bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity and Mortality Associated with Surgery of Traumatic C2 Fractures in Octogenarians
Authors: Dhall Sanjay S. , Yue John K. , Winkler Ethan A. , Mummaneni Praveen V. , Manley Geoffrey T. , Tarapore Phiroz E. 
Published: March 2017

Abstract

BACKGROUND: Management of axis fractures in the elderly remains controversial. As the US population increasingly lives past 80 years, published C2 fracture morbidity/mortality profiles in younger cohorts (55+) have become less applicable to octogenarians.

OBJECTIVE: To report associations between surgery and mortality, hospital length of stay and discharge disposition in octogenarians with traumatic C2 fractures.

METHODS: Retrospective cohort study of 3847 patients age ≥ 80 years representing 17 702 incidents nationwide, divided into surgery/nonsurgery cohorts, using the National Sample Program of the National Trauma Data Bank from 2003 to 2012. Inpatient complications, mortality, length of stay, and discharge disposition are characterized; multivariable regression was utilized to determine associations between surgery and outcomes.

Institutional Review Board (IRB): The National Sample Program dataset from the National Trauma Data Bank is fully deidentified and does not contain Health Insurance Portability and Accountability Act identifiers; therefore, this study is exempt from IRB review at the University of California, San Francisco.

RESULTS: Incidence of surgery was 10.3%. Surgery was associated with increased pneumonia, acute respiratory distress syndrome, and decubitus ulcer risks (P < .001). Inpatient mortality was 12.8% (nonsurgery—13.0%; surgery—10.3%; P = .120). Length of stay was 8.31 ± 9.32 days (nonsurgery 7.78 ± 9.21; surgery 12.86 ± 9.07; P < .001) and showed an adjusted mean increase of 5.68 days with surgery (95% confidence interval [4.74-6.61]). Of patients surviving to discharge, 26% returned home (nonsurgery—26.8%; surgery—18.8%; P = .001); surgery patients were less likely to return home (odds ratio 0.59 [0.44-0.78]).

CONCLUSION: The present study confirms that surgery of traumatic C2 fractures in octogenarians does not significantly affect inpatient mortality and increases discharge to institutionalized care. Patients undergoing surgery are more likely to require longer hospitalization and suffer increased medical complications during their stay. Given the retrospective nature of this study, it is unclear whether these conclusions reflect differences in injury severity between surgery cohorts. This question may be considered in a future prospective study.
Visual Deficit From Laser Interstitial Thermal Therapy for Temporal Lobe Epilepsy: Anatomical Considerations
Authors: Jermakowicz Walter J. , Ivan Michael E. , Cajigas Iahn , Ribot Ramses , Jusue-Torres Ignacio , Desai Mehul B. , Ruiz Armando , D’Haese Pierre-Francois , Kanner Andres M. , Jagid Jonathan R. 
Published: March 2017

Abstract

BACKGROUND: Laser interstitial thermal therapy (LITT) is quickly emerging as an effective surgical therapy for temporal lobe epilepsy (TLE). One of the most frequent complications of the procedure is postoperative visual field cuts, but the physiopathology of these deficits is unknown.

OBJECTIVE: To evaluate potential causes of visual deficits after LITT for TLE in an attempt to minimize this complication.

METHODS: This retrospective chart review compares the case of a 24-year-old male who developed homonymous hemianopsia following LITT for TLE to 17 prior patients who underwent the procedure and suffered no visual deficit. We examined both features of the surgical approach (trajectory, laser energy, ablation size) and of preoperative surgical anatomy, derived from volumetric tracings of mesiotemporal structures.

RESULTS: For the patient with postoperative homonymous hemianopsia imaging suggested inadvertent ablation of the lateral geniculate nucleus, although the laser was positioned entirely within the hippocampus. This patient's laser trajectory, ablation number, energy delivered, and ablation size were not significantly different from the prior patients. However, the subject with the visual deficit did have significantly smaller choroidal fissure cerebrospinal fluid volume.

