bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global Spinal Alignment in Cervical Kyphotic Deformity: The Importance of Head Position and Thoracolumbar Alignment in the Compensatory Mechanism
Authors: Mizutani Jun , Verma Kushagra , Endo Kenji , Ishii Ken , Abumi Kuniyoshi , Yagi Mitsuru , Hosogane Naobumi , Yang Jeffrey , Tay Bobby , Deviren Vedat , Ames Christopher 
Published: May 2017

Abstract

BACKGROUND
Previous studies have evaluated cervical kyphosis (C-kypho) using cervical curvature or chin-brow vertical angle, but the relationship between C-kypho and global spinal alignment is currently unknown.

OBJECTIVE
To elucidate global spinal alignment and compensatory mechanisms in primary symptomatic C-kypho using full-spine radiography.

METHODS
In this retrospective multicenter study, symptomatic primary C-kypho patients (Cerv group; n = 103) and adult thoracolumbar deformity patients (TL group; n = 119) were compared. We subanalyzed Cerv subgroups according to sagittal vertical axis (SVA) values of C7 (SVAC7 positive or negative [C7P or C7N]). Various Cobb angles (°) and SVAs (mm) were evaluated.

RESULTS
SVAC7 values were –20.2 and 63.6 mm in the Cerv group and TL group, respectively (P < .0001). Various statistically significant compensatory curvatures were observed in the Cerv group, namely larger lumbar lordosis (LL) and thoracic kyphosis. The C7N group had significantly lower SVACOG (center of gravity of the head) and SVAC7 (32.9 and –49.5 mm) values than the C7P group (115.9 and 45.1 mm). Sagittal curvatures were also different in T4-12, T10-L2, LL4-S, and LL. The value of pelvic incidence (PI)-LL was different (C7N vs C7P; –2.2° vs 9.9°; P < .0003). Compensatory sagittal curvatures were associated with potential for shifting of SVAC7 posteriorly to adjust head position. PI-LL affected these compensatory mechanisms.

CONCLUSION
Compensation in symptomatic primary C-kypho was via posterior shifting of SVAC7, small T1 slope, and large LL. However, even in C-kypho patients, lumbar degeneration might affect global spinal alignment. Thus, global spinal alignment with cervical kyphosis is characterized as head balanced or trunk balanced.
Surgical Decompression of High-Grade Spinal Cord Compression from Hormone Refractory Metastatic Prostate Cancer
Authors: Chohan Muhammad Omar , Kahn Sweena , Cederquist Gustav , Reiner Anne S , Schwab Joseph , Laufer Ilya , Bilsky Mark 
Published: May 2017

Abstract

BACKGROUND
Spine and nonspine skeletal metastases occur in more than 80% of patients with prostate cancer.

OBJECTIVE
To examine the characteristics of the patient population undergoing surgery for the treatment of prostate cancer metastatic to the spine.

METHODS
A retrospective chart review was performed on all patients treated at our institution from June 1993 to August 2014 for surgical management of metastatic spine disease from prostate cancer.

RESULTS
During the study period, 139 patients with 157 surgical lesions underwent surgery for metastatic spine disease. Decompression for high-grade epidural spinal cord compression was required for 126 patients with 143 lesions. Preoperatively, 69% had a motor deficit and 21% were nonambulatory, with 32% due to motor weakness. At surgery, 87% of patients had hormone-refractory prostate cancer (HRPC) and 61% failed prior radiation. Median overall survival for HRPC patients was 6.6 mo (95% confidence interval [CI]: 5.6-8.6) while the median overall survival for hormone-sensitive patients was 16.3 mo (95% CI: 4.0-26.6).

