bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Risk Factor Analysis of Postoperative Dysphagia After Anterior Cervical Discectomy and Fusion (ACDF) Using the Eating Assessment Tool-10 (EAT-10)
Authors: Yew Andrew Y. , Nguyen Matthew T. , Hsu Wellington K. , Patel Alpesh A. 
Published: June 2018

Study Design.
A retrospective case series.

Objective.
The aim of this study was to utilize the Eating Assessment Tool-10 (EAT-10) to quantitatively analyze risk factors contributing to dysphagia after anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
ACDF is one of the most common procedures performed in the United States, with postoperative dysphagia rates ranging from 2% to 60%. The EAT-10 is a self-administered, symptom-specific 10-item clinical instrument to document dysphagia symptom severity and has demonstrated excellent internal consistency, test-retest reliability, and criterion-based validity.

Methods.
This study utilized a retrospective chart review of 163 patients from July 2013 to October 2017 who underwent ACDF at a single institution and prospectively completed EAT-10 surveys pre- and postoperatively. EAT-10 scores were collected preoperatively and at postoperative day 1, day 14, 1 month, 3 months, 6 months, and 12 months. Preselected risk factors were abstracted from the patients’ chart. Univariate analyses were performed to identify candidate variables that correlated with abnormal EAT-10 scores at each time point. Multivariate logistic regression was then utilized to identify risk factors that were independently correlated with abnormal EAT-10 scores at each time point.

Results.
Female gender, younger patients, and increased operating room (OR) time was associated with increased rates of dysphagia in the early postoperative period. History of obstructive sleep apnea, history of asthma, increased American Society of Anesthesiologists (ASA) score, and a larger number of spinal levels included in the surgery were correlated with increased dysphagia in the later postoperative periods.

Conclusion.
Dysphagia is common following ACDF. Factors associated with longer-term dysphagia seem to be more associated with pre-existing medical comorbidities. Understanding risk factors that correlate with increased rates of dysphagia has the potential to improve preoperative patient counseling and changes in operative management.

Level of Evidence: 4
Preferences of Spine Surgeons With Regard to Management of Intraoperative Durotomy
Authors: Pendi Arif , Wang Jeffrey C. , Bederman Stacey Samuel , Farhan Saifal-Deen , Bhatia Nitin N. , Lee Yu-Po , Ashraf Jahanzeb , Acosta Frank L. 
Published: June 2018

Study Design:
This was a cross-sectional study.

Objective:
The objective of this study was to determine spine surgeons’ preferences for the intraoperative and postoperative management of intraoperative durotomy (IDT) in decompression and spinal fusion surgeries.

Summary of Background Data:
Management guidelines for IDT remain elusive. Traditionally, management consists of intraoperative suturing and postoperative bed rest. However, preferences of North American spine surgeons may vary, particularly according to type of surgery.

Materials and Methods:
Spine surgeons of AO Spine North America (AOSNA) were surveyed online anonymously to determine which techniques they preferred to manage IDT in decompression and fusion. Differences in preferences according to surgery type were compared using the Fisher exact test. A series of linear regressions were conducted to identify demographic predictors of spine surgeons’ preferences.

Results:
Of 217 respondents, most were male (95%), orthopedic surgeons (70%), practiced at an academic center (50%), were in practice 0–19 years (71%) and operated on 100–300 patients per year (70%). The majority of surgeons applied sutures (93%–96%) and sealant (82%–84%). Surgeons also used grafts (26%–27%), drains (18%), other techniques (4%–5%), blood patch (2%–3%), or no intraoperative management (1%–2%). Postoperatively, most surgeons recommended bed rest (74%–75%). Antibiotics (22%), immediate mobilization (18%–20%), reoperation (14%–16%), other techniques (6%), or no postoperative management (5%) were also preferred. Management preferences did not vary significantly between decompression and fusion surgeries (all P-values>0.05). Specialty, practice facility, years in practice, and patients per year were identified as independent predictors of IDT management preferences (P<0.05).

Conclusions:
Although North American spine surgeons preferred to manage IDT with sutures augmented by sealant followed by bed rest after surgery, less common techniques were also preferred during the intraoperative and postoperative periods. Notably, intraoperative and postoperative IDT management preferences did not change in accordance to the type of surgery being conducted.

