bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of Full-endoscopic Decompression via Interlaminar Approach for Central or Lateral Recess Spinal Stenosis of the Lumbar Spine
Authors: Lee Chang-Hyun , Choi Miyoung , Ryu Dal Sung , Choi Il , Kim Chi Heon , Kim Hyeun Sung , Sohn Moon-Jun 
Published: May 2018

Study Design.
A meta-analysis of five retrospective cohort studies.

Objective.
The aim of the study was to delineate the efficacy and safety of full-endoscopic decompression via the interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine using a meta-analysis.

Summary of Background Data.
The paradigm of spinal endoscopy is shifting from treatment of soft disc herniation to that of lumbar spinal stenosis. Technical advancements have enabled full-endoscopic decompression in spinal stenosis surgery. There is few strong evidence supporting this surgical technique, and clinicians usually rely on their own opinions and experiences.

Methods.
A systematic search of electronic databases, including PubMed, EMBASE, Cochrane Library, Web of science, and KoreaMed, up to August 2017 was performed to identify studies concerning full-endoscopic decompression via the interlaminar approach for lumbar spinal stenosis. Changes in clinical outcomes [Oswestry Disability Index (ODI) and Visual Analog Scales (VAS) for back and leg pain] were compared with the minimal clinically important difference (MCID) for each item. We then calculated the mean differences and 95% confidence intervals (95% CIs) using random-effects models.

Results.
We included data from five studies involving 156 patients at 6- and 12-month follow-ups. The majority of enrolled papers included patients with neurogenic claudication due to central stenosis refractory to conservative management and excluded patients with significant instability or previous surgery. The overall mean difference of patients with ODI and VAS scores for leg and back pain exceeded the criteria for MCID. ODI scores improved by 41.71 (95% CI, 39.80–43.62) after the surgery, which was twice the MCID. The VAS leg and back pain scores improved by 5.95 (95% CI, 5.70–6.21) and 4.22 (95% CI, 3.88–4.56), respectively, indicating statistically significant improvement over the MCID.

Conclusion.
Successful clinical outcomes can be achieved with full-endoscopic decompression via the interlaminar approach for lumbar central spinal stenosis in patients for the defined indications.

Level of Evidence: 2
Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Nonoperative Treatment
Authors: Furunes Håvard , Hellum Christian , Espeland Ansgar , Brox Jens Ivar , Småstuen Milada Cvancarova , Berg Linda , Storheim Kjersti 
Published: May 2018

Study Design.
A randomized controlled multicenter trial with 8-year follow-up.

Objective.
The aim of this study was to assess the long-term development of adjacent disc degeneration (ADD) after lumbar total disc replacement (TDR) or nonoperative treatment, and to analyze the association between ADD development and clinical outcome.

Summary of Background Data.
TDR was introduced as a motion-preserving alternative to spinal fusion, which has been reported to increase the risk of ADD. However, ADD may develop naturally regardless of any surgery, and no randomized study has assessed the long-term development of ADD after TDR versus nonoperative treatment.

Methods.
The study included 126 of the 173 patients with chronic low back pain (LBP) originally included in a randomized study comparing TDR with multidisciplinary rehabilitation. Magnetic resonance imaging (MRI) of the lumbar spine was performed before treatment and at 8-year follow-up. ADD was categorized as increased or not increased based on an evaluation of Modic changes, disc height reduction, disc contour, herniation size, nucleus pulposus signal, and posterior high intensity zones. We used a χ2 test or a Fisher exact test to compare crude proportions, and multiple linear regressions to analyze the association between increased ADD (yes/no) and change in Oswestry Disability Index (ODI) from pre-treatment to follow-up.

Results.
ADD increased (for at least one ADD variable) in 23 of 57 patients (40%) treated nonoperatively, and 29 of 69 patients (42%) treated with TDR (P = 0.86). We found no significant associations between ADD increase and the change in ODI.

Conclusion.
Increased ADD occurred with similar frequency after TDR and after nonoperative treatment, and was not related to the clinical outcome at 8-year follow-up.