CONCLUSION: Visual deficits are the most common complication of LITT for mesiotemporal epilepsy and patients at most risk may have small cerebrospinal fluid volume in the choroidal fissure, allowing heat to spread from the hippocampal body to the lateral geniculate nucleus. When such anatomy is identified on preoperative magnetic resonance imaging, we recommend lowering laser trajectory, decreasing ablation power through the hippocampal body, and using temperature safety markers at the lower thalamic border.
Fathers' Needs and Masculinity Dilemmas in a Neonatal Intensive Care Unit in Denmark
Authors: Noergaard Betty , Ammentorp Jette , Fenger-Gron Jesper , Kofoed Poul-Erik , Johannessen Helle , Thibeau Shelley 
Published: March 2017

Background:
Most healthcare professionals in neonatal intensive care units typically focus on the infants and mothers; fathers often feel powerless and find it difficult to establish a father-child relationship. In family-centered healthcare settings, exploring fathers' experiences and needs is important because men's roles in society, especially as fathers, are changing.

Purpose:
To describe fathers' needs when their infants are admitted to a neonatal intensive care unit and to discuss these needs within a theoretical framework of masculinity to advance understanding and generate meaningful knowledge for clinical practices.

Methods:
This qualitative study used participant observation, interviews, multiple sequential interviews, and a focus group discussion. Data were analyzed using grounded theory principles.

Results:
Analysis of the fathers' needs generated 2 primary themes: (1) Fathers as caregivers and breadwinners and (2) fathers and emotions. Fathers wished to be involved and to take care of their infants but have to balance cultural and social norms and expectations of being breadwinners with their wishes to be equal coparents.

Implications for Practice/Research:
Health professionals in neonatal intensive care units must be aware of fathers' need and desire to be equal coparents. Nurses should play a key role by, for example, showing that fathers are as important to their infants as are the mothers, helping them become involved in childcare, and ensuring that they are directly informed about their children's progress. Further research in other cultural settings would contribute to knowledge regarding fatherhood and the role of fathers in childcare.
Burden of Hearing Loss on Communication Partners and Its Influence on Pursuit of Hearing Evaluation
Authors: Schulz Kristine A. , Modeste Naomi , Lee Jerry W. , Roberts Rhonda , Saunders Gabrielle H. , Witsell David L. 
Published: March 2017

Objective:
Describe how the burden on the communication partner (CP) from the patient’s hearing loss, as perceived by both the patient and their CP, influences a patient’s pursuit of hearing evaluation.

Design:
Cross-sectional design. Demographics, perception of patient’s hearing loss, and associated burden on the CP were collected from both patient and CP via online questionnaires. Patients and their CPs from Duke University Medical Center Otolaryngology Clinic, 55 to 75 years of age, being seen for any reason, who indicated a CP has expressed concern about their hearing. Final sample was 245 matched pairs.

Results:
Based on completed questionnaires, on average, patients perceived their own hearing loss as more burdensome to the CP than the CP did. However, CPs of patients who believed themselves to have no hearing handicap scored the patient’s hearing loss 54.3% higher than the patient. The patient’s perspective about the amount of burden their hearing loss placed on the CP predicted patients seeking a hearing evaluation.

Conclusions:
Recognition of early stage hearing loss and associated burden on CPs may be delayed in patients; CPs may help elucidate unrecognized concerns. Educational approaches that raise awareness of burden of hearing loss on CPs along with hearing loss indications could be a feasible, multidimensional strategy to promote help seeking behaviors.
Infants’ and Adults’ Use of Temporal Cues in Consonant Discrimination
Authors: Cabrera Laurianne , Werner Lynne 
Published: March 2017

Objectives:
Adults can use slow temporal envelope cues, or amplitude modulation (AM), to identify speech sounds in quiet. Faster AM cues and the temporal fine structure, or frequency modulation (FM), play a more important role in noise. This study assessed whether fast and slow temporal modulation cues play a similar role in infants’ speech perception by comparing the ability of normal-hearing 3-month-olds and adults to use slow temporal envelope cues in discriminating consonants contrasts.

