bluuebunny/crossref_metadata_2025_split huggingface dataset:
Propofol Anesthesia Alters Spatial and Topologic Organization of Rat Brain Metabolism
Authors: Chen Yali , Bao Weiqi , Liang Xia , Zhang Jun 
Published: July 2019

Abstract

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What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Loss of consciousness during anesthesia reduces local and global rate of cerebral glucose metabolism. Despite this, the influence of gradual anesthetic-induced changes on consciousness across the entire brain metabolic network has barely been studied. The purpose of the present study was to identify specific cerebral metabolic patterns characteristic of different consciousness/anesthesia states induced by intravenous anesthetic propofol.

Methods
At various times, 20 Sprague–Dawley adult rats were intravenously administered three different dosages of propofol to induce different anesthetic states: mild sedation (20 mg · kg−1 · h−1), deep sedation (40 mg · kg−1 · h−1), and deep anesthesia (80 mg · kg−1 · h−1). Using [18F]fluorodeoxyglucose positron emission tomography brain imaging, alterations in the spatial pattern of metabolic distribution and metabolic topography were investigated by applying voxel-based spatial covariance analysis and graph-theory analysis.

Results
Evident reductions were found in baseline metabolism along with altered metabolic spatial distribution during propofol-induced anesthesia. Moreover, graph-theory analysis revealed a disruption in global and local efficiency of the metabolic brain network characterized by decreases in metabolic connectivity and energy efficiency during propofol-induced deep anesthesia (mild sedation global efficiency/local efficiency = 0.6985/0.7190, deep sedation global efficiency/local efficiency = 0.7444/0.7875, deep anesthesia global efficiency/local efficiency = 0.4498/0.6481; mild sedation vs. deep sedation, global efficiency: P = 0.356, local efficiency: P = 0.079; mild sedation vs. deep anesthesia, global efficiency: P < 0.0001, local efficiency: P < 0.0001; deep sedation vs. deep anesthesia, global efficiency: P < 0.0001, local efficiency: P < 0.0001). A strong spatial correlation was also found between cerebral metabolism and metabolic connectivity strength, which decreased significantly with deepening anesthesia level (correlation coefficients: mild sedation, r = 0.55, deep sedation, r = 0.47; deep anesthesia, r = 0.23; P < 0.0001 between the sedation and deep anesthesia groups).

Conclusions
The data revealed anesthesia-related alterations in spatial and topologic organization of metabolic brain network, as well as a close relationship between metabolic connectivity and cerebral metabolism during propofol anesthesia. These findings may provide novel insights into the metabolic mechanism of anesthetic-induced loss of consciousness.
The Far Side Opposite the Surgeon is Most Prone to Contamination From the C-Arm
Authors: Zuelzer David A. , Allen Jerad , Hsu Joseph R. , Matuszewski Paul E. 
Published: July 2019

Objective:
Fluoroscopy is used in many orthopaedic procedures. The C-Arm drape is known to be easily contaminated during orthogonal imaging. However, it is unknown if one area of the operative field is more prone to contamination than another. The purpose of this study was to determine if secondary transfer of contaminate from the undraped portion of the C-Arm occurs.

Methods:
A C-Arm was utilized with standardized draping in a simulated operating room. We used a simulated contaminant: a fluorescent powder that phosphoresces under ultraviolet light. The powder was placed over nonsterile portions. A darkened room with a black light, and a camera was used. C-Arm movements were simulated by cycling through lateral to Anteroposterior imaging. Images were taken before (control) and after cycles of orthogonal imaging. The change in light intensity was quantified at each time point over each area as a percentage of change.

Results:
Contamination of the surgical field was observed in all areas after 15 cycles, with the area adjacent to the C-Arm being most pronounced. A linear increase in intensity with increased cycles was observed (R
2 = 0.297; P = 0.036), with the mean increase in intensity of 5% after 15 cycles (95% confidence interval, 1.97–7.86). The remaining areas (closest to surgeon and middle) showed an increase as well but were not significant (P > 0.05).

