bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective Review of Immediate Restoration of Lordosis in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison of Static and Expandable Interbody Cages
Authors: Vaishnav Avani S , Saville Philip , McAnany Steven , Kirnaz Sertac , Wipplinger Christoph , Navarro-Ramirez Rodrigo , Hartl Roger , Yang Jingyan , Gang Catherine Himo , Qureshi Sheeraz A 
Published: August 2019

Abstract

BACKGROUND
Sagittal alignment is an important consideration in spine surgery. The literature is conflicted regarding the effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) on sagittal parameters and the role of expandable cage technology.

OBJECTIVE
To compare lordosis generated by static and expandable cages and to determine what factors affect postoperative sagittal parameters.

METHODS
Preoperative regional lordosis (RL), segmental lordosis (SL), and posterior disc height (PDH) were compared to postoperative values in single-level MI-TLIF performed using expandable or static cages. Patients were stratified based on preoperative SL: low lordosis (<15 degrees), moderate lordosis (15-25 degrees), and high lordosis (>25 degrees). Regression analyses were conducted to determine factors associated with postoperative SL and PDH.

RESULTS
Of the 171 patients included, 111 were in the static and 60 in the expandable cohorts. Patients with low preoperative lordosis experienced an increase in SL and maintained RL regardless of cage type. Those with moderate to high preoperative lordosis experienced a decrease in SL and RL with the static cage, but maintained SL and RL with the expandable cage. Although both cohorts showed an increase in PDH, the increase in the expandable cohort was greater. Preoperative SL was predictive of postoperative SL; preoperative SL, preoperative PDH, and cage type were predictive of postoperative PDH.

CONCLUSION
Expandable cages showed favorable results in restoring disc height and maintaining lordosis in the immediate postoperative period. Preoperative SL was the most significant predictor of postoperative SL. Thus, preoperative radiographic parameters and goals of surgery should be important considerations in surgical planning.
Does Mixotrophy in ciliates compensate for poor-quality prey? Experiments with heterotrophic–mixotrophic species pairs
Authors: Wickham Stephen A , Wimmer Romana 
Published: August 2019

Abstract
Fatty acid and sterol profiles play a large role in determining the food quality of prey in aquatic food webs. Ciliates have limited ability to synthesize essential polyunsaturated fatty acids (PUFA) and sterols, and must obtain these from their food. Many mixotrophic ciliates, however, are in a symbiosis with Chlorella, and this may compensate for prey that is low in PUFA and sterols. Moreover, when PUFA-rich prey are P-limited, mixotrophs may be less dependent than heterotrophs on having the optimal mixture of PUFA-rich and P-rich prey. To test these hypotheses, experiments were conducted using heterotrophic-mixotrophic species pairs and prey mixes with varying proportions of good and poor quality prey. Prey proportions had clear effects on ciliate growth rates, often with a clear threshold. In only one species, however, did mixotrophy appeared to be advantageous, with growth independent of the proportion of PUFA-rich prey. In the other two species pairs, mixotrophy gave at best a small advantage over heterotrophy when there was a large proportion of PUFA-poor prey, independent of whether the PUFA-rich prey was P-limited or P-replete. While PUFA- and sterol-rich prey are important for heterotrophic ciliates, mixotrophy cannot be universally employed as an alternate source of these required nutrients.
Helping Pregnant Women and Clinicians Understand the Risk of Ondansetron for Nausea and Vomiting During Pregnancy
Authors: Haas D.M. 
Published: August 2019

