bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presurgical Comorbidities as Risk Factors For Chronic Postsurgical Pain Following Total Knee Replacement
Authors: Skrejborg Peter , Petersen Kristian K. , Kold Søren , Kappel Andreas , Pedersen Christian , Østgaard Svend E. , Simonsen Ole , Arendt-Nielsen Lars 
Published: April 2019

Objectives:
Chronic postsurgical knee pain (CPSP) is a burden for ∼20% of the patients following total knee replacement (TKR). Presurgical pain intensities have consistently been found associated with CPSP, and it is suggested that comorbidities are likewise important for the development of CPSP. This study aimed to identify presurgical risk factors for the development of CPSP 5 years after TKR on the basis of medical records containing information with regard to comorbidities.

Materials and Methods:
Patients undergoing primary TKR surgery were contacted 5 years after TKR. Presurgical Knee Society Score and comorbidities were evaluated. Postsurgical knee pain at 5 years of follow-up was assessed on a Numeric Rating Scale (NRS, 0 to 10). Logistic regression models were utilized to identify patients with moderate-to-severe (NRS≥3) and mild-to-no (NRS<3) CPSP at 5-year follow-up. Odds ratio (OR) for significant factors was calculated.

Results:
A total of 604 patients were contacted, 493 patients responded, 352 patients provided a completed questionnaire. A total of 107 patients reported NRS≥3 at follow-up. Significant presurgical factors associated with CPSP were fibromyalgia (OR=20.66; P=0.024), chronic pain in body parts other than the knee (OR=6.70; P=0.033), previous diagnosis of cancer (OR=3.06; P=0.001), knee instability (OR=2.16; P=0.021), younger age (OR=2.15; P=0.007), and presurgical knee pain (OR=1.61; P=0.044). Regression analysis identified 36 of 107 (33.6%) patients with CPSP on the basis of presurgical factors, and 231 patients (94.3%) without CPSP were classified correctly.

Discussion:
The current study found that a variety of presurgical clinical factors can correctly classify 33.6% of patients at risk for developing CPSP 5 years following TKR.
The Association Between Patient Reported Outcomes of Spinal Surgery and Societal Costs
Authors: Hansson-Hedblom Amanda , Jonsson Emma , Fritzell Peter , Hägg Olle , Borgström Fredrik 
Published: April 2019

Study Design.
Retrospective register-based study using Swedish registers and data prospectively collected in quality register Swespine.

Objective.
Analyze the association of societal costs and spine surgery outcome in low back pain (LBP) patients based on patient reported outcome measures (PROMs).

Summary of Background Data.
Studies show that LBP has a substantial impact on societal cost. There are indications that the burden diverges over different patient groups, but little is known about cost patterns in relation to PROMs of LBP surgery.

Methods.
We utilized a database with data from six registers. All lumbar spine surgery patients registered in Swespine 2000 to 2012 were identified. Swespine collects PROMs Global Assessment of pain improvement (GA), Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and EuroQol five-dimension scale (EQ-5D). A literature search was conducted to identify threshold changes in ODI, VAS, and EQ-5D representing a significant improvement or deterioration as defined by the minimal clinically important difference (MCID). We categorized patients into groups by their GA response at 2-year follow-up and estimated mean changes in ODI, VAS, and EQ-5D for each group. These changes were compared with the MCID thresholds to determine a GA-anchored classification of surgical outcomes. Costs consisted of out/inpatient care, sick leave, early retirement, and pharmaceuticals.

Results.
In total, 12,350 patients were included. GA 1–2 (“pain has disappeared”/“pain is much improved”) were labeled successful surgery outcomes (67%), GA 3 (“pain somewhat improved”), undetermined (16%), and GA 4–5 (“no change in pain”/“pain has worsened”) unsuccessful (17%). Costs of the unsuccessful and undetermined were higher than of the successful during the entire study period, with differences increasing markedly post-surgery. For the successful, a downward cost trend was observed; costs almost returned to the level observed 3 years pre-surgery. No such trend was observed in the other groups.

Conclusion.
Identifying patients with higher probability of responding to surgery could lead to improved health and substantial societal cost savings.