Conclusions:
Secondary contamination of the surgical field from the C-Arm occurs. The area most prone to contamination is the area immediately adjacent to the fluoroscopy unit, usually opposite the surgeon.
Dual Time-Point 18F-FDG PET/CT in Spinal Sarcoidosis
Authors: Ordóñez-Rubiano Edgar G. , Solano-Noguera Diego F. , Row William , Weinberg Jeffrey , Tatsui Claudio E. , Johnson Jason M. , Gule-Monroe Maria K. 
Published: July 2019

Study Design.
A case series of dual time-point 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the diagnosis of spinal cord sarcoidosis.

Objective.
The aim of this study was to illustrate three cases of spinal sarcoidosis with occult presentation and subsequent identification with the use of dual time-point 18F-FDG PET/CT.

Summary of Background Data.
Sarcoidosis of the spinal cord is very rare and when it occurs without systemic manifestations of disease can be a challenging diagnostic dilemma frequently resulting in the need for spinal cord biopsy in order to establish a diagnosis.

Methods.
Case series presentation and report.

Results.
This manuscript presents a case series experience of dual time-point 18F-FDG PET/CT for the diagnosis of spinal cord sarcoidosis. We review the cases of three patients who presented with myelopathy and underwent 18F-FDG DTPI as part of the evaluation for enhancing spinal cord lesions of unknown etiology for 2 years at a university-based cancer hospital. 18F-FDG DTPI was vital in making the diagnosis of sarcoidosis, and in two of the cases, the patients were able to avoid biopsy, thereby avoiding potential morbidity from an invasive procedure.

Conclusion.

18F-FDG PET/CT imaging is a noninvasive imaging technique that can be crucial in the diagnosis of sarcoidosis of the spinal cord and help avoid unnecessary procedures.

Level of Evidence: 4
Imaging of the Spine
Authors: Das Jeeban Paul , Aherne Emily , Kavanagh Eoin 
Published: July 2019

Study Design.
A bibliometric review of the literature.

Objective.
The aim of this study was to identify the most highly cited articles relating to imaging of the spine and to analyze the most influential papers and evolving trends in spinal imaging research.

Summary of Background Data.
Spinal imaging is being performed with increasing frequency and is an essential step in the diagnosis and treatment planning of spinal pathology. A comprehensive review of the most influential articles in spinal imaging has not been performed, until now.

Methods.
A selection of search terms and keywords were inputted into the “Web of Science” database and the most highly cited articles in spinal imaging were selected from high impact factor journals. The top 100 articles were analyzed for year of publication, authorship, publishing journals, institution and country of origin, subject matter, article type, and level of evidence. In addition to total citation count, the number of annual citations was also calculated. Citation counts from Scopus and Google Scholar were also obtained for comparison across other citation index platforms.

Results.
The most highly cited articles in spinal imaging were published over 30 years, between 1983 and 2013. Total citation count ranged from 98 to 1243 with annual citation count ranging from 3.8 to 91.8. The greatest number of highly cited articles was produced in the United States (n = 49), involved magnetic resonance (n = 73) or multimodal (n = 17) imaging and focused on the lumbar spine (n = 42). The journals that contributed the most articles were Spine and Radiology each publishing 26 articles.

Conclusion.
Our study provided an extensive list of the most historically significant spinal imaging articles, acknowledging the key contributions made to the advancement of this specialist field.

Level of Evidence: 5
Pulsed Electromagnetic Fields Reduce Interleukin-6 Expression in Intervertebral Disc Cells Via Nuclear Factor-κβ and Mitogen-Activated Protein Kinase p38 Pathways
Authors: Tang Xinyan , Coughlin Dezba , Ballatori Alexander , Berg-Johansen Britta , Waldorff Erik I. , Zhang Nianli , Ryaby James T. , Aliston Tamara , Lotz Jeffrey C. 
Published: July 2019

Study Design.
This is an in vitro study of bovine disc cells exposed to pulsed electromagnetic fields.

