bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Surgery for Thoracic Myelopathy Owing to Thoracic Ossification of The Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients
Authors: Ando Kei , Imagama Shiro , Kaito Takashi , Takenaka Shota , Sakai Kenichiro , Egawa Satoru , Shindo Shigeo , Watanabe Kota , Fujita Nobuyuki , Matsumoto Morio , Nakashima Hideaki , Wada Kanichiro , Kimura Atsushi , Takeshita Katsushi , Kato Satoshi , Murakami Hideki , Takeuchi Kazuhiro , Takahata Masahiko , Koda Masao , Yamazaki Masashi , Watanabe Masahiko , Fujibayashi Shunsuke , Furuya Takeo , Kawaguchi Yoshiharu , Matsuyama Yukihiro , Yoshii Toshitaka , Okawa Atsushi 
Published: August 2019

Study Design.
Prospectively collected, multicenter, nationwide study.

Objective.
The aim of this study was to investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF).

Summary of Background Data.
A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items.

Methods.
Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopedic Association [JOA] score), symptoms, and intraoperative neurophysiological monitoring were investigated prospectively in 223 cases. Differences in these factors between fusion and nonfusion procedures for T-OLF were examined. The minimum follow-up period was 2 years after surgery

Results.
The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at computed tomography, and intramedullary high intensity area at magnetic resonance imaging (P < 0.01). The preoperative JOA score was lower (P < 0.05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, P < 0.05).

Conclusion.
The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.

Level of Evidence: 3
Emergency Department Visits for Acute Gastrointestinal Illness After a Major Water Pipe Break in 2010
Authors: Lin Cynthia J. , Richardson David B. , Hilborn Elizabeth D. , Weinberg Howard , Engel Larry S. , Wade Timothy J. 
Published: August 2019

Background:
When a water pipe breaks, contaminants can enter the drinking water system and cause waterborne illnesses such as acute gastrointestinal illness. In May 2010, a major water pipe broke near Boston, MA, and a boil water order was issued to nearly two million residents.

Methods:
Using a case-crossover study design, we examined the association between the water pipe break and subsequent emergency department visits for acute gastrointestinal illness. We identified cases of illness according to ICD-9-CM diagnosis codes and selected control dates 2 weeks before and after each case. We estimated the risk of visiting the emergency department during the 0–3 and 4–7 days after the water pipe break using conditional logistic regression models.

Results:
Our analysis included 5,726 emergency department visits for acute gastrointestinal illness from 3 April 2010 to 5 June 2010. Overall, there was a 1.3-fold increased odds for visiting the emergency department for acute gastrointestinal illness during the 0–3 days after the water pipe break (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) compared with referent dates selected 2 weeks before and after. During the 4–7 days after the break, the association diminished overall (OR = 1.1; 95% CI = 0.96, 1.2). However, in communities over 12 miles from the break, the 4- to 7-day association was elevated (OR = 1.4; 95% CI = 1.1, 1.8).

Conclusions:
This study suggests that a major water pipe break was associated with emergency department visits for acute gastrointestinal illness, particularly during the 0–3 days after the break, when a boil water order was in effect.
Diversity and inclusion: the role of unconscious bias on patient care, health outcomes and the workforce in obstetrics and gynaecology
Authors: Arvizo Cynthia , Garrison Etoi 
Published: August 2019

Purpose of review
Although the business world has long recognized the benefits of diversity and inclusion and the effects of unconscious bias, the discourse is just now gaining traction in the medical field. In addition, many businesses have developed key initiatives to address unconscious bias in the workplace.

Recent findings
In the medical field, diversity leads to improved health outcomes, increased access to healthcare by the underserved and more innovation. However, unconscious bias may inadvertently propagate health disparities, affect trainee evaluations, hinder faculty satisfaction and exclude populations from meaningful research.

Summary
In this review, we discuss diversity, inclusion and unconscious bias in obstetrics and gynaecology, as it relates to patient care, health outcomes, medical faculty and trainees. We also discuss potential interventions that mitigate these issues.
SPATIAL DISTRIBUTION OF CHORIOCAPILLARIS IMPAIRMENT IN EYES WITH CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION
Authors: Moult Eric M. , Alibhai Agha Yasin , Rebhun Carl , Lee ByungKun , Ploner Stefan , Schottenhamml Julia , Husvogt Lennart , Baumal Caroline R. , Witkin Andre J. , Maier Andreas , Duker Jay S. , Rosenfeld Phillip J. , Waheed Nadia K. , Fujimoto James G. 
Published: August 2019

Purpose:
To develop an optical coherence tomography angiography (OCTA)-based framework for quantitatively analyzing the spatial distribution of choriocapillaris (CC) impairment around choroidal neovascularization (CNV) secondary to age-related macular degeneration.