Design:
English consonant–vowel syllables differing in voicing or place of articulation were processed by 2 tone-excited vocoders to replace the original FM cues with pure tones in 32 frequency bands. AM cues were extracted in each frequency band with 2 different cutoff frequencies, 256 or 8 Hz. Discrimination was assessed for infants and adults using an observer-based testing method, in quiet or in a speech-shaped noise.

Results:
For infants, the effect of eliminating fast AM cues was the same in quiet and in noise: a high proportion of infants discriminated when both fast and slow AM cues were available, but less than half of the infants also discriminated when only slow AM cues were preserved. For adults, the effect of eliminating fast AM cues was greater in noise than in quiet: All adults discriminated in quiet whether or not fast AM cues were available, but in noise eliminating fast AM cues reduced the percentage of adults reaching criterion from 71 to 21%.

Conclusions:
In quiet, infants seem to depend on fast AM cues more than adults do. In noise, adults seem to depend on FM cues to a greater extent than infants do. However, infants and adults are similarly affected by a loss of fast AM cues in noise. Experience with the native language seems to change the relative importance of different acoustic cues for speech perception.
Correlative Analysis of Vertebral Trabecular Bone Microarchitecture and Mechanical Properties
Authors: Guenoun Daphne , Fouré Alexandre , Pithioux Martine , Guis Sandrine , Le Corroller Thomas , Mattei Jean-Pierre , Pauly Vanessa , Guye Maxime , Bernard Monique , Chabrand Patrick , Champsaur Pierre , Bendahan David 
Published: March 2017

Study Design.
High-resolution imaging and biomechanical investigation of ex-vivo vertebrae.

Objective.
The aim of this study was to assess bone microarchitecture of cadaveric vertebrae using ultra-high field (UHF) 7 Tesla magnetic resonance imaging (MRI) and to determine whether the corresponding microarchitecture parameters were related to bone mineral density (BMD) and bone strength assessed by dual-energy x-ray absorptiometry (DXA) and mechanical compression tests.

Summary of Background Data.
Limitations of DXA for the assessment of bone fragility and osteoporosis have been recognized and criteria of microarchitecture alteration have been included in the definition of osteoporosis. Although vertebral fracture is the most common osteoporotic fracture, no study has assessed directly vertebral trabecular bone microarchitecture.

Methods.
BMD of 24 vertebrae (L2, L3, L4) from eight cadavers was investigated using DXA. The bone volume fraction (BVF), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp) of each vertebra were quantified using UHF MRI. Measurements were performed by two operators to characterize the inter-rater reliability. The whole set of specimens underwent mechanical compression tests to failure and the corresponding failure stress was calculated.

Results.
The inter-rater reliability for bone microarchitecture parameters was good with intraclass correlation coefficients ranging from 0.82 to 0.94. Failure load and stress were significantly correlated with BVF, Tb.Sp, and BMD (P < 0.05). Tb.Th was only correlated with the failure stress (P < 0.05). Multiple regression analysis demonstrated that the combination of BVF and BMD improved the prediction of the failure stress from an adjusted R
2 = 0.384 for BMD alone to an adjusted R
2 = 0.414.

Conclusion.
We demonstrated for the first time that the vertebral bone microarchitecture assessed with UHF MRI was significantly correlated with biomechanical parameters. Our data suggest that the multimodal assessment of BMD and trabecular bone microarchitecture with UHF MRI provides additional information on the risk of vertebral bone fracture and might be of interest for the future investigation of selected osteoporotic patients.

Level of Evidence: N /A
Role of Cx43-Mediated NFкB Signaling Pathway in Ossification of Posterior Longitudinal Ligament
Authors: Chen Dechun , Chen Yu , Li Tiefeng , Shi Lei , Pan Mengxiao , Chen Deyu 
Published: March 2017

Study Design.