Objective.
The purpose of the present study was to investigate whether pulsed electromagnetic fields (PEMF) effects on the expression of interleukin-6 (IL-6) expression is mediated by two known inflammation regulators, nuclear factor-κB (NF-κβ) and phosphorylated mitogen-activated protein kinase p38 (p38-MAPK) signaling pathways

Summary of Background Data.
Inflammatory cytokines play a dominant role in the pathogenesis of disc degeneration. Increasing evidence showed that PEMF, a noninvasive biophysical stimulation, can have physiologically beneficial effects on inflammation and tissue repair. Our previous research shows that PEMF treatment can reduce IL-6 expression by intervertebral disc cells. However, the underlying mechanisms of PEMF action are yet to be uncovered.

Methods.
Intervertebral disc nuclear pulposus cells were challenged with interleukin-1α (IL-1α) (for mimicking inflammatory microenvironment) and treated with PEMF simultaneously up to 4 hours. Cells were then collected for NF-κβ and phosphorylated p38-MAPK protein detection with Western blot. Additionally, the RelA (p65) subunit of NF-κβ was examined with immunostaining for assessment of NF-κβ activation.

Results.
As expected, Western blot results showed that both NF-κβ and phosphorylated p38 expression were significantly increased by IL-1α treatment. This induction was significantly inhibited to control condition levels by PEMF treatment. Immunostaining demonstrated similar trends, that PEMF treatment reduced the NF-κβ activation induced by IL-1α exposure.

Conclusion.
Our data indicate that the previously-reported inhibitory effect of PEMF treatment on disc inflammation is mediated by NF-κβ and phosphorylated p38-MAPK signaling pathways. These results further establish PEMFs anti-inflammatory activity, and may inform potential future clinical uses for management of inflammation associated with disc degeneration.

Level of Evidence: N/A
Validation of the Disabilities of the Arm, Shoulder, and Hand in Patients Undergoing Cervical Spine Surgery
Authors: Khalifeh Jawad M. , Akbari Syed Hassan A. , Khandpur Umang , Johnston William , Wright Neill M. , Hawasli Ammar H. , Dorward Ian , Santiago Paul , Ray Wilson Z. 
Published: July 2019

Study Design.
Retrospective cohort study.

Objective.
To evaluate the performance and convergent validity of the disabilities of the arm, shoulder, and hand (DASH) in comparison with the visual analog scale (VAS) for pain, and neck disability index (NDI) in patients undergoing cervical spine surgery.

Summary of Background Data.
Neck-specific disability scales do not adequately assess concurrent upper extremity involvement in patients with cervical spine disorders. The DASH is a patient-reported outcomes (PRO) instrument designed to measure functional disability due to upper extremity conditions but has additionally been shown to perform well in patients with neck disorders.

Methods.
We identified patients who underwent cervical spine surgery at our institution between 2013 and 2016. We collected demographic information, clinical characteristics, and PRO measures—DASH, VAS, NDI—preoperatively, as well as early and late postoperatively. We calculated descriptive statistics and changes from baseline in PROs. Correlation coefficients were used to quantify the association between PRO measures. The analysis was stratified by radiculopathy and myelopathy diagnoses.

Results.
A total of 1046 patients (52.8% male) with PROs data at baseline were included in the analysis. The mean age at surgery ± SD was 57.2 ± 11.3 years, and postoperative follow-up duration 12.7 ± 10.7 months. The most common surgical procedure was anterior cervical discectomy and fusion (71.1%). Patients experienced clinically meaningful postoperative improvements in all PRO measures. The DASH showed moderate positive correlations with VAS preoperatively (Spearman rho = 0.43), as well as early (rho = 0.48) and late postoperatively (rho = 0.60). DASH and NDI scores were strongly positively correlated across operative states (Preoperative rho = 0.74, Early Postoperative rho = 0.78, Late Postoperative rho = 0.82). Stratified analysis by preoperative diagnosis showed similar within-groups trends and pairwise correlations. However, radiculopathy patients experienced larger magnitude early and late change scores.

Conclusion.
The DASH is a valid and responsive PRO measure to evaluate disabling upper extremity involvement in patients undergoing cervical spine surgery.