(JAMA. 2018;320 (23):2425–2426)
Nausea and vomiting during the first trimester of pregnancy is often unresponsive to conservative treatment and commonly requires antiemetic pharmacotherapy. First line agents, as per the American College of Obstetricians and Gynecologists’ treatment algorithm, are pyridoxine, alone or in combination with doxylamine. However, while the safety of pyridoxine has been well established, there remain concerns regarding potential effects of other antiemetic drugs on fetal development. In particular, the study by Huybrechts et al addressed concerns about potential associations between ondansetron, a serotonin receptor agonist and third-line agent, and fetal congenital malformations. The study found no significant associations between ondansetron and cardiac abnormalities [adjusted risk difference (aRR), −0.8; 95% confidence interval (CI), 0.92-1.06] and overall congenital anomalies. A small but significantly increased risk of oral clefts with first-trimester exposure to ondansetron was found (aRR, 1.24; 95% CI, 1.03-4.08).
Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial
Authors: Abdelaal Ahmed Mahmoud A. , Mansour A.Z. , Yassin H.M. , Hussein H.A. , Kamal A.M. , Elayashy M. , Elemady M.F. , Elkady H.W. , Mahmoud H.E. , Cusack B. , Hosny H. , Abdelhaq M. 
Published: August 2019

(Anesth Analg. 2018;127(6):1434–1439)
Postdural puncture headache (PDPH), with the postulated etiology of meningeal traction from low cerebrospinal fluid (CSF) pressure or cerebral vasodilation, is often treated with an epidural blood patch (EBP). A patient with a PDPH received neostigmine and atropine for management of postoperative ileus. Interestingly, her PDPH also resolved with this medication. This case resulted in the authors conducting a randomized controlled trial to study the efficacy of neostigmine and atropine in the management of PDPH.
Paracetamol is ineffective for acute low back pain even for patients who comply with treatment: complier average causal effect analysis of a randomized controlled trial
Authors: Schreijenberg Marco , Lin Chung-Wei Christine , Mclachlan Andrew J. , Williams Christopher M. , Kamper Steven J. , Koes Bart W. , Maher Christopher G. , Billot Laurent 
Published: August 2019

Abstract
In 2014, the Paracetamol for Acute Low Back Pain (PACE) trial demonstrated that paracetamol had no effect compared with placebo in acute low back pain (LBP). However, noncompliance was a potential limitation of this trial. The aim of this study was to investigate the efficacy of paracetamol in acute LBP among compliers. Using individual participant data from the PACE trial (ACTN12609000966291), complier average causal effect (CACE), intention-to-treat, and per protocol estimates were calculated for pain intensity (primary), disability, global rating of symptom change, and function (all secondary) after 2 weeks of follow-up. Compliance was defined as intake of an average of at least 4 of the prescribed 6 tablets of regular paracetamol per day (2660 mg in total) during the first 2 weeks after enrolment. Exploratory analyses using alternative time points and definitions of compliance were conducted. Mean between-group differences in pain intensity on a 0 to 10 scale using the primary time point and definition of compliance were not clinically relevant (propensity-weighted CACE 0.07 [−0.37 to 0.50] P = 0.76; joint modelling CACE 0.23 [−0.16 to 0.62] P = 0.24; intention-to-treat 0.11 [−0.20 to 0.42] P = 0.49; per protocol 0.29 [−0.07 to 0.65] P = 0.12); results for secondary outcomes and for exploratory analyses were similar. Paracetamol is ineffective for acute LBP even for patients who comply with treatment. This reinforces the notion that management of acute LBP should focus on providing patients advice and reassurance without the addition of paracetamol.
Auxiliary Kirschner wire technique in the closed reduction of children with Gartland Type III Supracondylar humerus fractures
Authors: Dong Liangchao , Wang Yichen , Qi Muyu , Wang Sun , Ying Hao , Shen Yang 
Published: August 2019