Level of Evidence: 3
Fluid Intake But Not Fluid Balance Is Associated With Poor Outcome in Nontraumatic Subarachnoid Hemorrhage Patients
Authors: Rass Verena , Gaasch Max , Kofler Mario , Schiefecker Alois Josef , Ianosi Bogdan-Andrei , Steinkohl Fabian , Beer Ronny , Pfausler Bettina , Gizewski Elke R. , Thomé Claudius , Schmutzhard Erich , Helbok Raimund 
Published: April 2019

Objectives:
Optimal fluid management is important in patients with acute brain injury, including subarachnoid hemorrhage. We aimed to examine the relationship between daily fluid intake and fluid balance with hospital complications and functional outcome.

Design:
Retrospective observational cohort study.

Setting:
Neurocritical care unit at a tertiary academic medical center.

Patients:
Two-hundred thirty-seven consecutive nontraumatic subarachnoid hemorrhage patients admitted to the neurologic ICU between 2010 and 2016.

Interventions:
Total daily amount of fluids and fluid balance were calculated over 15 days. Using multivariate generalized estimating equation models the association of daily fluid intake and fluid balance with disease severity, hospital complications and poor functional outcome (3-mo modified Rankin Score ≥ 3) was investigated. Additionally, we described the composition of fluids given.

Measurements and Main Results:
Patients presented with a median admission Hunt and Hess grade of 3 (interquartile range, 1–5) and were 57 years old (interquartile range, 47–67 yr old). A higher daily fluid intake was associated with higher admission Hunt and Hess grade (odds ratio, 1.61; 95% CI, 1.47–1.76; p < 0.001), increased pulmonary fluid accumulation (adjusted odds ratio, 1.11; 95% CI, 1.01–1.21; p = 0.033), prolonged mechanical ventilation (Wald statistic = 20.08; degrees of freedom = 1; p < 0.001), higher daily Subarachnoid hemorrhage Early Brain Edema Score (adjusted odds ratio, 1.11; 95% CI, 1.01–1.22; p = 0.034), occurrence of anemia (adjusted odds ratio, 1.36; 95% CI, 1.20–1.54; p < 0.001), delayed cerebral ischemia (adjusted odds ratio, 1.31; 95% CI, 1.14–1.51; p < 0.001), and poor functional outcome (adjusted odds ratio, 1.25; 95% CI, 1.10–1.41; p < 0.001). Daily fluid balance was associated with higher admission Hunt and Hess grade (odds ratio, 1.09; 95% CI, 1.05–1.13; p < 0.001) and anemia (adjusted odds ratio, 1.17; 95% CI, 1.03–1.33; p = 0.019). The main contributors to fluids were nutritional compounds (31%), IV drugs (30%), and volume substitution (17%).

Conclusions:
Our study demonstrates a significant association of fluid intake but not fluid balance with hospital complications and poor functional outcome in subarachnoid hemorrhage patients. A larger prospective study is needed to confirm our results.
Three Different Anesthesia Approaches in Blepharoptosis Surgery
Authors: Guo Ziyi , Park David Dae Hwan , Park Kisoo , Guo Naiqiang 
Published: April 2019

Background:
Despite the many methods of anesthesia for blepharoptosis, there is little documentation in the literature. When using the Müller aponeurosis composite flap advancement approach, one of the 3 anesthesia methods is chosen: general, local, and sedative anesthesia. On the other hand, the choice of anesthesia method is controversial.

Methods:
A total of 101 patients (48 female and 53 male) admitted to hospital for treatment were selected: 38 (37.6%) patients (49 eyes) with local anesthesia, 34 (33.7%) patients (60 eyes) with general anesthesia, and 29 (28.7%) patients (42 eyes) with sedative anesthesia.

Results:
The preoperative average marginal reflex distance (MRD1) in the local, general, and sedative anesthesia groups was 0.90, 0.35, and 0.47 mm, respectively. The corneal exposure area (CEA) in the local, general, and sedative approach groups was 63.2%, 57.8%, and 55.9%, respectively. The postoperative average distance for the MRD1 was significantly different among the 3 anesthesia approaches. The postoperative MRD1 in the local approach group was 3.28 mm and the CEA improved to 75.4%. In the general anesthesia approach group, the MRD1 was 3.01 mm and the CEA was 73.4%. In the sedative anesthesia approach group, the MRD1 and CEA were 3.62 mm and 74.0%, respectively. The MRD1 in the general, local, and sedative groups was 2.65 ± 1.48, 2.39 ± 1.65, and 3.17 ± 1.77, respectively; the difference was not significant (P > 0.05).

