bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autoimmune Progesterone Dermatitis Mistaken for Stevens-Johnson Syndrome
Authors: Drayer Sara M. , Laufer Larry R. , Farrell Maureen E. 
Published: March 2018

BACKGROUND:
Autoimmune progesterone dermatitis is an uncommon disease presenting with cyclical skin eruptions corresponding with the menstrual cycle luteal phase. Because symptoms are precipitated by rising progesterone levels, treatment relies on hormone suppression.

CASE:
A 22-year-old nulligravid woman presented with symptoms mistaken for Stevens-Johnson syndrome. A cyclic recurrence of symptoms occurred, and the diagnosis of autoimmune progesterone dermatitis was made by an intradermal progesterone challenge. After 48 months, her disease remained refractory to medical management, and definitive surgical treatment with bilateral oophorectomy was performed.

CONCLUSIONS:
Autoimmune progesterone dermatitis is a challenging diagnosis as a result of its rarity and variety of clinical presentations. Treatment centers on suppression of endogenous progesterone and avoidance of exogenous triggers. When these modalities fail, surgical management must be undertaken.
A 15-Year Study of Trends in Authorship by Gender in Two U.S. Obstetrics and Gynecology Journals
Authors: Metheny William P. , Jagadish Mayuri , Heidel R. Eric 
Published: March 2018

OBJECTIVE:
To assess whether there was a significant trend in the number of women as first, last, and coauthors in two U.S. journals of obstetrics and gynecology over the past 15 years and to assess whether this publication rate was commensurate with the percentage of women in the academic specialty.

METHODS:
This retrospective study identified the gender of first and last authors of original research articles for the years 2000, 2005, 2010, and 2015. We determined trends in publication rates of authorship and coauthorship by pairing the gender of the first and last authors. We selected a subset of the data to compare the percentages of women authors with MDs at U.S. academic institutions with the nationally reported percentages of women faculty in the specialty.

RESULTS:
The journals yielded 2,699 articles for analysis. The percentage of articles written by women as first authors increased from 37% in 2000 to 71% in 2015 and, as last authors, increased from 26% in 2000 to 49% in 2015. Paired as coauthors, women published at a rate of 11% in 2000 to 38% in 2015. The analysis of a subset of 1,621 articles showed that as first authors, women published at a rate equal to or above the percentage of women in academics, but as last authors published fewer articles than expected.

CONCLUSION:
Women published more articles over time, kept pace or exceeded their faculty percentages as first authors, lagged behind these percentages as last authors, and as coauthors eventually surpassed the publication rate of male coauthors.
Lack of Consensus in Physician Recommendations Regarding Return to Driving After Cervical Spine Surgery
Authors: Moses Michael J. , Tishelman Jared C. , Hasan Saqib , Zhou Peter L. , Zevgaras Ioanna , Smith Justin S. , Buckland Aaron J. , Kim Yong , Razi Afshin , Protopsaltis Themistocles S. 
Published: March 2018

Study Design.
A cross-sectional study.

Objective.
The goal of this study is to investigate how surgeons differ in collar and narcotic use, as well as return to driving recommendations following cervical spine surgeries and the associated medico-legal ramifications of these conditions.

Summary of Background Data.
Restoration of quality of life is one of the main goals of cervical spine surgery. Patients frequently inquire when they may safely resume driving after cervical spine surgery. There is no consensus regarding postoperative driving restrictions. This study addresses how surgeons differ in their recommendations concerning cervical immobilization, narcotic analgesia, and suggested timeline of return to driving following cervical spine surgery.

Methods.
Surgeons at the Cervical Spine Research Society annual meeting completed anonymous surveys assessing postoperative patient management following fusion and nonfusion cervical spine surgeries.

