bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of survival and cognitive performance in children treated for medulloblastoma in the PNET 4 randomized controlled trial
Authors: Câmara-Costa Hugo , Bull Kim S , Kennedy Colin , Wiener Andreas , Calaminus Gabriele , Resch Anika , Kieffer Virginie , Lalande Clémence , Poggi Geraldina , von Hoff Katja , Grill Jacques , Doz François , Rutkowski Stefan , Massimino Maura , Kortmann Rolf-Dieter , Lannering Birgitta , Dellatolas Georges , Chevignard Mathilde ,   on behalf of the Quality of Survival working group of the Brain Tumour Group of SIOP-Europe
Published: February 2017

Abstract

Background
The relationship between direct assessments of cognitive performance and questionnaires assessing quality of survival (QoS) is reported to be weak-to-nonexistent. Conversely, the associations between questionnaires evaluating distinct domains of QoS tend to be strong. This pattern remains understudied.

Methods
In the HIT-SIOP PNET4 randomized controlled trial, cognitive assessments, including Full Scale, Verbal and Performance IQ, Working Memory, and Processing Speed, were undertaken in 137 survivors of standard-risk medulloblastoma from 4 European countries. QoS questionnaires, including self-reports and/or parent reports of the Behavior Rating Inventory of Executive Function (BRIEF), the Health Utilities Index, the Strengths and Difficulties Questionnaire, and the Pediatric Quality of Life Inventory, were completed for 151 survivors. Correlations among direct cognitive assessments, QoS questionnaires, and clinical data were examined in participants with both assessments available (n = 86).

Results
Correlations between direct measures of cognitive performance and QoS questionnaires were weak, except for moderate correlations between the BRIEF Metacognition Index (parent report) and working memory (r = .32) and between health status (self-report) and cognitive outcomes (r = .35–.44). Correlations among QoS questionnaires were moderate to strong both for parent and self-report (r = .39–.76). Principal Component Analysis demonstrated that questionnaires and cognitive assessments loaded on 2 separate factors.

Conclusions
We hypothesize that the strong correlations among QoS questionnaires is partially attributable to the positive/negative polarity of all questions on the questionnaires, coupled with the relative absence of disease-specific questions. These factors may be influenced by respondents’ personality and emotional characteristics, unlike direct assessments of cognitive functioning, and should be taken into account in clinical trials.
Culture-Proven Thorn-Associated Infections in Arizona: 10-Year Experience at Mayo Clinic
Authors: Simmons Sierra C. , Budavari Adriane I. , Kusne Shimon , Zhang Nan , Vikram Holenarasipur R. , Blair Janis E. 
Published: February 2017

AbstractBackgroundThorn injuries are common in the desert Southwest; however, the frequency and microbiology of thorn-associated infections have not been systematically described. Most information comes from case reports describing infections from atypical or environmental microorganisms. Our aim was to summarize the spectrum of thorn-associated infections.MethodsWe conducted a retrospective review of electronic health records for patients presenting to our institution from January 1, 2005 to December 31, 2014 for treatment of thorn-associated injuries and then focused on the patients with cultures.ResultsOf 2758 records reviewed, 1327 patients had thorn-associated injuries; however, only 58 (4.4%) had cultures. Of these patients, 37 (64%) had positive findings; 5 had polymicrobial infection. The most commonly identified organisms were Staphylococcus aureus (n = 22, 59.0%) and coagulase-negative Staphylococcus species (n = 8, 21.6%). Other pathogens included Nocardia species (n = 3, 8.1%), Streptococcus species (n = 2, 5.4%), Gram-negative bacteria (n = 2, 5.4%), Aspergillus species (n = 2, 5.4%), Paecilomyces lilacinus (n = 1, 2.7%), and Candida species (n = 1, 2.7%). There were no infections caused by Pantoea agglomerans, Sporothrix schenckii, or Coccidioides spp.ConclusionsIn contrast to most published case reports, we found that typical cutaneous microorganisms, such as Staphylococcus species, caused the majority of culture-positive, thorn-related infections.
High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy
Authors: Duma Andreas , Pal Swatilika , Johnston Joshua , Helwani Mohammad A. , Bhat Adithya , Gill Bali , Rosenkvist Jessica , Cartmill Christopher , Brown Frank , Miller J. Philip , Scott Mitchell G. , Sanchez-Conde Francisco , Jarvis Michael , Farber Nuri B. , Zorumski Charles F. , Conway Charles , Nagele Peter 
Published: February 2017