Conclusions:
The general, local, and sedative anesthesia approaches are all effective in the correction of blepharoptosis; the results were similar regardless of the anesthesia approach. On the other hand, the patients felt more comfortable and surgeons could control the process more easily using the sedative approach.
Does Long-Term Rigid Contact Lens Wear Lead to Acquired Blepharoptosis in Chinese Eyes?
Authors: Yang Bi , Liu Longqian , Cho Pauline 
Published: April 2019

Objectives:
To determine whether long-term rigid contact lens wear leads to acquired blepharoptosis and whether its development is affected by lens removal methods.

Methods:
Ninety rigid contact lens wearers (45 rigid gas permeable [RGP] [15–19 years old] and 45 ortho-k [15–40 years old]) who had worn lenses for at least 2 years and 45 spectacle-wearing controls (15–19 years old) were recruited. Margin reflex distance (MRD) and palpebral fissure height (PFH) were measured both subjectively and objectively, but levator function (LF) could only be measured subjectively. For RGP subjects, measurements were made before and 5 min after lens removal. Measurements were compared among the groups and, for rigid lens wearers, between two different lens removal techniques: using a suction holder or by finger-lid manipulation.

Results:
No significant differences in MRD, PFH, and LF were found between different lens removal techniques in the rigid lens groups (P>0.05). No significant correlations were found between the parameters of interest and duration of lens wear (P>0.05). For the RGP group, MRD, PFH, and LF were significantly greater after than before lens removal (P<0.05), and after lens removal, MRD was significantly smaller than that of the ortho-k and spectacle groups (P<0.001, P=0.01, respectively) and PFH was significantly smaller than that of the ortho-k group (P=0.001). However, after lens removal, according to the definition (amount) for ptosis, no subject was diagnosed as having ptosis.

Conclusions:
Long-term rigid contact lens wear did not lead to acquired blepharoptosis in Chinese eyes. Margin reflex distance, PFH, and LF were not affected by different lens removal techniques.
Implementation of a Quality Index for Improvement of Quantification of Corneal Nerves in Corneal Confocal Microscopy Images: A Multicenter Study
Authors: Sturm Dietrich , Vollert Jan , Greiner Tineke , Rice Andrew S. C. , Kemp Harriet , Treede Rolf-Detlef , Schuh-Hofer Sigrid , Nielsen Stine E. , Eitner Lynn , Tegenthoff Martin , Petropoulos Ioannis N. , Malik Rayaz A. , Maier Christoph , Schmidt-Wilcke Tobias , Schargus Marc 
Published: April 2019

Purpose:
Corneal confocal microscopy (CCM) is an imaging method to detect loss of nerve fibers in the cornea. The impact of image quality on the CCM parameters has not been investigated. We developed a quality index (QI) with 3 stages for CCM images and compared the influence of the image quality on the quantification of corneal nerve parameters using 2 modes of analysis in healthy volunteers and patients with known peripheral neuropathy.

Methods:
Images of 75 participants were a posteriori analyzed, including 25 each in 3 image quality groups (QI 1–QI 3). Corneal nerve fiber length (CNFL) was analyzed using automated and semiautomated software, and corneal nerve fiber density and corneal nerve branch density were quantified using automated image analysis. Three masked raters assessed CCM image quality (QI) independently and categorized images into groups QI 1–QI 3. In addition, statistical analysis was used to compare interrater reliability. Analysis of variance was used for analysis between the groups. Interrater reliability analysis between the image ratings was performed by calculating Fleiss' kappa and its 95% confidence interval.

Results:
CNFL, corneal nerve fiber density, and corneal nerve branch density increased significantly with QI (P < 0.001, all post hoc tests P < 0.05). CNFL was higher using semiautomated compared with automated nerve analysis, independent of QI. Fleiss kappa coefficient for interrater reliability of QI was 0.72.

Conclusions:
The quantification of corneal nerve parameters depends on image quality, and poorer quality images are associated with lower values for corneal nerve parameters. We propose the QI as a tool to reduce variability in quantification of corneal nerve parameters.
Predictors of Severe Bleeding During Endobronchial Biopsy
Authors: Muthu Valliappan , Ram Babu , Sehgal Inderpaul S. , Dhooria Sahajal , Prasad Kuruswamy T. , Bal Amanjit , Aggarwal Ashutosh N. , Agarwal Ritesh 
Published: April 2019

Background:
Endobronchial biopsy (EBB) remains the standard procedure for evaluating endobronchial lesions visualized during flexible bronchoscopy. However, the predictors of bleeding and its impact on the diagnostic yield of EBB remains unknown.