In vivo and in vitro experiments.

Objective.
To illustrate the further molecular mechanism of Cx43-mediated osteoblastic differentiation of ligament cells.

Summary of Background Data.
Ossification of the posterior longitudinal ligament (OPLL) is one of the main causes of myelopathy in Asians, but its etiology has not been clarified. We have previously found the mechanical stress can upregulate Cx43 expression in ligament cells, which transduces mechanical signal to promote osteoblastic differentiation.

Methods.
The posterior longitudinal ligaments were collected intraoperatively. Ligament fibroblasts were isolated and cultured, and an in vitro mechanical loading model was established. In vivo and in vitro expression levels of Cx43 protein were compared between OPLL and non-OPLL patients. The activation of nuclear factor (NF)-κB (p65) signal and related inflammatory responses were detected in ligament cells under mechanical loading. The mechanical stress-induced inflammatory response and osteoblastic differentiation of OPLL cells were investigated after the treatment with Cx43 siRNA or NFкB (p65) inhibitor.

Results.
We first confirmed higher Cx43 levels in both in vivo ligament tissue from OPLL patients and in vitro cultured OPLL cells. We also found NFκB (p65) signal and related inflammatory response were activated by mechanical stimulation. The activation of NFκB (p65) signal was dependent upon Cx43, as its knockdown reduced signal. Moreover, treatment with Cx43 siRNA or NFкB (p65) inhibitor significantly decreased the mechanical-induced inflammation response, but partly attenuated mechanical-stimulated osteoblastic differentiation of OPLL cells.

Conclusion.
Cx43-mediated NFкB (p65) signal played an important role in mechanical stress-induced OPLL by transduction of mechanical signal, while giving rise to the activation of inflammatory response in ligament fibroblasts

Level of Evidence: N/A
Weight Gain After Vertical Expandable Prosthetic Titanium Rib Surgery May Be From Nutritional Optimization Rather Than Improvement in Pulmonary Function
Authors: Li Ying , Shlykov Maksim A. , Robbins Christopher B. , Farley Frances A. , Caird Michelle S. , Burke Michelle C. 
Published: March 2017

Study Design.
Prospective comparative study.

Objective.
To evaluate whether weight percentile (WP) increases after vertical expandable prosthetic titanium rib (VEPTR) insertion, and whether WP correlates with nutrition laboratories and pulmonary function.

Summary of Background Data.
Children with thoracic insufficiency syndrome often have “failure to thrive” (WP ≤5). Previous authors have reported an increase in WP after VEPTR surgery. Weight gain was hypothesized to be secondary to improved pulmonary function. The presence of a correlation between WP and nutrition laboratories and pulmonary function tests (PFT) after VEPTR insertion has not been studied.

Methods.
Demographic, nutrition, radiographic, and PFT data were collected on 35 VEPTR patients with a minimum follow-up of 2 years. The relationship between WP and nutrition laboratories and pulmonary function was analyzed.

Results.
Preoperative WP was ≤5 (PREOP≤5) in 13 patients (37%) and >5 (PREOP>5) in 22 patients (63%). Although all children gained weight, the PREOP≤5 group was more likely to have an increase in WP (P = 0.014). Sixty-eight percent of the PREOP>5 group had a decrease in WP and 32% of the PREOP>5 patients met the criteria for failure to thrive at final follow-up. Overall, there was no change in the number of children with a WP ≤5 (13 vs. 15). Forty-two percent of the children who maintained or increased their WP had a gastrostomy tube, compared to 19% of those who decreased their WP. Seventy-three percent of the patients with failure to thrive at final follow-up did not have a gastrostomy tube. No significant correlations were found between WP and nutrition laboratories, radiographic measures, or PFTs.

Conclusion.
We did not find an overall change in WP after VEPTR insertion. We did not find any correlation between WP and nutrition laboratories or pulmonary function. Weight gain after VEPTR surgery may be secondary to nutritional optimization in high-risk patients. Children who do not have failure to thrive at presentation also require attention.