Abstract
This study aimed to investigate the effect of auxiliary Kirschner wire (K-wire) technique in the closed reduction of children with Gartland type III supracondylar humerus fractures by comparing with manual reduction alone.
Retrospective analysis was performed on the clinical data of 68 cases of supracondylar humerus fractures. Thirty-six patients received closed reduction and percutaneous fixation with auxiliary K-wire technique (group A). Thirty-two patients received conventional manual reduction and percutaneous pin fixation (Group B).
In group A, the average operation time was 20.5 ± 8.5 minutes, the average frequency of intraoperative radiographic observations was 4.3 ± 1.1, the average fracture healing time was 6.2 ± 1.8 weeks, and the complication rate was 3/36, 8.3%. The mean operation time was 36.1 ± 10.2 minutes, the average frequency of intraoperative radiography was 8.9 + 1.7 times, the average fracture healing time was (6.1 ± 1.6) weeks, and the complication rate was 2/32, 6.3%. The operation time in group A was significantly shorter than that in group B. The difference between the 2 groups was statistically significant (P = .012). The frequency of radiography in group A was significantly less than that in group B (P = .001).
Compared with manual reduction, auxiliary K-wire technology can significantly shorten the operation time, reduce the radiant quantity of the surgeon, improve the efficiency of closed reduction of children with Gartland type III supracondylar humerus fractures, and reduce the risk of developing postoperative complications. And meanwhile, there is no significant effect on the imaging and functional outcomes of affected extremities, which is worthy of respect.
Impact of diagnostic bone biopsies on the management of non-vertebral osteomyelitis
Authors: Hirschfeld Cole B. , Kapadia Shashi N. , Bryan Joanna , Jannat-Khah Deanna P. , May Benjamin , Vielemeyer Ole , Esquivel Ernie L. 
Published: August 2019

Abstract
Optimal antibiotic management of patients with osteomyelitis remains a challenge for many clinicians. Although image-guided bone biopsy (IGB) remains the gold standard, its role in confirming diagnosis and guiding antibiotic management is not clear in patients with non-vertebral osteomyelitis.
To determine the diagnostic yield of IGB and its impact on antibiotic management in non-vertebral osteomyelitis.
Retrospective cohort study.
Urban academic medical center.
Patients admitted for non-vertebral osteomyelitis who underwent image-guided bone biopsy.
Primary outcomes were microbiologic and histopathological results. We evaluated the impact of IGB on clinician-initiated changes in antibiotic regimen before and after biopsy.
We evaluated 203 bone biopsies in 185 patients with clinical suspicion of osteomyelitis. 79% of patient received antibiotics prior to biopsy. Bone cultures were positive in 28% and histopathology confirmed osteomyelitis in 29%, but concordance was poor. Furthermore, clinical suspicion of infection was much higher, given that 68% received empiric antibiotics. Leukocytosis was significantly associated with positive cultures in multivariate analysis. There was no statistically significant correlation between antibiotic management and bone culture results. When culture yielded an organism, empiric regimens were kept the same, broadened or narrowed with equal frequency; targeted regimens were chosen only in 4 cases. Despite negative cultures in 98/138 cases having received empiric treatment, antibiotics were discontinued in only 8 cases. Even when empiric treatment was not given, negative cultures did not dissuade clinicians from eventual antibiotic use in a significant number of cases (17/48). In 46/71 patients whose final regimen included vancomycin, there was no evidence of current or past infection with MRSA.
In patients with non-vertebral osteomyelitis, the diagnostic yield of image-guided bone biopsy is low, and clinicians frequently make decisions regarding antibiotic management that are not aligned with culture results.
Validation of the mortality in emergency department sepsis (MEDS) score in a Singaporean cohort
Authors: Pong Jeremy Zhenwen , Koh Zhi Xiong , Samsudin Mas’uud Ibnu , Fook-Chong Stephanie , Liu Nan , Ong Marcus Eng Hock 
Published: August 2019