CONCLUSION
The majority of patients undergoing surgery for prostate cancer metastases to the spine were refractory to hormone therapy, indicating that patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression or spinal instability. A significant number of HRPC patients presented with neurological deficits attributable to spinal cord compression. Vigilant monitoring for the development of signs and symptoms of epidural spinal cord compression and spinal instability in hormone-refractory patients is recommended. Surgical decision making may be affected by the much shorter postoperative survival for HRPC patients as compared to patients with hormone-sensitive cancer.
The Pandemic H30 Subclone of Sequence Type 131 (ST131) as the Leading Cause of Multidrug-Resistant Escherichia coli Infections in the United States (2011–2012)
Authors: Johnson James R. , Porter Stephen , Thuras Paul , Castanheira Mariana 
Published: May 2017

AbstractBackgroundExtraintestinal Escherichia coli infections are increasingly challenging due to emerging antimicrobial resistance, including resistance to extended-spectrum beta-lactams and fluoroquinolones. Sequence type 131 (ST131) is a leading contributor.MethodsThree hundred sixty E. coli clinical isolates from across the United States (2011–2012), selected randomly from the SENTRY collection within 3 resistance categories (extended-spectrum cephalosporin [ECS]–reduced susceptibility [RS]; fluoroquinolone-resistant, ESC-susceptible; and fluoroquinolone-susceptible, ESC-susceptible) were typed for phylogroup, sequence type complex (STc), subsets thereof, virulence genotype, O type, and beta-lactamase genes. Molecular results were compared with susceptibility profile, specimen type, age, and sex.ResultsPhylogroup B2 accounted for most isolates, especially fluoroquinolone-resistant isolates (83%). Group B2–derived ST131 and its H30 subclone (divided between H30Rx and H30R1) predominated, especially among ESC-RS and fluoroquinolone-resistant isolates. In contrast, among fluoroquinolone-susceptible isolates, group B2–derived STc73 and STc95 predominated. Within each resistance category, ST131 isolates exhibited more extensive resistance and/or virulence profiles than non-ST131 isolates. ST131-H30 was distributed broadly by geographical region, age, and specimen type and exhibited distinctive beta-lactamase genes. Back-calculations indicated that within the source population ST131 accounted for 26.4% of isolates overall (vs 17% in 2007), including 19.8% ST131-H30, 13.2% ST131-H30R1, and 6.6% each ST131-H30Rx and non-H30 ST131.ConclusionsST131-H30, with its ESC resistance-associated H30Rx subset, caused most antimicrobial-resistant E. coli infections across the United States in 2011–2012 and, since 2007, increased in relative prevalence by &gt;50%. Focused attention to this strain could help combat the current E. coli resistance epidemic.
Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association
Authors: Levenhagen Kimberly , Davies Claire , Perdomo Marisa , Ryans Kathryn , Gilchrist Laura 
Published: May 2017

Abstract
The Oncology Section of the American Physical Therapy Association (APTA) developed a clinical practice guideline to aid the clinician in diagnosing secondary upper quadrant cancer-related lymphedema. Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in the diagnostic process. Overall clinical practice recommendations were formulated based on the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. In an effort to maximize clinical applicability, recommendations were based on the characteristics as to the location and stage of a patient's upper quadrant lymphedema.
Hearing Threshold Shifts Among 11- to 35-Year-Olds With Early Hearing Impairment
Authors: Carter Lyndal , Black Deborah 
Published: May 2017