Level of Evidence
Level V.
Minimally Invasive Cervical Laminectomy for Cervical Spondylotic Myelopathy
Authors: Ross Miner N. , Ross Donald A. 
Published: June 2018

Objective:
Cervical spondylotic myelopathy is a common cause of neurological disability, especially in aging populations. There are several approaches to decompress the cervical spinal cord, including anterior cervical discectomy and fusion, corpectomy and fusion, arthroplasty, posterior cervical laminectomy with or without fusion, and laminoplasty. Less well described is minimally invasive cervical laminectomy. The authors report their technique and results for minimally invasive cervical laminectomy.

Materials and Methods:
The authors describe in detail their surgical technique and results of 30 consecutive cases. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) myelopathy scores were recorded.

Results:
In total, 30 cases were included. Mean age was 69 years (range, 57–89 y). Twelve procedures were at C3–4, 4 at C4–5, 5 at C5–6, 4 at C7–T1, 3 at C3–4 and C4–5, 1 at C4–5 and C5–6, and 1 at C5–6 and C6–7. Mean preoperative mJOA score was 12.1 (range, 4–15). Average length of surgery was 142 minutes. Mean follow-up was 27 months (range, 3–64 mo). At 3 months, mean postoperative mJOA score was 14.0 (range, 5–17). Mean mJOA improvement of 1.9 was statistically significant (P<0.001). Seventeen patients had magnetic resonance imaging (MRI) available at 3 months postoperatively (5 patients had no MRI, 3 patients had MRI contraindications, and 5 are pending). No MRI findings led to further surgery. There were no durotomies and no wound infections. A single patient had an unexplained new neurological deficit that resolved over 6 months.

Conclusions:
Minimally invasive laminectomy for cervical myelopathy is safe and effective and may be an underutilized procedure.
Influence of Sex, Age, and Weight on Levetiracetam Pharmacokinetics
Authors: Alzueta Natalia , Ortega Ana , Aldaz Azucena 
Published: June 2018

Background:Levetiracetam (LEV) is a second-generation antiepileptic drug extensively used in therapeutics. The aim of this study was to evaluate the influence that sex, age, and weight exert on LEV pharmacokinetics in clinical practice.Methods:We conducted a 6-year retrospective observational study. Patients were classified in subgroups according to sex, weight (normal range, overweight, and obese), and age (young adult: 16–30 years old, middle-aged adult: 31–50 years old, advanced adult: 51–64 years old, and elderly adult: ≥65 years old). We compared LEV apparent oral clearance (LEV CL/F) between the subgroups.Results:A total of 238 LEV basal serum concentrations (LEV C0) corresponding to 156 patients were identified. Significant differences were observed in LEV CL/F between males and females when LEV CL/F was expressed as L/h [mean (SD): 4.79 (1.84) L/h in males versus 4.13 (1.64) L/h in females;P< 0.001]. These differences were not significant when LEV CL/F was normalized by weight [mean (SD): 60.64 (24.90) mL/h/kg in males versus 64.10 (28.87) mL/h/kg in females; n.s.]. Weight in females was 17% lower compared with males. A progressive reduction in LEV CL/F was observed with increasing age, in a proportion that was similar to the decline in renal function. The elderly patients presented 30% lower LEV CL/F (mL/h/kg) and 43% lower creatinine clearance (CCr) in comparison with adults. No statistically significant differences were observed in LEV CL/F calculated in L/h between weight subgroups. However, when LEV CL/F was expressed in mL/h/kg, a progressive reduction was observed [normal weight: 72.21 (28.97); overweight: 57.84 (25.38); obese: 49.45 (14.50);P< 0.001]. A significant and positive correlation between CCr and LEV CL/F was observed, confirming the important role of the renal function in LEV CL/F. The CCr increased in each sex group when weight increased; however, LEV CL/F (L/h) remained constant.Conclusions:Sex, age, and weight affect LEV pharmacokinetics, having an impact on the individual dosage regimen needed to achieve the therapeutic objective. Sex is a conditioning factor of LEV CL/F, although its influence is principally due to the weight. LEV CL/F decreases with advancing age, proportionally to the decline in renal function. It is confirmed that LEV dosage per body weight is not required, and prescribing higher doses of LEV in obese patients is not justified. These data suggest that routine LEV therapeutic drug monitoring in the elderly patients, patients with renal dysfunction, and obese patients is indicated.
Outcome of Human Donor Corneas Stored for More Than 4 Weeks
Authors: Madzak Aida , Hjortdal Jesper 
Published: June 2018

