil presented with subacute left knee and right wrist pain. She received local steroid injections to both areas as an outpatient without improvement in her symptoms. She had recently traveled to India, her home country, to visit relatives. Aspiration of the knee revealed 4+ acid fast bacilli on smear, and she was taken for surgical debridement. She was started on empiric antibiotics for presumed infection with rapidly growing mycobacteria. Her course was complicated by acute onset abdominal pain with pneumoperitoneum and mesenteric abscess on imaging, requiring exploratory laparotomy. Surgical cultures from all sites were positive for Mycobacterium tuberculosis. Her medications were adjusted to rifabutin, isoniazid, pyrazinamide, and ethambutol. Pretransplant screening results were unknown. She was discharged in stable condition and completed 12 months of medical therapy.
Suppression of neuropathic pain by selective silencing of dorsal root ganglion ectopia using nonblocking concentrations of lidocaine
Authors: Yatziv Shai-Lee , Devor Marshall 
Published: May 2019

AbstractNeuropathic pain is frequently driven by ectopic impulse discharge (ectopia) generated in injured peripheral afferent neurons. Observations in the spinal nerve ligation (SNL) model in rats suggest that cell bodies in the dorsal root ganglion (DRG) contribute 3 times more to the ectopic barrage than the site of nerve injury (neuroma). The DRG is therefore a prime interventional target for pain control. Since DRG ectopia is selectively suppressed with lidocaine at concentrations too low to block axonal impulse propagation, we asked whether targeted delivery of dilute lidocaine to the L5 DRG can relieve L5 SNL-induced tactile allodynia without blocking normal sensation or motor function. Results showed that intraforaminal injection of 10-µL bolus doses of 0.2% lidocaine suppressed allodynia transiently, while sustained infusion over 2 weeks using osmotic minipumps suppressed it for the duration of the infusion. Bolus injections of morphine or fentanyl were ineffective. Lidocaine applied to the cut spinal nerve end or the L4 DRG did not affect allodynia, suggesting that discharge originating in the neuroma and in neighboring “uninjured” afferents makes at best a minor contribution. Spike electrogenesis in the DRG is apparently the primary driver of tactile allodynia in the SNL model of neuropathic pain, and it can be controlled selectively by superfusing the relevant DRG(s) with nonblocking concentrations of lidocaine. This approach has potential clinical application in conditions such as postherpetic neuralgia and phantom limb pain in which one or only a few identifiable ganglia are implicated as pain drivers.
Innovations in Pressure Injury Reporting: Creating Actionable Data for Improvement
Authors: Polancich Shea , Williamson Jason , Poe Terri , Armstrong Amy , Vander Noot Ross M. 
Published: May 2019

ABSTRACT
This department column highlights translation of research into health care quality practice. Achieving the highest quality of health care requires attention to developing and sustaining process efficiencies, and a thorough understanding of data and reporting. Mitigating or eliminating harm from pressure injuries may be more quickly achieved when accurate and consistent data are available for creating actionable interventions. The three aims of this project were to (1) confirm internally reported hospital acquired pressure injury data, (2) identify opportunities for improving the accuracy of internal reports, and (3) design and implement innovative quality informatics solutions for pressure injury reporting.
Clinical application of diffusion-weighted imaging and dynamic contrast-enhanced MRI in assessing the clinical curative effect of early ankylosing spondylitis
Authors: Shi Zhaojuan , Han Jiankui , Qin Jian , Zhang Yue 
Published: May 2019

Abstract
The study aimed to demonstrate the clinical application value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing a clinical curative effect of early ankylosing spondylitis (AS).
Forty-eight patients with early AS who were already treated combinations by traditional Chinese and Western medicine were involved in this study. All subjects underwent the conventional MRI, DWI, and DCE-MRI scanning of bilateral sacroiliac joints before and after treatment. The relevant data, such as the mean apparent diffusion coefficient (ADC) value, time–intensity curve of subarticular surface bone marrow, and the relationship between ADC value and enhancement factor (Fenh), enhancement slope (Senh), and time to peak (TTP), were obtained.
1. The mean ADC value of the subarticular surface bone marrow of patients and after clinical treatment was (5.05 ± 1.10) × 10−4 and (4.34 ± 0.55) × 10−4 mm2/s in ilium and (4.63 ± 0.79) × 10−4 and (3.96 ± 0.23) × 10−4 mm2/s in sacrum, respectively. 2. In the DCE-MRI follow-up treatment imaging of 48 patients with AS (192 parts), the TIC curve type recorded was as follows: 43.75% (84/192) of type II, 56.25% (108/192) of type III, and type I curve was not seen. The number of type II curve was significantly reduced for pre treatment group (84 cases) compared with that post treatment group (124 cases). The Fenh, Senh, and TTP values were respective (113.38 ± 44.71)%, (60.94 ± 38.56)% min, (129.52 ± 42.66) s in ilium and (83.03 ± 20.39)%, (44.91 ± 15.19)% min, (123.44 ± 28.50) s in sacrum before clinical treatment. After the treatment, the Fenh, Senh, and TTP values were respective (75.90 ± 17.97)%, (33.96 ± 11.36)% min, (138.67 ± 26.60) s in ilium and (73.28 ± 15.67)%, (31.92 ± 8.15)% min, (140.19 ± 19.88) s in sacrum. The Fenh, Senh, and TTP values of semiquantitative indexes before and after clinical treatment were significantly different.
DWI and DCE-MRI sequences can help evaluate the degree of active changes in AS inflammation and treatment effect in patients with early AS, and provide reliable imaging evidence.