Objectives:Data obtained from the clinical records of selected 11- to 35-year-olds with preadult onset hearing impairment were analyzed with 2 primary aims: (1) to determine the incidence of hearing threshold level (HTL) shift in this cohort and, (2) to examine the relationship between HTL shift, whole-of-life noise exposure, and other factors.Design:Cross-sectional cohort study. Retrospective HTL + survey data for a sample of 237 young Australians receiving hearing (re)habilitation services were obtained. From these data, two subsets, (A) n = 127 and (B) n = 79, were analyzed. Participants with risk factors for progressive hearing loss (other than noise exposure) were excluded from both subsets. Subset (A) additionally excluded cochlear implant recipients, and subset (B) excluded cases with diagnosis of hearing loss after age 5 years. Using subset (A) data, the differences between final (recent) and specified baseline (initial) HTLs at 250, 500, 1000, 2000, and 4000 Hz were calculated and three criteria for HTL shift were applied. Correlations between reported noise exposure and HTL shift were calculated (Mann–WhitneyUtest). Using subset (B) data, relationships between high frequency (HF) HTL shift and exposure, and other personal and extrinsic factors were examined (Cox Regression model). Survival analyses (Kaplan–Meier) were performed to reveal the temporal pattern of HF shift. The magnitude of HF shifts at 5, 10, and 15 years post initial (i.e., specified baseline) audiogram were also calculated.Results:For subset (A), HTL shift (≥15 dB any frequency, and/or ≥10 dB*at two adjacent frequencies) was observed in 46.5% of cases examined. HF shift (≥15 dB at 2000 and/or 4000 Hz; one or both ears) was observed in 33.1% of cases. There was no relationship between HTL shift and reported whole-of-life exposure. For subset (B), no relationship was found between HF shift and noise exposure, nor 9 of 10 personal or extrinsic covariates tested. HF shift was significantly associated with HTL ≥ 70 dB at 2000 and/or 4000 Hz at initial audiogram. Survival analysis also illustrated that HF shift was more frequent, and occurred earlier, when HF hearing loss was ≥70 dB at initial audiogram. Median HF shifts at 15 years after initial audiogram were in the magnitude of 5 to 10 dB, and at the 90th percentile were 25 to 30 dB.Conclusions:HTL shift was observed in almost 50% of cases without predisposing factors for progressive hearing loss. The magnitude of HF shift increased gradually over time. While no relationship was found between HTL shift and noise exposure, the interpretation of this finding is restrained by the small spread of whole-of-life noise exposures, within a relatively conservative range. Nevertheless, this is the first direct examination of the relationship between HTL shift and noise exposure in young people with preadult hearing impairment.
High-resolution Esophageal Manometry Patterns in Children and Adolescents With Rumination Syndrome
Authors: Righini Grunder Franziska , Aspirot Ann , Faure Christophe 
Published: May 2017

ABSTRACT

Background:
Rumination is defined by effortless regurgitation within seconds or minutes of ingested food. The aim of this study was to determine the high-resolution esophageal manometry (HREM) pattern in children with rumination syndrome.

Methods:
HREM was evaluated in 15 pediatric patients with rumination syndrome according to the Rome criteria and compared with 15 controls. Primary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg. Secondary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg during a transient lower esophageal sphincter relaxation (TLESR).

Results:
Ninety-two episodes of rumination were demonstrated during HREM study in 12 of the 15 patients (80%; 1–29 episodes per patient; median intragastric pressure 49.6 mmHg). Primary rumination occurred in 3 patients and secondary rumination in 5 patients. One patient had primary and secondary rumination episodes. In 3 patients, classification of rumination episodes was not possible due to repetitive swallowing leading to lower esophageal sphincter relaxation. In the control group, no episodes of rumination occurred. The sensitivity and the specificity of the HREM study (association of a clinical rumination episode with a rise in gastric pressure >30 mmHg) to confirm the diagnosis of rumination were 80% and 100%, respectively.

Conclusions:
HREM allows confirming diagnosis of rumination syndrome and to differentiate between primary and secondary rumination in the presence of objective rumination episodes. Further research is needed to study whether HREM results may influence treatment and outcome of children with rumination syndrome.
A Case Report of Transient Cortical Blindness After Angiography
Authors: Chen Chih Yen , Chen Chi Jen , Tseng Ying Chi 
Published: May 2017

Introduction:
Transient cortical blindness (TCB) is a rare complication after angiography and is proposed to be related to contrast extravasation. We present the first case of TCB after angiography that was evaluated using serial arterial spin-labeling magnetic resonance perfusion (ASLMRP) and susceptibility-weighted imaging (SWI).

Case Report:
A 65-year-old woman with dyslipidemia who had been treated for left vertebral artery dissection 3 months previously presented with dizziness and right hemiparesis. Magnetic resonance imaging of the brain revealed suspected dissection of the V4 segment of the left vertebral artery. Cerebral angiography was performed using a total of 46 mL of nonionic contrast material. Approximately 3 hours after the procedure, the patient started complaining of a slight headache and nausea along with bilateral cortical blindness. The 6-hour ASLMRP and SWI of the brain, respectively, revealed hypoperfusion and increased oxygen extraction fraction in the bilateral occipital lobes. The patient gradually regained vision over the next 12 hours, and follow-up ASLMRP and SWI revealed normal perfusion and normal SWI findings, respectively.