Purpose:
Organ culture is the most common method for preservation of human donor corneas within Europe, and the maximum accepted storage period is typically set to 4 weeks. However, little is known about the fate of prolonged (4+ wks) organ culture storage of donor corneas. The aim of this study was to evaluate the clinical outcomes of corneal grafts preserved from 4 to 7 weeks compared with corneal grafts preserved up to 4 weeks in organ culture medium.

Methods:
A registry study was performed, identifying 1252 corneal transplantations [Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP)] between February 2008 and November 2015 at Aarhus University Hospital, Denmark. Data were extracted from The Danish Cornea Bank Registry and The Swedish Cornea Registry, which also includes Danish patients. The outcomes evaluated, 2 years after transplantation, were graft function, rebubbling rates in DSAEK surgeries, rejection rates, and endothelial cell density (ECD).

Results:
A total of 808 donor corneas were stored for ≤29 days, with a mean preservation time being 20 ± 6 days (mean ± SD, range: 6–29 days). A total of 444 donor corneas were stored for >29 days, with a mean preservation time being 38 ± 7 days (mean ± SD, range: 30–72 days). In both DSAEK (n = 835) and PKP (n = 417), no statistically significant difference was observed in the frequency of graft failure (DSAEK, P = 0.9 and PKP, P = 0.74), rebubbling rates (DSAEK P = 0.07), rejection rates (DSAEK, P = 0.08 and PKP, P = 0.95), or ECD (DSAEK, P = 0.56 and PKP, P = 0.44) between donor corneas cultured for ≤29 days and donor corneas cultured for >29 days.

Conclusions:
Corneas stored in organ culture for more than 4 weeks are equally suitable for DSAEK and PKP transplantation as corneas stored in organ culture for up to 4 weeks.
Catheter-assisted 360-Degree Trabeculotomy for Congenital Glaucoma
Authors: Toshev Anani P. , Much Martin M. , Klink Thomas , Pfeiffer Norbert , Hoffmann Esther M. , Grehn Franz 
Published: June 2018

Purpose:
To determine feasibility, efficacy, and safety of ab externo 360-degree trabeculotomy with illuminated microcatheter for congenital glaucoma.

Patients and Methods:
The postoperative results of 36 eyes in 23 consecutive patients who underwent 360-degree trabeculotomy for primary congenital glaucoma (PCG) or secondary congenital glaucoma using an illuminated microcatheter were retrospectively analyzed. Success criteria were defined as intraocular pressure (IOP) ≤18 mm Hg without (complete success) and with medication (qualified success).

Results:
In all previously nonoperated eyes with PCG (group 1), the Schlemm’s canal was identified and circumferentially cannulated for 360-degree trabeculotomy. In group 2 comprising of operated eyes with PCG and eyes with secondary congenital glaucoma, the performance of 360-degree trabeculotomy failed in 4 eyes because of the Schlemm’s canal occlusion or high tissue resistance of the trabecular meshwork. Mean preoperative IOP was 28.6±5 and 29.6±9 mm Hg with 7 of 20 eyes and 7 of 9 eyes receiving IOP-lowering medication in group 1 and group 2, respectively. Mean postoperative IOP was reduced to 13±2.7 and 20.2±7.1 mm Hg after a mean follow-up of 15.3 and 12.7 months with 4 of 20 eyes and 5 of 9 eyes receiving medication in group 1 and group 2, respectively. Four eyes underwent further surgery. Complete success was achieved in 16 and 3 eyes, whereas qualified success was achieved in 20 and 4 eyes from group 1 and group 2, respectively. In all eyes, a mild to moderate postoperative hyphema was observed.