Level of Evidence: 1
Clinical Impact and Economic Burden of Hospital-Acquired Conditions Following Common Surgical Procedures
Authors: Horn Samantha R. , Liu Tiffany C. , Horowitz Jason A. , Oh Cheongeun , Bortz Cole A. , Segreto Frank A. , Vasquez-Montes Dennis , Steinmetz Leah M. , Deflorimonte Chloe , Vira Shaleen , Diebo Bassel G. , Neuman Brian J. , Raad Micheal , Sciubba Daniel M. , Lafage Renaud , Lafage Virginie , Hassanzadeh Hamid , Passias Peter G. 
Published: May 2018

Study Design.
Retrospective review of prospectively collected data.

Objective.
To assess the clinical impact and economic burden of the three most common hospital-acquired conditions (HACs) that occur within 30-day postoperatively for all spine surgeries and to compare these rates with other common surgical procedures.

Summary of Background Data.
HACs are part of a non-payment policy by the Centers for Medicare and Medicaid Services and thus prompt hospitals to improve patient outcomes and safety.

Methods.
Patients more than 18 years who underwent elective spine surgery were identified in American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2013. Primary outcomes were cost associated with the occurrence of three most common HACs. Cost associated with HAC occurrence derived from the PearlDiver database.

Results.
Ninety thousand five hundred fifty one elective spine surgery patients were identified, where 3021 (3.3%) developed at least one HAC. Surgical site infection (SSI) was the most common HAC (1.4%), then urinary tract infection (UTI) (1.3%) and venous thromboembolism (VTE) (0.8%). Length of stay (LOS) was longer for patients who experienced a HAC (5.1 vs. 3.2 d, P < 0.001). When adjusted for age, sex, and Charlson Comorbidity Index, LOS was 1.48 ± 0.04 days longer (P < 0.001) and payments were $8893 ± $148 greater (P < 0.001) for patients with at least one HAC. With the exception of craniotomy, patients undergoing common procedures with HAC had increased LOS and higher payments (P < 0.001). Adjusted additional LOS was 0.44 ± 0.02 and 0.38 ± 0.03 days for total knee arthroplasty and total hip arthroplasty, and payments were $1974 and $1882 greater. HACs following hip fracture repair were associated with 1.30 ± 0.11 days LOS and $4842 in payments (P < 0.001). Compared with elective spine surgery, only bariatric and cardiothoracic surgery demonstrated greater adjusted additional payments for patients with at least one HAC ($9975 and $10,868, respectively).

Conclusion.
HACs in elective spine surgery are associated with a substantial cost burden to the health care system. When adjusted for demographic factors and comorbidities, average LOS is 1.48 days longer and episode payments are $8893 greater for patients who experience at least one HAC compared with those who do not.

Level of Evidence: 3
Inappropriate Antibiotic Prescribing for Acute Bronchitis in Children and Impact on Subsequent Episodes of Care and Treatment
Authors: Morgan Jake R. , Carey Kathleen M. , Barlam Tamar F. , Christiansen Cindy L. , Drainoni Mari-Lynn 
Published: May 2018

Background:
To examine whether inappropriate antibiotic treatment for an initial bout of acute bronchitis in childhood affects patterns of future healthcare utilization and antibiotic prescribing.

Methods:
We conducted a retrospective analysis of children with at least 1 acute bronchitis episode, defined as the 14-day period after an acute bronchitis visit, born in 2008 and followed through 2015 in a nationally representative commercial claims database. We predicted the likelihood of returning for a subsequent acute bronchitis episode, and being prescribed an antibiotic as part of that episode, as a function of whether or not the child was prescribed an antibiotic as part of the first acute bronchitis episode controlling for patient, provider and practice characteristics.

Results:
Children prescribed an antibiotic as part of their initial acute bronchitis episode were more likely both to have a subsequent acute bronchitis episode (hazard ratio = 1.23; 95% confidence interval: 1.17–1.30) and to be prescribed an antibiotic as part of that second episode (hazard ratio = 2.13; 95% confidence interval: 1.99–2.28) compared with children who were not prescribed as part of their first episode. Children diagnosed with asthma were more likely to experience a second visit for acute bronchitis, but less likely to receive an antibiotic as part of that second episode.