Conclusions:
Hypoperfusion on ASLMRP and increased oxygen extraction fraction on SWI results derived for a patient presenting with TCB were demonstrated. Thus, we hypothesize that endothelin-related vasoconstriction is a pathophysiologic mechanism for TCB. To the best of our knowledge, this report is the first to describe ASLMRP and SWI findings in TCB after angiography.
Angioinvasive Aspergillus-associated Stroke in an Immunocompetent Host Following Cardiac Surgery and ECMO
Authors: Kavi Tapan , Madan Nikhil , Majic Tamara , Rosengart Axel , Maya Marcel , Bannykh Serguei , Lahiri Shouri 
Published: May 2017

Introduction:
Invasive cerebral aspergillosis is an uncommon cause of stroke among immunocompetent patients and has not been reported in association with cardiac surgery or extracorporeal membrane oxygenation (ECMO). We report the case of an immunocompetent host who developed aspergillus-associated stroke following coronary artery bypass graft (CABG) and ECMO.

Case Report:
A 59-year-old woman developed cardiogenic shock after 3-vessel-CABG requiring intra-aortic balloon pump placement and subsequent veno-arterial ECMO. Noncontrast computed tomography of the brain was suggestive of multiple bihemispheric ischemic infarcts. Postmortem pathologic analysis revealed aspergillus-associated inflammation of blood vessels and ischemic and petechial hemorrhagic strokes in the affected territories.

Discussion and Conclusions:
Ischemic infarcts in the setting of CABG or ECMO are often presumed to be thromboembolic from the heart or device, related to underlying hemodynamic instability, or due to a clinically apparent systemic infection such as endocarditis. This report suggests that invasive cerebral aspergillosis should be considered in seemingly immunocompetent patients following CABG or ECMO. The mechanism is unclear, but may be related to systemic inflammatory dysregulation resulting in increased susceptibility to uncommon pathogens.
Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis
Authors: Sendarrubias Marta , Carrón Marta , Molina Juan Carlos , Pérez Maria Ángeles , Marañón Rafael , Mora Andrea 
Published: May 2017

Objectives
We designed a study to compare rapid intravenous rehydration based on 0.9% normal saline (NS) or on NS + glucose 2.5% serum (SGS 2.5%) in patients with dehydration secondary to acute gastroenteritis. Our hypothesis is that the addition of glucose 2.5% serum (SGS 2.5%) to 0.9% saline solution could reduce the proportion of hospital admissions and return emergency visits in these patients. The secondary objective was to identify differences in the evolution of blood glucose and ketonemia between the groups.

Methods
We designed a prospective randomized open-label clinical trial that was conducted in 2 tertiary hospitals over 9 months. Patients were randomized to receive SGS 2.5% or NS. Baseline clinical, analytical, and disease-related data were collected. Data were analyzed using SPSS.

Results
The frequency of hospitalization in the SGS 2.5% group was 30.3% (n = 23) compared with 34.8% (n = 24) in the NS group, although the difference was not statistically significant (P = 0.59). The frequency of return visits to the emergency department was 17.8% (n = 8) in the NS group and 5.6% (n = 3) in the SGS 2.5% group (P = 0.091). Changes in glucose and ketone levels were more favorable in the SGS 2.5% group.