Level of Evidence: 2
Drivers of Medicare Reimbursement for Thoracolumbar Fusion
Authors: Khanna Krishn , Padegimas Eric M. , Zmistowski Benjamin , Howley Michael , Verma Kushagra 
Published: March 2017

Study Design.
A retrospective observational study.

Objective.
The purpose of this study is to examine the variation in thoracolumbar fusion (TLF) payment and determine the drivers of this variation.

Summary of Background Data.
As health care spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators. There is a wide variation in TLF charges, but the drivers for this variation are not clear.

Methods.
Claims for TLF were identified in the CMS data by analyzing Diagnosis Related Group (DRG) number 460 (“Spinal Fusion Except Cervical without Major Complications or Comorbidities”). Data on factors that may impact cost of care were collected from four sources: the United States Census Bureau, CMS, the Dartmouth Atlas, and WWAMI Rural Health Research Center. These were then grouped into seven categories: quality, supply, demand, substitute treatment availability, patient characteristics, competitive factors, and provider characteristics. Predictive reimbursement models were created from the data using multivariate linear regression to understand the factors that influence TLF reimbursement.

Results.
There was significant geographic variability in reimbursement. The largest contribution to reimbursement variation came from variables in the demand (ΔR

2

= 13.4%, P < 0.001), supply (ΔR

2

= 9.2%, P < 0.001), and competitive factor domains (ΔR

2

= 9.1%, P < 0.001). The top three drivers that increased reimbursement were provider charges (β = 0.37, P < 0.001), total Medicare reimbursement in the region (β = 0.19, P < 0.001), and the number of spinal surgeries per 1000 patients in that region (β = 0.06, P = 0.02). Institutional volume, a surrogate for quality was negatively associated with TLF reimbursement.

Conclusion.
There was wide variation in reimbursement for TLF across the U.S. The variables that drive TLF reimbursement variation include supply, demand, and competition. Interestingly, quality of care was not associated with increased TLF reimbursement.

Level of Evidence: N/A
Using Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in Critical Care: A Systematic Review of the Evidence for Benefit or Harm*
Authors: Kelly John M. , Rubenfeld Gordon D. , Masson Neil , Min Arimie , Adhikari Neill K. J. 
Published: March 2017

Objective:
Selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors are among the most commonly prescribed drugs in patients admitted to the ICU. Our objective was to systematically review available literature for evidence of benefit or harm in ICU patients resulting from chronic effects, continued use, or withdrawal.

Data Sources:
Medline, Embase, and Cochrane Central Register of Controlled Trials (1990 to November 2014).

Study Selection:
We searched for studies of ICU patients with recorded selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor prescription before or during admission, and reporting morbidity, mortality, adverse events, and resource measures like ICU length of stay. We considered all study designs. We excluded studies of deliberate overdose and depression in non-ICU settings. Two authors independently and in duplicate screened citations and reviewed text of studies to apply selection criteria.

Data Extraction:
Two authors abstracted data on patient characteristics in exposed and control groups; use of selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors previously or during ICU; comparator intervention; and outcomes, and also assessed methodologic quality.

Data Synthesis:
The database search retrieved 4,172 unique citations, of which 289 were reviewed, and 13 studies representing a total of 20,048 patients met selection criteria. There were five cohort studies, one case series, and seven case reports. Only one case report suggested benefit from selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor use and 11 studies reported morbidity in patients using these medications at admission to ICU. However, due to inadequate drug administration reporting, it was generally unclear if outpatient selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors were continued in ICU, complicating interpretation.

Conclusions:
There may be excess morbidity in critically ill selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor users, but uncertainty remains whether this is due to chronic effects, ongoing use, or drug withdrawal. Further research with improved standards of drug administration reporting is needed to help clinicians decide when to use selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors in critically ill patients.