Methods:
In a retrospective, cross-sectional study, 400-kHz swept-source OCTA images from 7 eyes of 6 patients with CNV secondary to age-related macular degeneration were quantitatively analyzed using custom software. A lesion-centered zonal OCTA analysis technique—which portioned the field-of-view into zones relative to CNV boundaries—was developed to quantify the spatial dependence of CC flow deficits.

Results:
Quantitative, lesion-centered zonal analysis of CC OCTA images revealed highest flow-deficit percentages near CNV boundaries, decreasing in zones farther from the boundaries. Optical coherence tomography angiography using shorter (1.5 ms) interscan times revealed more severe flow deficits than OCTA using longer (3.0 ms) interscan times; however, spatial trends were similar for both interscan times. A detailed description of the OCTA processing steps and parameters was provided so as to elucidate their influence on quantitative measurements.

Conclusion:
Impairment of the CC, assessed by flow-deficit percentages, was most prominent closest to CNV boundaries. The lesion-centered zonal analysis technique enabled quantitative CC measurements relative to focal lesions. Understanding how processing steps, imaging/processing parameters, and artifacts can affect quantitative CC measurements is important for longitudinal, OCTA-based studies of disease progression, and treatment response.
BASELINE CHARACTERISTICS OF VITREOMACULAR TRACTION PROGRESSING TO FULL-THICKNESS MACULAR OR LAMELLAR HOLES IN THE PHASE III TRIALS OF ENZYMATIC VITREOLYSIS
Authors: Schneider Eric W. , Jaffe Glenn J. 
Published: August 2019

Purpose:
To identify characteristics associated with progression from vitreomacular traction (VMT) to a full-thickness macular hole (FTMH) or lamellar hole (LH).

Methods:
Post-hoc analysis of the Phase III clinical trial comparing ocriplasmin with placebo for treatment of vitreomacular adhesion (MIVI-TRUST). Exact logistic regression analyses were used to identify baseline characteristics significantly associated with progression from vitreomacular traction to FTMH or LH over the 6-month study period.

Results:
Twenty eyes (4.5%) developed an FTMH and 38 (9.7%) developed an LH during the study period. The rate of progression to FTMH or LH did not differ significantly between ocriplasmin- and saline-treated eyes (P = 0.090 for FTMH, P = 0.369 for LH). On univariate analysis, the presence of subretinal fluid (adjusted odds ratio 5.64, 95% confidence interval 2.02–17.17, P < 0.001) and mean subretinal fluid thickness (adjusted odds ratio 1.10, 95% confidence interval 1.04–1.16, P = 0.003) were associated with FTMH development. Both remained significantly associated with FTMH development on multivariate testing. On univariate analysis, the presence of macular schisis (adjusted odds ratio 2.26, 95% confidence interval 1.30–3.82, P = 0.004) and mean retinal thickness (adjusted odds ratio 1.06, 95% confidence interval 1.01–1.10, P = 0.010) were associated with LH development. Schisis remained a significant predictor of LH formation on multivariate testing.

Conclusion:
Vitreomacular traction is more likely to progress to FTMH when associated with subretinal fluid, but when associated with intraretinal changes (such as schisis), vitreomacular traction appears more likely to progress to a LH after a single intravitreal injection of ocriplasmin or saline.
Comparison of Musculoskeletal Infections due to Nontyphoidal Salmonella Species and Staphylococcus aureus in Immunocompetent Children
Authors: Boguniewicz Juri , Rubiano Landinez Andrea , Kaplan Sheldon L. , Lamb Gabriella S. 
Published: August 2019

Background:
Nontyphoidal Salmonella species (NTS) rarely cause musculoskeletal infections in healthy children. Data on NTS musculoskeletal infections in healthy children are limited. No previous studies have directly compared children with NTS musculoskeletal infections with those with Staphylococcus aureus.