Results.
Seventy percent of surgeons returned completed surveys (n = 71). About 80.3% were orthopedic surgeons and 94.2% completed a spine fellowship. Experienced surgeons (>15 years in practice) were more likely to let patients return to driving within 2 weeks than less experienced surgeons (47.1% vs. 24.3%, P = 0.013) for multilevel anterior discectomy and fusion (ACDF) and laminectomy with fusion procedures. There were no differences between surgeons practicing inside and outside the USA for prescribing collars or return to driving time. Cervical collars were used more for fusions than nonfusions (57.7% vs. 31.0%, P = 0.001). Surgeons reported 75.3% of patients ask when they may resume driving. For cervical fusions, 31.4% of surgeons allowed their patients to resume driving while restricting them with collars for longer durations. Furthermore, 27.5% of surgeons allowed their patients to resume driving while taking narcotics postoperatively.

Conclusion.
This survey-based study highlights the lack of consensus regarding patient “fitness to drive” following cervical spine surgery. The importance of establishing evidence-based guidelines is critical, as recommendations for driving in the postoperative period may have significant medical, legal, and financial implications.

Level of Evidence: 5
Patient's Subjective Impression of Cervical Range of Motion
Authors: Langenfeld Anke , Bastiaenen Carolien , Sieben Judith , Humphreys B. Kim , Swanenburg Jaap 
Published: March 2018

Study Design.
Mixed-method.

Objective.
To evaluate the association between objective and subjective cervical range of motion (ROM) among patients with neck pain, and to assess the awareness of impairments.

Summary of Background Data.
Cervical ROM is frequently used to evaluate neck pain, but it is also important to know what a patient expects from treatment, because this can profoundly affect treatment outcomes and patient satisfaction.

Methods.
We used a cervical ROM instrument, the Neck Disability Index (NDI), and a self-administered ROM questionnaire for the neck (S-ROM-Neck). Ten patients took part in semi-structured interviews. Correlations were analyzed using Spearman rank order correlations (rs). Differences between patient and assessor were evaluated by the Mann-Whitney U test. Qualitative data were analyzed by content analysis.

Results.
Thirty participants (mean age 43.80 years; 21 females) were included. The correlation (rs) for the S-ROM-Neck between patient and assessor was 0.679 [95% confidence interval (95% CI) 0.404–0.884; P = 0.000]. The correlation between the NDI and S-ROM-Neck was 0.178 (95% CI −0.233 to -0.533; P = 346) for the assessor and −0.116 (95% CI −0.475 to −0.219, P = 0.541) for the patient (U = 448, z = −0.030, P = 0.976). Qualitative analysis revealed that patients had general restrictions in daily life and with specific movements, but that they adjusted their behavior to avoid impairment.

Conclusion.
There was a significant correlation between patient and therapist ratings of cervical spine mobility. Although patients experience restriction while moving and are impaired in specific activities, they adjust their lifestyle to accommodate their limitations.

Level of Evidence: 4
Impact of Multilevel Facetectomy and Rod Curvature on Anatomical Spinal Reconstruction in Thoracic Adolescent Idiopathic Scoliosis
Authors: Sudo Hideki , Abe Yuichiro , Kokabu Terufumi , Kuroki Kei , Iwata Akira , Iwasaki Norimasa 
Published: March 2018

Study Design.
A prospective, nonrandomized study.

Objective.
The aim of this study was to assess surgical outcomes of multilevel facetectomy and rod curvature with simultaneous double-rod rotation technique for anatomical spinal reconstruction in thoracic adolescent idiopathic scoliosis (AIS).

Summary of Background Data.
Although some surgical techniques maintain or restore thoracic kyphosis (TK), next-generation strategies for thoracic AIS should include corrections in three anatomical planes.

Methods.
The study included 39 consecutive patients with Lenke 1 or Lenke 2 thoracic AIS treated at our institution. After all-level facetectomy at instrumentation level, except for the lowest intervertebral segment, two rods were identically bent to guide postoperative anatomical TK without reference to the intraoperative coronal alignment of the AIS deformity. Outcome measures included patient demographics, radiographic measurements, and Scoliosis Research Society (SRS) questionnaire scores.