Conclusions:
Ab externo catheter-assisted 360-degree trabeculotomy controls IOP in a majority of patients with congenital glaucoma after a single operation. Moderate blood reflux in the anterior chamber is considered as a common postoperative finding. We did not observe hypotony or other severe complications in our series. In 1 patient, we experienced catheter misdirection in an eye that had previously undergone trabeculotomy.
West Indies Glaucoma Laser Study (WIGLS)—2: Predictors of Selective Laser Trabeculoplasty Efficacy in Afro-Caribbeans With Glaucoma
Authors: Realini Tony , Shillingford-Ricketts Hazel , Burt Darra , Balasubramani Goundappa K. 
Published: June 2018

Purpose:
To identify factors associated with intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in Afro-Caribbean people with primary open-angle glaucoma (POAG).

Design:
This was a prospective stepped-wedge study.

Methods:
Data were drawn from 72 Afro-Caribbean subjects with POAG participating in the ongoing West Indies Glaucoma Laser Study. Multivariable mixed-model analysis was utilized to develop a predictive model for percent IOP reduction 12 months following SLT. Putative factors (age, sex, site, baseline IOP, prior use of prostaglandin therapy, number of prewashout IOP-lowering medications, central corneal thickness, severity of glaucoma, duration of follow-up, and signs of acute postoperative inflammation) were evaluated in bivariate analysis. Factors significant at P≤0.2 were included in the final model. Right and left eye data were modeled separately.

Results:
At month 12 following SLT, mean IOP reductions in the West Indies Glaucoma Laser Study were 6.2 to 6.5 mm Hg (29.7% to 31.0%) in right and left eyes. The only factor significant in both eyes (P=0.0005 in right eyes and P<0.0001 in left eyes) was time, with IOP reductions being greatest at month 3 and declining slightly over time through month 12. Vertical cup-disc ratio (P=0.006) and prior prostaglandin therapy (P=0.004) were significant only in right eyes, and central corneal thickness (P=0.014) was significant only in left eyes. Factors significant only unilaterally did not approach significance in fellow eyes, suggesting the possibility that these represent type 1 errors. Site (St. Lucia vs. Dominica) was not a significant factor, establishing generalizability of these treatment outcomes to a broader population of African-derived people.

Conclusions:
This analysis did not identify any subject-specific factors consistently predictive of therapeutic response to SLT. Of note, no factors predicted a suboptimal response. These findings favorably position SLT for broad application as primary therapy in African-derived people with POAG.
Estimating relative efficacy in acute postoperative pain: network meta-analysis is consistent with indirect comparison to placebo alone
Authors: Moore R. Andrew , Derry Sheena , Wiffen Philip J. , Banerjee Samik , Karan Rajesh , Glimm Ekkehard , Wiksten Anna , Aldington Dominic , Eccleston Christopher 
Published: June 2018

Abstract
Network meta-analysis uses direct comparisons of interventions within randomized controlled trials and indirect comparisons across them. Network meta-analysis uses more data than a series of direct comparisons with placebo, and theoretically should produce more reliable results. We used a Cochrane overview review of acute postoperative pain trials and other systematic reviews to provide data to test this hypothesis. Some 261 trials published between 1966 and 2016 included 39,753 patients examining 52 active drug and dose combinations (27,726 given active drug and 12,027 placebo), in any type of surgery (72% dental). Most trials were small; 42% of patients were in trials with arms <50 patients, and 27% in trials with arms ≥100 patients. Response to placebo in third molar extraction fell by half in studies over 30 to 40 years (171 trials, 7882 patients given placebo). Network meta-analysis and Cochrane analyses provided very similar results (average difference 0.04 number needed to treat units), with no significant difference for almost all comparisons apart from some with small patient numbers or small effect size, or both. Network meta-analysis did not detect significant differences between effective analgesics. The similarity between network meta-analysis and Cochrane indirect analyses probably arose from stringent quality criteria in trials accepted in Cochrane reviews (with consequent low risk of bias) and consistency in methods and outcomes. Network meta-analysis is a useful analytical tool that increases our confidence in estimates of efficacy of analgesics in acute postoperative pain, in this case by providing similar results.
Lionfish venom elicits pain predominantly through the activation of nonpeptidergic nociceptors
Authors: Mouchbahani-Constance Stephanie , Lesperance L. Stephen , Petitjean Hugues , Davidova Albena , Macpherson Amanda , Prescott Steven A. , Sharif-Naeini Reza 
Published: June 2018