Methods:
This was a case-control study of children 30 days–18 years old seen at Texas Children’s Hospital between 2010 and 2017 with NTS musculoskeletal infections. Controls were children with S. aureus musculoskeletal infections matched on date of infection. Patients with known predisposing conditions were excluded. Demographic and clinical risk factors between the 2 groups were compared.

Results:
From 2010 to 2017, 27 cases of NTS musculoskeletal infections were identified, 12 (46.0%) of which occurred in healthy children. The control group had 53 patients. Predictors of NTS musculoskeletal infections included exposure to reptiles [odds ratio (OR) 8.50, 95% confidence interval (CI): 11.24–58.23] and preceding gastrointestinal symptoms (OR 5.63, 95% CI: 1.45–21.89). Children with NTS musculoskeletal infections had greater odds of pelvic and/or spinal involvement than S. aureus controls (OR 5.32, 95% CI: 1.42–20.13). Complications occurred in 16.7% of NTS cases versus 32% of S. aureus controls.

Conclusions:
Healthy children with NTS musculoskeletal infections more frequently report reptile exposure and preceding gastrointestinal symptoms and have pelvic and spinal involvement compared with children with musculoskeletal infections due to S. aureus. NTS should be considered as a potential cause of musculoskeletal infections in children with these risk factors. In contrast to previous case reports and case series, children with NTS musculoskeletal infections had a low rate of complications.
The Use of Antidepressant Medications During Pregnancy and the Risk of Neonatal Seizures
Authors: Uguz Faruk 
Published: August 2019

AbstractPurposeThis review examined the current literature about the potential relationship between the use of antidepressants during pregnancy and neonatal seizures.MethodsPubMed was searched for English language reports published between January 1, 1996, and October 31, 2018, by using combinations of the following key words:pregnancy,neonatal outcome,neonatal convulsion,neonatal seizure,SSRI,selective serotonin norepinephrine reuptake inhibitor (SNRI),tricyclic antidepressant (TCA),antidepressants,sertraline,fluoxetine,paroxetine,citalopram,escitalopram,fluvoxamine,venlafaxine,mirtazapine,duloxetine,bupropion,amitriptyline,imipramine,and clomipramine.FindingsA total of 9 relevant studies that met the review criteria were examined. The prevalence rates of neonatal seizures in the antidepressant groups and control groups were 0.30% to 0.91% and 0.10% to 0.30%, respectively. The use of selective serotonin reuptake inhibitors was associated with up to 5-fold increase in the risk of neonatal seizures. Compared with the controls, higher risks were reported in newborns of pregnant women using any antidepressant or tricyclic antidepressants albeit in a limited number of studies. Exposure to antidepressants in the third trimester of pregnancy appeared to be associated more with neonatal seizures compared with earlier exposure.ImplicatonsAlthough an increased risk of neonatal seizures in newborns antenatally exposed to antidepressants especially selective serotonin reuptake inhibitors may be suggested, the available studies have severe methodological limitations to enable any firm conclusion.
An Educational Intervention for Acute Dizziness Care: A Randomized, Vignette-based Study
Authors: Meurer William J. , Johnson Patricia , Brown Devin , Tsodikov Alexander , Rowell Brigid , Fagerlin Angela , Telian Steven A. , Damschroder Laura , An Lawrence C. , Morgenstern Lewis B. , Kerber Kevin A. 
Published: August 2019

Importance:
Benign paroxysmal positional vertigo (BPPV) is a common cause of acute dizziness. Strong evidence exists for diagnosing BPPV using the Dix-Hallpike Test (DHT) and treating it with the canalith repositioning maneuver (CRM). Despite this, both are infrequently used in the emergency department (ED).

Objective:
As an early method to evaluate a BPPV-focused educational intervention, we evaluated whether an educational intervention improved ED provider performance on hypothetical stroke and BPPV cases delivered by vignette.

Design:
A randomized, controlled, educational intervention study in ED physicians. The intervention aimed to promote the appropriate use of the DHT and CRM. A BPPV vignette, a stroke-dizziness (safety) vignette, and vignette scoring schemes (higher scores indicating more optimal care) used previously established vignette methodology.

Setting:
We recruited participants at the exhibitor hall of an emergency medicine annual meeting.