Results.
After 2 years of follow-up, the average main thoracic Cobb angle correction rate was 83.5%, and the final correction loss was 2.2°. The average preoperative TK (T5–T12) significantly increased from 13.2° to 24.6° (P < 0.001) at final follow-up. The percentage of patients with a T6–T8 location of the TK apex significantly increased from 51.3% preoperatively to 87.2% at final follow-up. The average preoperative vertebral rotation angle significantly decreased from 18.7° to 12.8° postoperatively (P < 0.001). The average preoperative total SRS questionnaire score significantly increased from 3.5 to 4.5 (P < 0.001) at final follow-up. There was no implant breakage and vascular and neurologic complications, with all patients demonstrating solid fusion at final follow-up.

Conclusion.
Multilevel facetectomy and rod curvature play an important role in anatomical spinal reconstruction in patients with thoracic AIS. From the spatiotemporal point of view, four-dimensional correction could be actively performed by rod curvature under multilevel facetectomy and is expected to obtain an anatomical thoracic spine postoperatively, indicating that an anatomically designed rod could be supplied as a pre-bent rod.

Level of Evidence: 3
Synchrotron Radiation Imaging Reveals the Role of Estrogen in Promoting Angiogenesis After Acute Spinal Cord Injury in Rats
Authors: Ni Shuangfei , Cao Yong , Jiang Liyuan , Luo Zixiang , Lu Hongbin , Hu Jianzhong , Wu Tianding 
Published: March 2018

Study Design.
The efficacy of estrogen on vessel angiogenesis in acute spinal cord injury (SCI) in a rat model was evaluated by synchrotron radiation.

Objective.
Here, we investigate the change in injured spinal cord vessels and used the synchrotron radiation to investigate the effect of estrogen on vessel angiogenesis and functional recovery in a rat model of SCI.

Summary of Background Data.
The promotion of angiogenesis after SCI may be a therapeutic target in the treatment of SCI. Estrogen has been reported to improve locomotor recovery after SCI. However, how estrogen regulates angiogenesis in acute SCI and enhances neurological functional recovery has not been fully characterized.

Methods.
Synchrotron radiation imaging combined with histological methods was used to image angiogenesis in acute spinal cord treatment with estrogen in rats.

Results.
Synchrotron radiation imaging vividly demonstrated three-dimensional vessel changes in the spinal cord after injury. The imaging showed that vessel number, vessel volume fraction, and vessel connectivity value in the groups treated with estrogen after SCI were significantly increased compared to control groups (P < 0.05). Vessel angiogenesis increased in groups treated with estrogen compared with control rats, which was confirmed with histological staining. Estrogen treatment also attenuated the injury-induced lesion area compared with control groups and improved locomotor functional recovery after SCI.

Conclusion.
The results indicated that synchrotron radiation is a powerful imaging tool for visualizing angiogenesis after acute SCI. Estrogen treatment exerted a neuroprotective effect on acute SCI treatment by promoting angiogenesis and reducing the injury-induced lesion area could be recommended as a potential preclinical treatment approach for acute SCI.

Level of Evidence: N/A
Selective Anterior Lumbar Interbody Fusion for Low Back Pain Associated With Degenerative Disc Disease Versus Nonsurgical Management
Authors: Kleimeyer John P. , Cheng Ivan , Alamin Todd F. , Hu Serena S. , Cha Thomas , Yanamadala Vijay , Wood Kirkham B. 
Published: March 2018

Study Design.
This is a retrospective cohort study.

Objective.
To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management.

Summary of Background Data.
Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial. Surgical fusion has previously provided mixed results with limited durable improvement of pain and function.

Methods.
Seventy-five patients with one or two levels of symptomatic Pfirrmann grades 3 to 5 disc degeneration from L3-S1 were identified. All patients had failed at least 6 months of nonsurgical treatment. Forty-two patients underwent one- or two-level ALIFs; 33 continued multimodal nonsurgical care. Patients were evaluated radiographically and the visual analog pain scale (VAS), Oswestry Disability Index (ODI), EuroQol five dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System scores for pain interference, pain intensity, and anxiety. As-treated analysis was performed to evaluate outcomes at a mean follow-up of 7.4 years (range: 2.5–12).