Abstract

Background
While electroconvulsive therapy is widely regarded as a lifesaving and safe procedure, evidence regarding its effects on myocardial cell injury is sparse. The objective of this investigation was to determine the incidence and magnitude of new cardiac troponin elevation after electroconvulsive therapy using a novel high-sensitivity cardiac troponin I assay.

Methods
This was a prospective cohort study in adult patients undergoing electroconvulsive therapy in a single academic center (up to three electroconvulsive therapy treatments per patient). The primary outcome was new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy, defined as an increase of high-sensitivity cardiac troponin I greater than 100% after electroconvulsive therapy compared to baseline with at least one value above the limit of quantification (10 ng/l). Twelve-lead electrocardiogram and high-sensitivity cardiac troponin I values were obtained before and 15 to 30 min after electroconvulsive therapy; in a subset of patients, an additional 2-h high-sensitivity cardiac troponin I value was obtained.

Results
The final study population was 100 patients and a total of 245 electroconvulsive therapy treatment sessions. Eight patients (8 of 100; 8%) experienced new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy with a cumulative incidence of 3.7% (9 of 245 treatments; one patient had two high-sensitivity cardiac troponin I elevations), two of whom had a non–ST-elevation myocardial infarction (incidence 2 of 245; 0.8%). Median high-sensitivity cardiac troponin I concentrations did not increase significantly after electroconvulsive therapy. Tachycardia and/or elevated systolic blood pressure developed after approximately two thirds of electroconvulsive therapy treatments.

Conclusions
Electroconvulsive therapy appears safe from a cardiac standpoint in a large majority of patients. A small subset of patients with preexisting cardiovascular risk factors, however, may develop new cardiac troponin elevation after electroconvulsive therapy, the clinical relevance of which is unclear in the absence of signs of myocardial ischemia.
Anesthetic Neuroprotection in Experimental Stroke in Rodents
Authors: Archer David P. , Walker Andrew M. , McCann Sarah K. , Moser Joanna J. , Appireddy Ramana M. 
Published: February 2017

Abstract

Background
Patients undergoing endovascular therapy for acute ischemic stroke may require general anesthesia to undergo the procedure. At present, there is little clinical evidence to guide the choice of anesthetic in this acute setting. The clinical implications of experimental studies demonstrating anesthetic neuroprotection are poorly understood. Here, the authors evaluated the impact of anesthetic treatment on neurologic outcome in experimental stroke.

Methods
Controlled studies of anesthetics in stroke using the filament occlusion model were identified in electronic databases up to December 15, 2015. The primary outcome measures, infarct volume, and neurologic deficit score were used to calculate the normalized mean difference for each comparison. Meta-analysis of normalized mean difference values provided estimates of neuroprotection and contributions of predefined factors: study quality, the timing of treatment, and the duration of ischemia.

Results
In 80 retrieved publications anesthetic treatment reduced neurologic injury by 28% (95% CI, 24 to 32%; P < 0.0001). Internal validity was high: publication bias enhanced the effect size by 4% or less, effect size increased with study quality (P = 0.0004), and approximately 70% of studies were adequately powered. Apart from study quality, no predefined factor influenced neuroprotection. Neuroprotection failed in animals with comorbidities. Neuroprotection by anesthetics was associated with prosurvival mechanisms.