Participants:
We recruited 48 emergency physicians. All were board certified or residency trained and board eligible. All were engaged in the active practice of emergency medicine. None were trainees.

Interventions:
Intervention group: a narrated, educational presentation by computer followed by the clinical vignettes. Control group: Received no educational intervention and completed the clinical vignettes—intended to mirror current clinician practice.

Main Outcome Measure:
Primary endpoint: total score (out of 200 points) on a vignette-based scoring instrument assessing the performance of history, physical, and diagnostic testing on hypothetical stroke and BPPV cases.

Results:
The efficacy threshold was crossed at the interim analysis. The intervention group had higher performance scores compared with controls (113.2 versus 68.6, p < 0.00001). BPPV and safety subscores were both significantly higher in the intervention group. Sixty-two percent of the intervention group planned to use the DHT versus 29% of controls. After the vignette described characteristic BPPV nystagmus, 100% of the intervention group planned to use the CRM versus 17% of controls.

Conclusions and Relevance:
The educational intervention increased provider performance in dizziness vignettes, including more frequent appropriate use of the DHT/CRM. These findings indicate the intervention positively influenced planned behavior. Future work is needed to implement and evaluate this intervention in clinical practice.
Hepatitis E infection in a patient with rheumatoid arthritis treated with leflunomide
Authors: Carubbi Francesco , Picchi Giovanna , Di Bartolomeo Salvatore , Ricciardi Alessandra , Cipriani Paola , Marola Laura , Grimaldi Alessandro , Giacomelli Roberto 
Published: August 2019

Abstract

Rationale:
Hepatitis E is an infectious disease due to inflammation of the liver caused by hepatitis E virus (HEV) and represents one of the most common causes of acute hepatitis and jaundice in the world. Although data of hepatitis E infection in patients with rheumatoid arthritis (RA) are accumulating, little is known on the course of HEV infection. We reported, for the 1st time, a case of patient with RA with hepatitis E that developed during leflunomide therapy in combination with low-dose steroids.

Patient concerns:
We present a 39-year-old woman, affected by RA and treated with leflunomide, reported diffuse itching and persistent fatigue laboratory data revealed elevated liver enzyme levels.

Diagnosis:
Positivity for anti-HEV IgM and IgG was observed. HEV-RNA of the genotype 3 was detected, indicating acute E hepatitis.

Interventions and outcomes:
Leflunomide was stopped and restarted 5 months after the initial diagnosis at the same dosage, with a close clinical and laboratory follow-up. The virus was eradicated from the serum without chronic transformation. The patient is alive and well 7 months after the initial diagnosis.

Lessons:
To our knowledge, this report is the 1st case of acute E hepatitis in a patient with RA developed during leflunomide therapy in combination with low-dose steroids. Moreover, geoepidemiology of infection is important, due to the fact that Abruzzo, a central region of Italy, has the highest HEV seroprevalence in general population, related to the zoonotic transmission of the infection from domestic and wild animals. Our case highlighted that immunosuppressive therapy, and in particular leflunomide, could be safely reintroduced after the resolution of the infection and the clearance of the virus. Further studies are needed to evaluate potential advantages in serologic testing for HEV infection as a part of the routine workup done to patients with rheumatic diseases and selected for immunosuppressive therapy.
A national center for persistent severe pain after groin hernia repair
Authors: Jensen Elisabeth Kjær , Ringsted Thomas K. , Bischoff Joakim M. , Petersen Morten A. , Rosenberg Jacob , Kehlet Henrik , Werner Mads U. 
Published: August 2019