Results.
There were no differences in pretreatment demographics or nonsurgical therapy utilization between study arms. At final follow-up, the surgical arm demonstrated lower VAS, ODI, EQ-5D, and Patient-Reported Outcomes Measurement Information System pain intensity scores versus the nonsurgical arm. VAS and ODI scores improved 52.3% and 51.1% in the surgical arm, respectively, versus 15.8% and −0.8% in the nonsurgical arm. Single-level fusions demonstrated improved outcomes versus two-level fusions. The pseudarthrosis rate was 6.5%, with one patient undergoing reoperation. Asymptomatic adjacent segment degeneration was identified in 11.9% of patients.

Conclusion.
Selective ALIF limited to one or two levels in the lower lumbar spine provided improved pain and function when compared with continued nonsurgical care. ALIF may be a safe and effective treatment for low back pain associated with disc degeneration in select patients who fail nonsurgical management.

Level of Evidence: 3
NRS20: Combined Back and Leg Pain Score
Authors: Cawley Derek T. , Larrieu Daniel , Fujishiro Takashi , Kieser David , Boissiere Louis , Acaroglu Emre , Alanay Ahmet , Kleinstück Frank , Pellisé Ferran , Pérez-Grueso Francisco Sánchez , Vital Jean-Marc , Gille Olivier , Obeid Ibrahim 
Published: March 2018

Study Design.
Multicenter, prospective study of consecutive adult spinal deformity (ASD) patients.

Objective.
To evaluate back and leg pain as a combined score in ASD and compare their relative and cumulative correlations with health-related quality of life (HRQOL) and sagittal parameters.

Summary of Background Data.
Pain and disability are commonly reported in patients with ASD. This can affect their back, their legs or both. ASD-associated pain has been correlated with numerous HRQOL scores and radiological parameters.

Methods.
Preoperative pain intensity was assessed with a Numerical Rating Scale (NRS) for individual back and leg pain as well as a combined score, NRS20 (0–20, back plus leg pain).
This yielded a range of static measures in all patients with ASD with differing burdens of disease. Linear regression analysis was performed to calculate the correlation between pain and HRQOL scores (Scoliosis Research Society 22, 36-Item Short Form Health Survey Physical Component Summary, 36-Item Short Form Health Survey Mental Component Summary, Core Outcome Measures Index, and Oswestry Disability Index), and radiological spinopelvic parameters (sagittal and coronal planes).

Results.
A total of 1309 patients were included in this study. A combined score (NRS20) was better correlated with HRQOL (P < 0.01 for all) and sagittal parameters (P < 0.01 for all) than individual back or leg pain scores. Evaluation of the relative contributions of back and leg pain demonstrate a higher correlation with HRQOL scores for back pain and a higher correlation with sagittal parameters for leg pain. The distribution of NRS20 pain scores demonstrated three clear patterns of pain: back pain only, moderate back pain with varying mild-moderate leg pain, and severe equivalent back and leg pain. Similar values were noted for nonoperative and operative patients.

Conclusion.
The distribution and intensity of pain and its correlations with clinical and radiological parameters provide insight into the pathogenesis of ASD. A combined score has a simple yet valuable contribution to the assessment of symptoms in ASD.

Level of Evidence: 3
Does Regional Lung Strain Correlate With Regional Inflammation in Acute Respiratory Distress Syndrome During Nonprotective Ventilation? An Experimental Porcine Study*
Authors: Retamal Jaime , Hurtado Daniel , Villarroel Nicolás , Bruhn Alejandro , Bugedo Guillermo , Amato Marcelo Britto Passos , Costa Eduardo Leite Vieira , Hedenstierna Göran , Larsson Anders , Borges João Batista 
Published: March 2018

Objective:
It is known that ventilator-induced lung injury causes increased pulmonary inflammation. It has been suggested that one of the underlying mechanisms may be strain. The aim of this study was to investigate whether lung regional strain correlates with regional inflammation in a porcine model of acute respiratory distress syndrome.