Conclusions:
Inappropriate antibiotic prescribing for a child’s initial acute bronchitis episode of care predicted likelihood of subsequent acute bronchitis episodes and antibiotic prescriptions. Providers should consider the downstream effect of inappropriate antibiotic prescribing for acute bronchitis in childhood.
Chronic neuropathic pain reduces opioid receptor availability with associated anhedonia in rat
Authors: Thompson Scott J. , Pitcher Mark H. , Stone Laura S. , Tarum Farid , Niu Gang , Chen Xiaoyuan , Kiesewetter Dale O. , Schweinhardt Petra , Bushnell M. Catherine 
Published: May 2018

Abstract
The opioid system plays a critical role in both the experience and management of pain. Although acute activation of the opioid system can lead to pain relief, the effects of chronic pain on the opioid system remain opaque. Cross-sectional positron emission tomography (PET) studies show reduced availability of brain opioid receptors in patients with chronic pain but are unable to (1) determine whether these changes are due to the chronic pain itself or due to preexisting or medication-induced differences in the endogenous opioid system, and (2) identify the neurobiological substrate of reduced opioid receptor availability. We investigated these possibilities using a well-controlled longitudinal study design in rat. Using [18F]-FDPN-PET in either sham rats (n = 17) or spared nerve injury rats (n = 17), we confirmed reduced opioid receptor availability in the insula, caudate–putamen, and motor cortex of nerve injured rats 3 months after surgery, indicating that painful neuropathy altered the endogenous opioid system. Immunohistochemistry showed reduced expression of the mu-opioid receptor, MOR1, in the caudate–putamen and insula. Neither the opioid peptide enkephalin nor the neuronal marker NeuN differed between groups. In nerve-injured animals, sucrose preference, a measure of anhedonia/depression-like behavior, positively correlated with PET opioid receptor availability and MOR1-immunoreactivity in the caudate–putamen. These findings provide new evidence that the altered supraspinal opioid receptor availability observed in human patients with chronic pain may be a direct result of chronic pain. Moreover, reduced opioid receptor availability seems to reflect decreased receptor expression, which may contribute to pain-induced depression.
Pain sensitization associated with nonresponse after physiotherapy in people with knee osteoarthritis
Authors: O'Leary Helen , Smart Keith M. , Moloney Niamh A. , Blake Catherine , Doody Catherine M. 
Published: May 2018

Abstract
In knee osteoarthritis (OA), pain sensitization has been linked to a more severe symptomatology, but the prognostic implications of pain sensitivity in people undergoing conservative treatment such as physiotherapy are not established. This study aimed to prospectively investigate the association between features of pain sensitization and clinical outcome (nonresponse) after guideline-based physiotherapy in people with knee OA. Participants (n = 156) with moderate/severe knee OA were recruited from secondary care. All participants completed self-administered questionnaires and underwent quantitative sensory testing at baseline, thereby establishing subjective and objective measures of pain sensitization. Participants (n = 134) were later classified after a physiotherapy intervention, using treatment responder criteria (responder/nonresponder). Quantitative sensory testing data were reduced to a core set of latent variables using principal component analysis. A hierarchical logistic regression model was constructed to investigate whether features related to pain sensitization predicted nonresponse after controlling for other known predictors of poor outcome in knee OA. Higher temporal summation (odds ratio 2.00, 95% confidence interval 1.23-3.27) and lower pressure pain thresholds (odds ratio 0.48, 95% confidence interval 0.29-0.81) emerged as robust predictors of nonresponse after physiotherapy, along with a higher comorbidity score. The model demonstrated high sensitivity (87.8%) but modest specificity (52.3%). The independent relationship between pain sensitization and nonresponse may indicate an underlying explanatory association between neuroplastic changes in nociceptive processing and the maintenance of ongoing pain and disability in knee OA pain. These preliminary results suggest that interventions targeting pain sensitization may warrant future investigation in this population.
Middle Ear Pressures in Wind Instrument Musicians
Authors: Osborne Max Sallis , Morris Simon , Clark Matthew P. , Begg Philip 
Published: May 2018

Objectives:
This study aimed to assess if playing wind instruments leads to a measurable increase in middle ear pressure during note generation and to provide evidence to clinicians to advise musicians undergoing middle ear surgery.