Level of Evidence: 3
Comparison of Radiological Features and Clinical Characteristics in Scoliosis Patients With Chiari I Malformation and Idiopathic Syringomyelia
Authors: Shen Jianxiong , Tan Haining , Chen Chong , Zhang Jianguo , Lin Youxi , Rong Tianhua , Jiao Yang , Liang Jinqian , Li Zheng 
Published: July 2019

Study Design.
Retrospective study.

Objective.
To compare syrinx characteristics, scoliotic parameters, and neurological deficits between Chiari I malformation (CIM) and idiopathic syringomyelia (IS) in the scoliotic population.

Summary of Background Data.
CIM and IS are common in neuromuscular scoliosis patients; however, differences in syrinx characteristics, scoliotic parameters, and neurological deficits between CIM and IS are unclear.

Methods.
Thirty-six patients with scoliosis secondary to CIM were enrolled retrospectively and matched with 36 IS patients for sex, age, scoliosis classification, and Cobb angle. Information on radiographic features of scoliosis and syrinx and neurological deficits was systematically collected.

Results.
Sex, age, and coronal, and sagittal scoliosis parameters did not differ between the CIM and IS groups. The CIM group had a longer syrinx (12.9 ± 4.0 vertebral levels vs. 8.7 ± 5.5 vertebral levels, P < 0.001), a higher cranial extent (3.6 ± 2.2 vs. 5.2 ± 3.5, P = 0.027), and a lower caudal extent (15.6 ± 2.9 vs. 13.0 ± 4.6, P = 0.006) than the IS group, despite no differences in syrinx/cord (S/C) ratio or syrinx classification. No differences in neurological deficits were identified between the CIM and IS patients.

Conclusion.
With demographic and scoliotic coronal parameters matched, the CIM patients had a longer syrinx, located at a higher cranial and lower caudal level, compared with the IS group. No significant differences in syrinx S/C ratio, sagittal features of scoliosis, or neurological deficits were detected between the two groups.

Level of Evidence: 3
Benchmarks of Duration and Magnitude of Opioid Consumption After Common Spinal Procedures
Authors: Cook David J. , Kaskovich Samuel , Pirkle Sean , Ho Alisha , Conti Mica Megan , Shi Lewis , Lee Michael 
Published: July 2019

Study Design.
A retrospective cohort study performed in a nationwide insurance claims database.

Objective.
This study aimed to examine duration and magnitude of postoperative opioid prescriptions following common spinal procedures.

Summary of Background Data.
Postoperative opioid prescription practices vary widely among providers and procedures and standards of care are not well-established. Previous work does not adequately quantify both duration and magnitude of opioid prescription.

Methods.
Forty seven thousand eight hundred twenty three patients with record of any of four common spinal procedures in a nationwide insurance claims database were stratified by preoperative opioid use into three categories: “opioid naive,” “sporadic user,” or “chronic user,” defined as 0, 1, or 2+ prescriptions filled in the 6 months preceding surgery. Those with record of subsequent surgery or readmission were excluded. Duration of opioid use was defined as the time between the index surgery and the last record of filling an opioid prescription. Magnitude of opioid use was defined as milligram morphine equivalents (MME) filled by 30 days post-op, converted to 5 mg oxycodone pills for interpretation.

Results.
Opioid naive patients were less likely than chronic opioid users to fill any opioid prescription after surgery (63–68% naive vs. 91–95% chronic, P < 0.001), and when they did, their prescriptions were smaller in magnitude (76–91 pills naive vs. 127–152 pills chronic). One year after surgery, 15% to 18% of opioid naive and 50% to 64% of chronic opioid users continued filling prescriptions.

Conclusion.
Opioid naive patients use less postoperative opioids, and for a shorter period of time, than chronic users. This study serves as a normative benchmark for examining postoperative opioid use, which can assist providers in identifying patients with opioid dependence. Importantly, this work calls out the high risk of opioid exposure, as 15% to 18% of opioid naive patients continued filling opioid prescriptions 1 year after surgery.

Level of Evidence: 3
Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks
Authors: Myhrvold Birgitte Lawaetz , Kongsted Alice , Irgens Pernille , Robinson Hilde Stendal , Thoresen Magne , Vøllestad Nina Køpke 
Published: July 2019

Study Design.
A prospective observational study.