Methods:
This was a retrospective study of subjects who underwent EBB for suspected neoplastic endobronchial lesion. We noted the demographic details, radiology, bronchoscopy findings (vascularity and location of the lesion), and the procedural details. Immediately after EBB, the bronchoscopist recorded the severity of bleed as none, mild, moderate, or severe (requiring instillation of cold saline/topical adrenaline or tamponade to control bleed). We assessed the diagnostic yield of EBB, the incidence and predictors of severe bleeding.

Results:
A total of 537 subjects with a mean age of 59.7 years (84.2% males) were included. On histopathology, malignancy was confirmed in 429 (85.8%) subjects. Severe bleeding occurred in 45 (8%) subjects. On a multivariate logistic regression analysis, bronchoscopic appearance of increased vascularity [odds ratio (95% confidence interval), 2.68 (1.38-5.19)] and the central location of the tumor [odds ratio (95% confidence interval), 3.01 (1.52-5.96)] were independent predictors of severe bleeding during EBB. Severe bleeding led to significantly lesser median number of biopsies (4 vs. 6, P=0.001) obtained, and a higher proportion of nondiagnostic biopsies (20% vs. 7.1%, P=0.004).

Conclusion:
Severe bleeding during EBB was associated with a decrease in the number of biopsies obtained and a lower diagnostic yield. A centrally located and vascular-appearing lesion on bronchoscopy predicted severe bleeding.
Practical and ethical issues for delivery of advanced ENT services in the Indian subcontinent: efforts to ‘Bridge the Gap’
Authors: Kumar Raghu Nandhan Sampath , Kameswaran Mohan 
Published: April 2019

Purpose of reviewThe Indian healthcare industry, one of the largest in the world, caters for 1.3 billion people. The modern middle class addresses its needs by visiting private hospitals, which provide comprehensive services but at a high cost. The low socioeconomic individuals visit government hospitals where all basic services are available, but there is a struggle to provide advanced healthcare. In order to rectify this dichotomous approach, new initiatives are being implemented to provide uniform healthcare across the society.Recent findingsTechnological advancements have been rapid and modern methods have reached the shores of India at the same pace as in the western world. In otolaryngology, advanced services especially for restoration of hearing loss and multimodality treatments for head and neck cancers have been two areas where practical and ethical dilemmas have existed to provide the most optimal treatment at subsidized costs. This article explores these two areas as examples to understand the specific problems encountered in delivering advanced ENT care in a low-resource setting in a large populous country.SummaryIntroduction of government health insurance schemes have helped the poor to make use of advanced healthcare. The highlight of this scheme has been the inclusion of expensive interventions like cochlear and auditory brainstem implantation, whereby cost of the device, surgery and habilitation have all been delivered cost free for eligible children.
Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support: A Multicenter Pediatric Interventional Cardiology Early-Career Society Study*
Authors: Zampi Jeffrey D. , Alghanem Fares , Yu Sunkyung , Callahan Ryan , Curzon Christopher L. , Delaney Jeffrey W. , Gray Robert G. , Herbert Carrie E. , Leahy Ryan A. , Lowery Ray , Pasquali Sara K. , Patel Priti M. , Porras Diego , Shahanavaz Shabana , Thiagarajan Ravi R. , Trucco Sara M. , Turner Mariel E. , Veeram Reddy Surendranath R. , West Shawn C. , Whiteside Wendy , Goldstein Bryan H. 
Published: April 2019

Objectives:
To assess the variation in timing of left atrial decompression and its association with clinical outcomes in pediatric patients supported with venoarterial extracorporeal membrane oxygenation across a multicenter cohort.

Design:
Multicenter retrospective study.

Setting:
Eleven pediatric hospitals within the United States.

Patients:
Patients less than 18 years on venoarterial extracorporeal membrane oxygenation who underwent left atrial decompression from 2004 to 2016.

Interventions:
None.

Measurements and Main Results:
A total of 137 patients (median age, 4.7 yr) were included. Cardiomyopathy was the most common diagnosis (47%). Cardiac arrest (39%) and low cardiac output (50%) were the most common extracorporeal membrane oxygenation indications. Median time to left atrial decompression was 6.2 hours (interquartile range, 3.8–17.2 hr) with the optimal cut-point of greater than or equal to 18 hours for late decompression determined by receiver operating characteristic curve. In univariate analysis, late decompression was associated with longer extracorporeal membrane oxygenation duration (median 8.5 vs 5 d; p = 0.02). In multivariable analysis taking into account clinical confounder and center effects, late decompression remained significantly associated with prolonged extracorporeal membrane oxygenation duration (adjusted odds ratio, 4.4; p = 0.002). Late decompression was also associated with longer duration of mechanical ventilation (adjusted odds ratio, 4.8; p = 0.002). Timing of decompression was not associated with in-hospital survival (p = 0.36) or overall survival (p = 0.42) with median follow-up of 3.2 years.