Design:
Retrospective analysis of CT images and positron emission tomography images using [18F]fluoro-2-deoxy-D-glucose.

Setting:
University animal research laboratory.

Subjects:
Seven piglets subjected to experimental acute respiratory distress syndrome and five ventilated controls.

Interventions:
Acute respiratory distress syndrome was induced by repeated lung lavages, followed by 210 minutes of injurious mechanical ventilation using low positive end-expiratory pressures (mean, 4 cm H2O) and high inspiratory pressures (mean plateau pressure, 45 cm H2O). All animals were subsequently studied with CT scans acquired at end-expiration and end-inspiration, to obtain maps of volumetric strain (inspiratory volume – expiratory volume)/expiratory volume, and dynamic positron emission tomography imaging. Strain maps and positron emission tomography images were divided into 10 isogravitational horizontal regions-of-interest, from which spatial correlation was calculated for each animal.

Measurements and Main Results:
The acute respiratory distress syndrome model resulted in a decrease in respiratory system compliance (20.3 ± 3.4 to 14.0 ± 4.9 mL/cm H2O; p < 0.05) and oxygenation (Pao
2/Fio
2, 489 ± 80 to 92 ± 59; p < 0.05), whereas the control animals did not exhibit changes. In the acute respiratory distress syndrome group, strain maps showed a heterogeneous distribution with a greater concentration in the intermediate gravitational regions, which was similar to the distribution of [18F]fluoro-2-deoxy-D-glucose uptake observed in the positron emission tomography images, resulting in a positive spatial correlation between both variables (median R
2 = 0.71 [0.02–0.84]; p < 0.05 in five of seven animals), which was not observed in the control animals.

Conclusion:
In this porcine acute respiratory distress syndrome model, regional lung strain was spatially correlated with regional inflammation, supporting that strain is a relevant and prominent determinant of ventilator-induced lung injury.
Impact of Preadmission Opioid Treatment on 1-Year Mortality Following Nonsurgical Intensive Care*
Authors: Munch Troels , Christiansen Christian Fynbo , Pedersen Lars , Sørensen Henrik Toft 
Published: March 2018

Objectives:
Compare all-cause mortality following nonsurgical ICU admission for opioid users with nonusers.

Design:
Nationwide register-based cohort study.

Setting:
All 43 ICUs in Denmark (7,028,668 citizens cumulatively during the study period). The Danish National Health Service provides universal healthcare, guaranteeing equal access to healthcare along with partial reimbursement for prescribed drugs.

Patients:
All 118,388 nonsurgical patients admitted to an ICU from 2005 to 2014.

Intervention:
Patients were categorized according to timing of last redeemed opioid prescription before admission: current user (prior 0–30 d), recent user (prior 31–365 d), former user (prior 365+ d), or nonuser (no prescription since 1994).

Measurements:
All-cause mortality 0–30 days and 31–365 days following ICU admission was calculated using the Kaplan-Meier method. Crude and adjusted hazard ratios with 95% CIs were computed using Cox regression, comparing users with nonusers. Adjusted models included age, gender, socioeconomic factors, comedications, and comorbidity.

Main Results:
Fifteen percent of the patients were current opioid users, 15% recent users, 30% former users, and 40% nonusers. Zero- to 30-day mortality was 35% for current users, 29% for recent users, 24% for former users, and 21% for nonusers. After confounder adjustment, current users remained at elevated risk during the first 30 days following ICU admission (hazard ratio, 1.20; 95% CI, 1.15–1.24). No association remained for recent or former users. A similar pattern was evident for 31–365-day all-cause mortality: 24% for current users, 19% for recent users, 13% for former users, and 10% for nonusers. During 31–365 days of follow-up, both current users and recent users remained at elevated risk of mortality after adjustment (hazard ratio, 1.47; 95% CI, 1.39–1.55 and hazard ratio, 1.20; 95% CI, 1.13–1.27, respectively).

Conclusions:
Current opioid users experience increased mortality during the first year following ICU admission.