Abstract
Severe persistent pain after groin hernia repair impairs quality-of-life. Prospective, consecutive cohort study including patients with pain-related impairment of physical and social life. Relevant surgical records were obtained, and examinations were by standardized clinical and neurophysiological tests. Patients demonstrating pain sensitivity to pressure algometry in the operated groin underwent re-surgery, while patients with neuropathic pain received pharmacotherapy. Questionnaires at baseline (Q0) and at the 5-year time point (Q5Y) were used in outcome analyses of pain intensity (numeric rating scale [NRS] 0–10) and pain-related effect on the activity-of-daily-living (Activities Assessment Scale [AAS]). Data are mean (95% CI).
Analyses were made in 172/204 (84%) eligible patients. In 54/172 (31%) patients re-surgery (meshectomy/selective neurectomy) was performed, while the remaining 118/172 (69%) patients received pharmacotherapy. In the re-surgery group, activity-related, and average NRS-scores at Q0 were 6.6 (5.6–7.9) and 5.9 (5.6–5.9), respectively. Correspondingly, NRS-scores at Q5Y was 4.1 (3.3–5.1) and 3.1 (2.3–4.0; Q0 vs. Q5Y: P < .0005), respectively. Although both groups experienced a significant improvement in AAS-scores comparing Q0 vs. Q5Y (re-surgery group: 28% (4–43%; P < .0001); pharmacotherapy group: 5% (0–11%; P = .005)) the improvement was significantly larger in the re-surgery group (P = .02).
This 5-year cohort study in patients with severe persistent pain after groin hernia repair signals that selection to re-surgery or pharmacotherapy, based on examination of pain sensitivity, is associated with significant improvement in outcome. Analyzing composite endpoints, combining pain and physical function, are novel in exploring interventional effects.
ClinicalTrials.gov Identifier NCT03713047
Computed tomography pulmonary angiograms using a novel dual-layer spectral detector
Authors: Iuga Andra-Iza , Doerner Jonas , Siedek Florian , Haneder Stefan , Byrtus Jonathan , Luetkens Julian A. , Maintz David , Hickethier Tilman 
Published: August 2019

Abstract

Objective:
The aim of this study was to determine optimal window settings for conventional polyenergetic and virtual monoenergetic images derived from computed tomography pulmonary angiogram (CTPA) examinations of a novel dual-layer spectral detector computed tomography system (DLCT).

Methods:
Monoenergetic (40 keV) and polyenergetic images of 50 CTPA examinations were calculated and the best individual window width and level (W/L) values were manually assessed. Optimized values were obtained afterwards based on regression analysis. Diameters of standardized pulmonary artery segments and subjective image quality parameters were evaluated and compared.

Results:
Attenuation and contrast-to-noise values were higher in monoenergetic than in polyenergetic images (P≤.001). Averaged best individual W/L for polyenergetic and monoenergetic were 1020/170 and 2070/480 HU, respectively.
All adjusted W/L-settings varied significantly compared to standard settings (700/100 HU) and obtained higher subjective image quality scores. A systematic overestimation of artery diameters for standard window settings in monoenergetic images was observed.

Conclusions:
Appropriate W/L-settings are required to assess polyenergetic and monoenergetic CTPA images of a novel DLCT. W/L-settings of 1020/170 HU and 2070/480 HU were found to be the best averaged values for polyenergetic and monoenergetic CTPA images, respectively.
Efficacy of Jianpi Liqi therapy for functional dyspepsia
Authors: Ye Jin-Tong , Dai Yun-Kai , Li Dan-Yan , Zhang Yun-Zhan , Huang Meng-Xin , Chen Wei-Jing , Li Ru-Liu , Hu Ling 
Published: August 2019

Abstract

Background:
We performed this meta-analysis to assess the efficacy and safety of Jianpi Liqi therapy (JLT), a traditional Chinese medicine therapy, in treating functional dyspepsia (FD).

Methods:
We systematically searched 13 databases from their inception to 15th, May 2019. Eligible studies were randomized controlled trials (RCTs) that compared JLT medicine with conventional pharmacotherapy (CP) in treating patients with FD. Cochrane Collaboration tool, Review Manager 5.3 and STATA 11.0, GRADE profiler 3.6 were used for evaluating risk of bias, analyzing, and assessing quality of evidence respectively.

Results:
After exclusions, 15 RCTs including a total of 1451 participants were included for analysis. We found evidence that JLT had better efficacy than CP (domperidone, omeprazole, esomeprazole, mosapride, lansoprazole, compound digestive enzymes, lactasin tablets) for FD (OR 0.34; 95% CI 0.26, 0.45; P < .00001). Moreover, JLT had more improvement on symptoms including abdominal pain, abdominal distention, early satiety, belching, poor appetite, and fatigue compared with CP. In addition, serious adverse events were not observed in treatment courses.

Conclusion:
This meta-analysis suggested that JLT appears to have better efficacy in treating FD compared with CP. It may be an effective and safe therapy option for patients with FD. Though, more large-sample and strictly designed RCTs are needed to confirm our findings.
PROSPERO registration number: CRD42019133241.