Conclusions:
In this multicenter study of pediatric patients receiving venoarterial extracorporeal membrane oxygenation, late left atrial decompression (≥ 18 hr) was associated with longer duration of extracorporeal membrane oxygenation support and mechanical ventilation. Although no survival benefit was demonstrated, the known morbidities associated with prolonged extracorporeal membrane oxygenation use may justify a recommendation for early left atrial decompression.
Predictors of Disengagement in Care for Individuals Receiving Pre-exposure Prophylaxis (PrEP)
Authors: Zucker Jason , Carnevale Caroline , Richards Paul , Slowikowski Jacek , Borsa Alexander , Gottlieb Felix , Vakkur Isabella , Hyden Christel , Olender Susan , Cohall Alwyn , Gordon Peter , Sobieszczyk Magdalena E. 
Published: April 2019

Background:
HIV pre-exposure prophylaxis (PrEP) reduces incident HIV infections, but efficacy depends on adherence and retention, among other factors. Substance use disorders, unmet mental health needs, and demographic factors are associated with nonadherence in HIV-infected patients; we studied whether these affect PrEP retention in care.

Methods:
To investigate potential risk factors disengagement in a comprehensive HIV prevention program, we conducted a retrospective cohort analysis of individuals starting tenofovir–emtricitabine between January 1, 2015, and November 30, 2017. The primary outcome was adherence to the initial 3-visit schedule after PrEP initiation.

Results:
The cohort was predominantly African American (23%) and Hispanic (46%). Race, ethnicity, substance use, patient health questionnaire 9 score, insurance, and housing status were not associated with retention at the third follow-up visit. Age <30, PrEP initiation in 2017, PrEP initiation in the sexual health clinic, and PrEP same-day start were associated with lower retention; male gender at birth, transition from post‐exposure prophylaxis (PEP) to PrEP, feeling that they could benefit from, or participating in mental health services were associated with increased retention. Overall, retention in HIV preventative care at the first follow-up visit (68%) and third follow-up visit (35%) after PrEP initiation was low.

Conclusion:
Clinic services and ancillary services (such as mental health) may facilitate retention in care. In this study, select social and behavioral determinants of health were not found to be linked to retention. Focused investigation of reasons for dropout may elucidate the challenges to maintaining individuals in PrEP care and direct resource allocation to those in greatest need.
Differences Between Groups of Pre-exposure Prophylaxis (PrEP) Using Couples in HIV-Negative/Unknown Relationships
Authors: John Steven A. , Robles Gabriel , Starks Tyrel J. , Rendina H. Jonathon 
Published: April 2019

Background:
Epidemiology research is limited on the characteristics of HIV pre-exposure prophylaxis (PrEP) using couples.

Setting:
US nationwide sample recruited online in 2017.

Methods:
HIV negative/unknown gay, bisexual, and other men who have sex with men with HIV negative/unknown partners (n = 3140) were asked about individual and main partner PrEP uptake. Men were coded into the following 5 groups: (1) neither participant nor partner on PrEP, (2) partner only on PrEP, (3) participant only on PrEP, (4) both on PrEP, and (5) unknown partner PrEP use. We examined associations of demographics, relationship factors, condomless anal sex (CAS) with main and causal partners, bacterial sexually transmitted infection diagnoses, and sexual positioning with reported dyadic PrEP use using fully adjusted multinomial logistic regressions.

Results:
PrEP use was 3.2% for the partner only, 5.7% for the participant only, and 4.9% for both the participant and partner; 5.6% reported not knowing their partner's PrEP use status. Men who reported any CAS with their main partner or any CAS with male casual partners were both more likely to be classified in the dyadic PrEP use group compared with the neither on PrEP group. Compared with monogamous, men in open arrangements were more likely to be classified in each of the 3 PrEP groups compared with the neither on PrEP group. Six-month bacterial sexually transmitted infection prevalence was 2.8%, 8.1%, 8.3%, 15.6%, and 4.0% for the 5 groups, respectively.

Conclusions:
PrEP use occurred during times of higher risk behavior engagement, but further efforts are needed to expand PrEP use to more partnered gay, bisexual, and other men who have sex with men.