Abstract
The emergency department (ED) serves as the first point of hospital contact for most septic patients. Early mortality risk stratification using a quick and accurate triage tool would have great value in guiding management. The mortality in emergency department sepsis (MEDS) score was developed to risk stratify patients presenting to the ED with suspected sepsis, and its performance in the literature has been promising. We report in this study the first utilization of the MEDS score in a Singaporean cohort.
In this retrospective observational cohort study, adult patients presenting to the ED with suspected sepsis and fulfilling systemic inflammatory response syndrome (SIRS) criteria were recruited. Primary outcome was 30-day in-hospital mortality (IHM) and secondary outcome was 72-hour mortality. MEDS, acute physiology and chronic health evaluation II (APACHE II), and sequential organ failure assessment (SOFA) scores were compared for prediction of primary and secondary outcomes. Receiver operating characteristic (ROC) analysis was conducted to compare predictive performance.
Of the 249 patients included in the study, 46 patients (18.5%) met 30-day IHM. MEDS score achieved an area under the ROC curve (AUC) of 0.87 (95% confidence interval [CI], 0.82–0.93), outperforming the APACHE II score (0.77, 95% CI 0.69–0.85) and SOFA score (0.78, 95% CI 0.71–0.85). On secondary analysis, MEDS score was superior to both APACHE II and SOFA scores in predicting 72-hour mortality, with AUC of 0.88 (95% CI 0.82–0.95), 0.81 (95% CI 0.72–0.89), and 0.79 (95% CI 0.71–0.87), respectively. In predicting 30-day IHM, MEDS score ≥12, APACHE II score ≥23, and SOFA score ≥5 performed at sensitivities of 76.1%, 67.4%, and 76.1%, and specificities of 83.3%, 73.9%, and 65.0%, respectively.
The MEDS score performed well in its ability for mortality risk stratification in a Singaporean ED cohort.
Influence of angiotensin-converting enzyme inhibition on reversibility of alterations in arterial wall and cognitive performance associated with early hypertension
Authors: Csikai Enikő , Andrejkovics Mónika , Balajthy-Hidegh Bernadett , Hofgárt Gergely , Kardos László , Diószegi Ágnes , Rostás Róbert , Czuriga-Kovács Katalin Réka , Csongrádi Éva , Csiba László 
Published: August 2019

Abstract
The importance of optimal blood pressure control for preventing or reducing the impairment of vascular and cognitive functions is well known. However, the reversibility of early alterations in vascular and cognitive functions through antihypertensive agents is under-investigated. In this study, we evaluated the influence of 3 months of angiotensin-converting enzyme (ACE) inhibition treatment on the morphological and functional arterial wall and cognitive performance changes in 30 newly diagnosed primary hypertensive patients.
Common carotid intima-media thickness (IMT) and brachial artery flow-mediated dilatation (FMD) were detected by ultrasonography. Arterial stiffness indicated by augmentation index (AIx) and pulse wave velocity (PWV) was assessed by arteriography. Cognitive functions were assessed by neuropsychological examination.
The executive function overall score was significantly higher at 3-month follow-up than at baseline (median, 0.233 (IQR, 0.447) vs –0.038 (0.936); P = .001). Three-month ACE inhibition did not produce significant improvement in IMT, FMD, AIx and PWV values. Significant negative associations were revealed between IMT and complex attention (r = –0.598, P = .0008), executive function (r = –0.617, P = .0005), and immediate memory (r = –0.420, P = .026) overall scores at follow-up. AIx had significant negative correlations with complex attention (r = –0.568, P = .001), executive function (r = –0.374, P = .046), and immediate memory (r = –0.507, P = .005). PWV correlated significantly and negatively with complex attention (r = –0.490, P = .007).
Timely and effective antihypertensive therapy with ACE inhibitors has significant beneficial effects on cognitive performance in as few as 3 months. Early ACE inhibition may have an important role in the reversal of initial impairments of cognitive function associated with hypertension-induced vascular alterations.
TRIAD XII: Are Patients Aware of and Agree With DNR or POLST Orders in Their Medical Records
Authors: Mirarchi Ferdinando L. , Juhasz Kristin , Cooney Timothy E. , Puller Justin , Kordes Tammy , Weissert Lynn , Lewis Mary Lynn , Intrieri Brandon , Cook Nathan 
Published: August 2019

Objective
The aim of the study was to determine (1) whether do-not-resuscitate (DNR) orders created upon hospital admission or Physician Orders for Life-Sustaining Treatment (POLST) are consistent patient preferences for treatment and (2) patient/health care agent (HCA) awareness and agreement of these orders.

Methods
We identified patients with DNR and/or POLST orders after hospital admission from September 1, 2017, to September 30, 2018, documented demographics, relevant medical information, evaluated frailty, and interviewed the patient and when indicated the HCA.