Conclusions
Our results enabled us to conclude that there were no significant differences in hospital admission or return visits to the emergency department between children with dehydration secondary to acute gastroenteritis.
Congenital Clavicular Pseudoarthosis—How to Differentiate It From the More Common Clavicular Fractures
Authors: Chalfant James Stewart , Sanchez Thomas Ray 
Published: May 2017

Abstract
Congenital pseudoarthrosis of the clavicle is a rare entity that can be confused for a traumatic injury. We present 4 cases of congenital clavicular pseudoarthrosis and discuss its imaging findings that can help differentiate it from the more common clavicular facture. We also reviewed its epidemiology, embryology, and management based on available and most recent literature.
Predictive Variables for Abnormal Comprehensive Metabolic Panel Testing and Potential Cost Savings in Children Receiving Pediatric Emergency Department Care
Authors: Huckaby Matthew David , Freeman Shayla , Thurmond Christopher , Cooper Matthew , Losek Joseph D. 
Published: May 2017

Objective
The aim of this study was to determine variables predictive of abnormal comprehensive metabolic panel (CMP) results in pediatric emergency department (PED) patients and the potential cost savings of a basic metabolic panel (BMP) versus a CMP.

Methods
This is a retrospective cross-sectional descriptive study of children (<18 y) at an urban academic PED (annual census, 22,000). Clinical data included 12 clinical variables: right upper quadrant pain, overdose, emesis, liver disorder, malignancy, heart disease, bleeding disorder, jaundice, right upper quadrant tenderness, hepatomegaly, ascites/peripheral edema and shock, and the liver function test (LFT) results not in a BMP (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, total protein, and albumin).

Results
There were 207 children in the study population. The mean age was 8 years. There were 106 boys (51%).
Variables significantly associated with abnormal LFT result were history of liver disease (P = 0.007), history of heart disease (P = 0.040), jaundice (P = 0.045), and hepatomegaly (P = 0.048). The false-negative rate was 16%. However, of the 10 patients for whom this false-negative rate remained true, the LFT values were marginally abnormal, and performance of further investigation of these results was minimal to none. There were 66 patients with no clinical variables and normal CMP results. With a cost difference of $21 between BMP and CMP, this gives a potential savings of $7125 if extrapolated for 1 year in our PED.

Conclusions
Limiting testing to a BMP for patients with none of the 12 clinical variables has the potential annual cost savings of $7125.
Oral Mucosal Envenomation of an Infant by a Puss Caterpillar
Authors: Pappano Dante Allen , Trout Fryxell Rebecca , Warren Molly 
Published: May 2017

Abstract
The term “puss caterpillar” describes the larva of at least two Megalopygidae species common to North America. Accidental contact with the hairs (setae) is intensely painful, and serious systemic effects have been reported. We describe the envenomation of an infant through the face and oral mucosa, resulting in severe discomfort, limited oral intake, and vomiting, but no other untoward effects.
Emergency Management of the Ingested Magnet
Authors: Bauman Brent , McEachron Kendall , Goldman Deborah , Louiselle Amanda , Zheng Eugene , Mills David , Louie Jeffrey , Segura Bradley 
Published: May 2017

Introduction
Accidental ingestion of foreign bodies is an increasing problem in the pediatric population. Symptoms are often nonspecific and may lead to a missed diagnosis because the ingestion event often goes unwitnessed.

Case
We present a case of a missed diagnosis of a multiple magnet ingestion event in a pediatric patient leading to operative management. A 2-year-old boy with a 4-week history of nonspecific abdominal pain presented to the emergency department (ED) with vomiting and worsening abdominal pain. He was recently seen in the ED for nonspecific abdominal pain diagnosed as acute otitis media. In this second ED visit, the child was found to be febrile and tachycardic and had signs of peritonitis. Radiographs revealed a foreign body in the right lower quadrant. The child was taken to the operating room where multiple intestinal perforations were identified and repaired. The child had an uneventful postoperative course and was discharged 7 days later.

Discussion
There are increasing awareness and growing concern over complications from pediatric magnet ingestion. Complications from neodymium magnet ingestion may include bowel obstruction, perforation, and fistula formation. The risk of complications is especially high with multiple-magnet ingestion. Pediatric foreign-body magnet ingestion may be a diagnostic challenge because the associated symptoms are nonspecific, and the ingestion is often unwitnessed.

Conclusions
Our case represents the missed diagnosis of 4 magnets ingested separately over time. Emergency department providers may benefit from a clinical algorithm guiding the management of these increasingly prevalent patient presentations to prevent delayed diagnoses and to decrease morbidity.