Study Design:
An observational cohort study of 40 volunteers in 7 different wind instrument categories underwent tympanometry at rest and during note production.

Setting:
Community.

Patients:
Recreational musicians aged over 18 years recruited from the student body attending Birmingham University, UK.

Intervention:
None.

Main Outcome Measures:
Tympanometry is used as a noninvasive measure of middle ear pressure. The pressure at which peak compliance occurred was taken as an indirect measure of middle ear pressure. The data produced at rest and during note production was statistically analysed with paired t testing and significance set at a p value less than 0.01.

Results:
Overall a statistically significant increase in middle ear pressure change of 0.63 mm Hg (p = 0.0001) during note production was identified. Musicians playing the oboe and trumpet demonstrate the largest increase in middle ear pressure of 1.46 mm Hg (p = 0.0053) and 0.78 mm Hg (p = 0.0005) respectively.

Conclusion:
The data provided by this study gives evidence for the first time that playing wind instruments does increase middle ear pressure. Although the clinical significance of this is yet to be determined the authors would advise that musicians who undergo otological procedures should refrain from playing their instruments until full recovery has been achieved as advised by their clinician following direct microscopic review.
Drug-resistant cytomegalovirus: clinical implications of specific mutations
Authors: Razonable Raymund R. 
Published: May 2018

Purpose of review
Cytomegalovirus (CMV) infection can be refractory to antiviral treatment. Although refractoriness can be due impaired host immunity, it can also be due to viral mutations that confer antiviral drug resistance. This article provides a succinct review of mutations in CMV genes that confer drug resistance, and offer guidance on clinical management.

Recent findings
Recent advances in medical and research technology have confirmed traditional mutations and identified novel ones that confer resistance to current antiviral drugs. Resistance to ganciclovir is commonly predicted by mutations in UL97, which encode for viral kinase that catalyzes its phosphorylation. Mutations in UL54, which encode for CMV DNA polymerase, confer resistance (or cross-resistance) to ganciclovir, cidofovir and/or foscarnet. Resistance to letermovir, the new drug approved for CMV prophylaxis in allogeneic hematopoietic stem cell transplant recipients, has emerged and mapped most commonly to mutations in UL56 and less commonly UL51 and UL89, the gene complex that encode for viral terminase.

Summary
Mutations in CMV genes can be selected during antiviral drug exposure, and manifests phenotypically as nonresponsive drug-resistant disease. Knowledge of specific mutations informs clinicians in selecting appropriate antivirals for managing transplant patients with CMV disease.
Early diagnosis of fungal infections in lung transplant recipients, colonization versus invasive disease?
Authors: Herrera Sabina , Husain Shahid 
Published: May 2018

Purpose of review
The diagnosis of invasive aspergillosis remains challenging in solid organ transplants in general, and in lung transplant recipients, in particular, because of colonization. Lung transplant recipients may be over treated with antifungal drugs because of the lack of appropriate diagnostic tools.

Recent findings
A review of the new developments of diagnostic tools and whether this help distinguishing colonization from invasive disease is presented.

Summary
Efforts are being made to develop new tools that will allow us to identify which patients will develop IPA, and those who will be able to control the disease.
Plasma Hepcidin Levels in Healthy Children: Review of Current Literature Highlights Limited Studies
Authors: Kumar Surjeet , Bhatia Prateek , Jain Richa , Bharti Bhavneet 
Published: May 2018

Background:
There are few studies that highlight pediatric hepcidin reference ranges especially from Asian subcontinent. In current study, plasma from 131 children (72 boys and 59 girls; 1 to 12 y) was analyzed for hepcidin-25 by enzyme-linked immunosorbent assay.