Abstract
The lionfish (Pterois volitans) is a venomous invasive species found in the Caribbean and Northwestern Atlantic. It poses a growing health problem because of the increase in frequency of painful stings, for which no treatment or antidote exists, and the long-term disability caused by the pain. Understanding the venom's algogenic properties can help identify better treatment for these envenomations. In this study, we provide the first characterization of the pain and inflammation caused by lionfish venom and examine the mechanisms through which it causes pain using a combination of in vivo and in vitro approaches including behavioral, physiological, calcium imaging, and electrophysiological testing. Intraplantar injections of the venom produce a significant increase in pain behavior, as well as a marked increase in mechanical sensitivity for up to 24 hours after injection. The algogenic substance(s) are heat-labile peptides that cause neurogenic inflammation at the site of injection and induction of Fos and microglia activation in the superficial layers of the dorsal horn. Finally, calcium imaging and electrophysiology experiments show that the venom acts predominantly on nonpeptidergic, TRPV1-negative, nociceptors, a subset of neurons implicated in sensing mechanical pain. These data provide the first characterization of the pain and inflammation caused by lionfish venom, as well as the first insight into its possible cellular mechanism of action.
Azithromycin and Sensorineural Hearing Loss in Adults: A Retrospective Cohort Study
Authors: Alrwisan Adel , Antonelli Patrick J. , Brumback Babette A. , Wei Yu-Jung , Winterstein Almut G. 
Published: June 2018

Objective:
To examine whether short-term use of azithromycin increases the risk of sensorineural hearing loss (SNHL) in adults with uncomplicated infections.

Study Design:
A retrospective cohort study using Medicaid claims data, 1999 to 2010.

Patients:
Adults (18–64 years old) who had continuous enrollment in Medicaid for the 12 months (baseline) before the date of first dispensation (index date) of oral azithromycin or amoxicillin ± clavulanate for uncomplicated infections.

Main Outcome Definition:
We operationalized sensorineural hearing loss (SNHL) by a charge for audiometry and followed by a diagnosis of SNHL within 30 days.

Analysis:
We adjusted for the baseline covariates through propensity score matching. Adults were followed for up to 120 days after the index date. The hazard of SNHL in azithromycin-exposed adults was compared with those who had amoxicillin ± clavulanate using a Cox proportional hazard model. We performed several sensitivity analyses by varying the follow-up time, SNHL definition, adjusting for cumulative antibiotic use, and switching exposure status during the follow-up period.

Results:
A total of 493,774 patients entered the study cohort. The unadjusted incidence rates of SNHL were 38 and 41 cases per 10,000 patient-years following exposure to azithromycin and amoxicillin ± clavulanate, respectively. The adjusted (matched) hazard ratio (HR) of SNHL for azithromycin versus amoxicillin ± clavulanate was 0.91 (95% confidence interval [CI], 0.77–1.07). The sensitivity analyses findings were consistent with the primary analysis.

Conclusion:
Azithromycin short-term use was not associated with an increased risk of SNHL in comparison to amoxicillin ± clavulanate.
Pregnancy as a risk factor for thyroid cancer progression
Authors: Rakhlin Luba , Fish Stephanie 
Published: June 2018

Purpose of review
The current review evaluates the impact of pregnancy on women with thyroid cancer in three different clinical situations: those with newly diagnosed differentiated thyroid cancer (DTC), those under active surveillance for papillary thyroid microcarcinomas (PMCs), and those with previously treated DTC.

Recent findings
Recent pregnancy is not associated with high-risk pathological features of DTC. In women with known PMCs under active surveillance, pregnancy does not increase the risk of disease progression. Thus, deferring surgery for newly diagnosed DTC or known PMCs until after delivery is safe for both mother and the unborn child. If a woman with previously treated DTC is planning pregnancy, response-to-therapy status is an excellent guide for predicting pregnancy-associated disease progression or recurrence.

Summary
Clinical studies consistently show that pregnancy is not associated with significant disease progression in newly diagnosed thyroid cancer, PMCs under active surveillance, or previously treated DTC.