Objective.
To externally validate the prediction model developed by Schellingerhout and colleagues predicting global perceived effect at 12 weeks in patients with neck pain and to update and internally validate the updated model.

Summary of Background Data.
Only one prediction model for neck pain has undergone some external validation with good promise. However, the model needs testing in other populations before implementation in clinical practice.

Methods.
Patients with neck pain (n = 773) consulting Norwegian chiropractors were followed for 12 weeks. Parameters from the original prediction model were applied to this sample for external validation. Subsequently, two random samples were drawn from the full study sample. One sample (n = 436) was used to update the model; by recalibration, removing noninformative covariates, and adding new possible predictors. The updated model was tested in the other sample (n = 303) using stepwise logistic regression analysis. Main outcomes for performance of models were discrimination and calibration plots.

Results.
Three hundred seventy patients (47%) in the full study sample reported persistent pain at 12 weeks. The performance of the original model was poor, area under the receiver operating characteristics curve was 0.55 with a Confidence Interval of 0.51–0.59. The updated model included Radiating pain to shoulder and/or elbow, education level, physical activity, consultation-type (first- time, follow-up or maintenance consultation), expected course of neck pain, previous course of neck pain, number of pain sites, and the interaction term Physical activity##Number of pain sites. The area under the receiver operating characteristics curve was 0.65 with a 95% Confidence Interval of 0.58–0.71 for the updated model.

Conclusion.
The predictive accuracy of the original model performed insufficiently in the sample of patients from Norwegian chiropractors and the model is therefore not recommended for that setting. Only one predictor from the original model was retained in the updated model, which demonstrated reasonable good performance predicting outcome at 12 weeks. Before considering clinical use, a new external validation is required.

Level of Evidence: 3
Propensity-matched Comparison of Outcomes and Costs After Macroscopic and Microscopic Anterior Cervical Corpectomy Using a National Longitudinal Database
Authors: Ho Allen Lin , Rezaii Paymon Garakani , Pendharkar Arjun Vivek , Sussman Eric Scott , Veeravagu Anand , Ratliff John Kevin , Desai Atman Mukesh 
Published: July 2019

Study Design.
A retrospective analysis of national longitudinal database.

Objective.
The aim of this study was to examine the outcomes and cost-effectiveness of operating microscope utilization in anterior cervical corpectomy (ACC).

Summary of Background Data.
The operating microscope allows for superior visualization and facilitates ACC with less manipulation of tissue and improved decompression of neural elements. However, many groups report no difference in outcomes with increased cost associated with microscope utilization.

Methods.
A longitudinal database (MarketScan) was utilized to identify patients undergoing ACC with or without microscope between 2007 and 2016. Propensity matching was performed to normalize differences between the two cohorts. Outcomes and costs were subsequently compared.

Results.
A total of 11,590 patients were identified for the “macroscopic” group, while 4299 patients were identified for the “microscopic” group. For the propensity-matched analysis, 4298 patients in either cohort were successfully matched according to preoperative characteristics. Hospital length of stay was found to be significantly longer in the macroscopic group than the microscopic group (1.86 nights vs. 1.56 nights, P < 0.0001). Macroscopic ACC patients had an overall higher rate of readmissions [30-day: 4.2% vs. 3.2%, odds ratio (OR) = 0.76 (0.61–0.96), P = 0.0223; 90-day: 7.0% vs. 5.9%, OR = 0.82 (0.69–0.98), P = 0.0223]. Microscopic ACC patients had a higher rate of discharge to home [86.6% vs. 92.5%, OR = 1.91 (1.65–2.21), P < 0.0001] and lower rates of new referrals to pain management [1.0% vs. 0.4%, OR = 0.42 (0.23–0.74), P = 0.0018] compared with macroscopic ACC. Postoperative complication rate was not found to be significantly different between the groups. Finally, total initial admission charges were not significantly different between the macroscopic and microscopic groups ($30,175 vs. $29,827, P = 0.9880).

Conclusion.
The present study suggests that the use of the operating microscope for ACC is associated with decreased length of stay, readmissions, and new referrals to pain management, as well as higher rate of discharge to home.

Level of Evidence: 3