Observations:
The median (interquartile range) plasma hepcidin in boys was 21.89 ng/mL (16.50 to 51.70 ng/mL) and girls was 21.95 ng/mL (19.20 to 47.70 ng/mL). No statistically significant difference (P=0.937) of plasma hepcidin levels in sex was noted. However, multiple regression analysis revealed a significant correlation between plasma hepcidin levels and ferritin (P=0.000).

Conclusions:
Our study results highlight relatively lower median hepcidin values in children 1 to 12 years of age as compared with western data. This may be attributed to either lack of a harmonized and standard enzyme-linked immunosorbent assay detection methodology or to presence of clinically significant polymorphisms in hepcidin gene in our population.
Effectiveness of Physiotherapy Interventions on Spasticity in People With Multiple Sclerosis
Authors: Etoom Mohammad , Khraiwesh Yazan , Lena Francesco , Hawamdeh Mohannad , Hawamdeh Ziad , Centonze Diego , Foti Calogero 
Published: May 2018

Abstract

Objective
The aim of the study was to examine the effectiveness of physiotherapy (PT) interventions on spasticity in people with multiple sclerosis.

Design
A systematic search was performed using PRISMA guidance. Studies evaluate the effect of PT interventions on spasticity were included. People with multiple sclerosis, spasticity, disability and PT interventions characteristics were extracted in included studies. Level of evidence was synthesized by the Grade of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses were performed by calculating Hedges g at 95% confidence interval.

Results
A total of 29 studies were included in the review, and 25 were included in the meta-analyses. The included PT interventions were exercise therapy, electrical stimulation, radial shock wave therapy, vibration, and standing. The review and meta-analyses showed different evidences of benefits and nonbenefits for PT interventions on some spasticity outcomes. The best quality evidences were for beneficial effects of exercise therapy especially robot gait training and outpatient exercise programs on self-perceived spasticity and muscle tone respectively. The review results were positive regarding the acute effects, follow-up measurements, safety, progressive MS, and nonambulatory people with multiple sclerosis. The included articles were heterogeneous and badly reported in PT interventions and people with multiple sclerosis characteristics.

Conclusions
Physiotherapy interventions can be a safe and beneficial option for spasticity in people with multiple sclerosis. No firm conclusion can be drawn on overall spasticity. Further researches in different spasticity aspects are needed.
Nerve Stimulation Enhances Task-Oriented Training for Moderate-to-Severe Hemiparesis 3–12 Months After Stroke
Authors: Carrico Cheryl , Westgate Philip M. , Salmon Powell Elizabeth , Chelette Kenneth C. , Nichols Laurie , Pettigrew L. Creed , Sawaki Lumy 
Published: May 2018

Objective
The aim of the study was to determine whether somatosensory stimulation affects outcomes of motor training for moderate-to-severe upper limb hemiparesis less than 12 mos before stroke.

Design
Fifty-five adults participated in 18 intervention sessions pairing 2 hours of active (n = 33) or sham (n = 22) somatosensory stimulation with 4 hours of intensive task-oriented motor training. Wolf Motor Function Test, Action Research Arm Test, Fugl-Meyer Assessment, and Stroke Impact Scale were administered at baseline, postintervention, and 1- and 4-mo follow-up.

Results
Statistically significant between-groups differences favored the active condition on Wolf Motor Function Test at post (P = 0.04) and Action Research Arm Test at post (P = 0.02), 1 mo (P = 0.01), and 4 mos (P = 0.01) but favored the sham condition on Stroke Impact Scale at 1 mo (P = 0.03). There were no significant between-groups differences on Fugl-Meyer Assessment.

Conclusions
Somatosensory stimulation can improve objective outcomes of motor training for moderate-to-severe hemiparesis less than 12 mos after stroke, although it needs to be determined whether the magnitude of between-groups differences in this study is clinically relevant. Future studies should investigate the intervention's impact on disability and functional recovery for this population as well as neurophysiological mechanisms underlying intervention effects.