Results
Of 114 eligible cases, 101 met inclusion criteria. Patients on average were 76 years old, 55% were female, and most white (85%). Physicians (85%) commonly created the orders. A living will was present in the record for 22% of cases and a POLST in 8%. The median frailty score of “4” (interquartile range = 2.5) suggested patients who require minimal assistance. Thirty percent of patients requested cardiopulmonary resuscitation and 63% wanted a trial attempt of aggressive treatment if in improvement is deemed likely. In 25% of the cases, patients/HCAs were unaware of the DNR order, 50% were unsure of their prognosis, and another 40% felt their condition was not terminal. Overall, 44% of the time, the existing DNR, and POLST were discordant with patient wishes and 38% were rescinded. Of the 6% not rescinded, further clarifications were required. Discordant orders were associated with younger, slightly less-frail patients.

Conclusions
Do-not-resuscitate and POLST orders can often be inaccurate, undisclosed, and discordant with patient wishes for medical care. Patient safety and quality initiatives should be adopted to prevent medical errors.
Practical Considerations for APOL1 Genotyping in the Living Kidney Donor Evaluation
Authors: Mena-Gutierrez Alejandra M. , Reeves-Daniel Amber M. , Jay Colleen L. , Freedman Barry I. 
Published: August 2019

Background.
Association between the apolipoprotein L1 gene (APOL1) and nephropathy has altered the epidemiology of chronic kidney disease. In addition, donor APOL1 genotypes play important roles in the time to allograft failure in kidneys transplanted from deceased donors and the safety of living kidney donation.

Methods.
This article reviews genetic testing for inherited kidney disease in living kidney donors to improve donor safety. APOL1 genotyping in donors with recent African ancestry is considered.

Results.
Based on current data, transplant physicians should discuss APOL1 genotyping with potential living kidney donors self-reporting recent African ancestry. Until results from APOL1 Long-term Kidney Transplant Outcomes Network ancillary studies are available, we present practical approaches from our experience for considering APOL1 genotyping in the living donor evaluation.

Conclusions.
Transplant physicians should inform potential living kidney donors at risk for APOL1-associated nephropathy about the gene and possibility of genetic testing early in the donor evaluation, well before scheduling the donor nephrectomy. Transplant programs must weigh risks of performing a donor nephrectomy in those with 2 APOL1 renal risk variants (high-risk genotypes), particularly younger individuals. Our program counsels kidney donors with APOL1 high-risk genotypes in the same fashion as with risk genotypes in other nephropathy genes. Because most African American kidney donor candidates lacking hypertension, proteinuria and reduced kidney function after workup will not possess APOL1 high-risk genotypes, genetic testing is unlikely to markedly increase donor declines and may reassure donors with regard to their long-term kidney outcomes, potentially increasing the number of African American donors.
Gender bias in research teams and the underrepresentation of women in science
Authors: Dakin Roslyn , Ryder T. Brandt 
Published: August 2019

AbstractWhy are females still underrepresented in science? The social factors that affect career choices and trajectories are thought to be important but are poorly understood. We analyzed author gender in a sample of >61,000 scientific articles in the biological sciences to evaluate the factors that shape the formation of research teams. We find that authorship teams are more gender-assorted than expected by chance, with excess homotypic assortment accounting for up to 7% of published articles. One possible mechanism that could explain gender assortment and broader patterns of female representation is that women may focus on different research topics than men (i.e., the “topic preference” hypothesis). An alternative hypothesis is that researchers may consciously or unconsciously prefer to work within same-gender teams (the “gender homophily” hypothesis). Using network analysis, we find no evidence to support the topic preference hypothesis, because the topics of female-authored articles are no more similar to each other than expected within the broader research landscape. Instead, consistent with a model of moderate gender homophily, we find that the prevalence of matched-gender teams increases as a discipline moves towards gender parity. This can occur because latent preferences are more easily fulfilled in a gender-diverse environment. Finally, we show that female authors pay a substantial citation cost to work in gender-matched teams. Notably, the prevalence of homotypic assortment is predicted to increase in the future if more disciplines shift towards gender parity. These data indicate that social preferences can have important downstream consequences for the retention of women and other underrepresented groups in science.