Conclusions
Anesthetic neuroprotection is a robust finding in studies using the filament occlusion model of ischemic stroke and should be assumed to influence outcomes in studies using this model. Neuroprotection failed in female animals and animals with comorbidities, suggesting that the results in young male animals may not reflect human stroke.
Impact of Pain on Incident Risk of Disability in Elderly Japanese
Authors: Kaiho Yu , Sugawara Yumi , Sugiyama Kemmyo , Tomata Yasutake , Endo Yasuhiro , Toyama Hiroaki , Yamauchi Masanori , Tsuji Ichiro 
Published: February 2017

Abstract

Background
Although several cross-sectional studies have reported that pain is associated with functional disability in the elderly, data regarding a longitudinal association between pain and disability are inconsistent. This study aimed to investigate the association of pain severity with subsequent functional disability due to all causes as well as stroke, dementia, and joint disease/fracture.

Methods
The authors conducted a prospective cohort study of 13,702 Japanese individuals aged 65 yr or older. Information regarding pain severity during the previous 4 weeks and other lifestyle factors was collected via questionnaire in 2006. Data on the incidence of functional disability were retrieved from the Long-term Care Insurance database. Cox proportional hazards regression analysis was used to estimate the multivariate-adjusted hazard ratios for incident functional disability.

Results
The authors documented 2,686 (19.6%) cases of incident functional disability. The multivariate hazard ratio of functional disability was 1.15 (95% CI, 1.02 to 1.31) among respondents with moderate pain and 1.31 (95% CI, 1.12 to 1.54) among respondents with severe pain in comparison with those without pain (P trend < 0.001). These positive associations were particularly remarkable for disability due to joint disease/fracture: the multivariate hazard ratio was 1.88 (95% CI, 1.37 to 2.58) for moderate pain and 2.76 (95% CI, 1.93 to 3.95) for severe pain (P trend < 0.001). There was a negative association between pain severity and disability due to dementia (P trend = 0.041) and no significant association between pain severity and disability due to stroke.

Conclusions
Among elderly Japanese individuals, the authors found a significant positive association between pain severity and future incident functional disability.
Psychosocial Stress After a Disaster and Low Back Pain-Related Interference With Daily Living Among College Students
Authors: Kato Kinshi , Sekiguchi Miho , Nikaido Takuya , Otoshi Ken-ichi , Matsuo Yohei , Igari Takahiro , Kobayashi Yoshihiro , Takegami Misa , Fukumori Norio , Fukuma Shingo , Kikuchi Shin-ichi , Fukuhara Shun-ichi , Konno Shin-ichi 
Published: February 2017

Study Design.
A cohort study.

Objective.
To investigate the association between psychosocial stress and low back pain (LBP)-related interference with daily living among college students.

Summary of Background Data.
Few longitudinal studies have examined the likelihood of developing LBP in the presence of a designated psychosocial stressor. All participants in the present study were suddenly affected by the Great East Japan disaster after enrolment in our cohort study.

Methods.
The present study was initiated among 95 students at Fukushima Medical University in January 2011. We assessed psychosocial stress in students using the Japanese version of the Perceived Stress Scale (JPSS). Follow-up surveys were conducted in July 2011 and May 2013, analyzing 94 students. Students were then divided into three groups (improved, −19 to −4; Maintained, −3 to +4; Aggravated, +5 to +22) based on the tertile points of JPSS change from baseline to 4 months after the disaster. LBP-related interference with daily living was assessed using the Brief Pain Inventory (BPI) questionnaire. Linear regression modeling was performed with BPI at 4 months after the disaster as the outcome, and JPSS change, sex, history of LBP, baseline physical activity, and baseline BPI as explanatory variables.

Results.
We found a significant increase in BPI score for the aggravated stress group (β coefficient, +0.79; 95% confidence interval, +0.06–+1.53), compared with the improved stress group. History of LBP and higher physical activity were also significantly associated with BPI.

Conclusion.
The present study suggests that perceived psychosocial stress induced by the disaster may be associated with LBP-related interference with daily living among college students in Fukushima.

Level of Evidence: 3
Prognostic Factors for Failure of Antibiotic Treatment in Patients With Osteomyelitis of the Spine
Authors: de Graeff Jan Jaap , Paulino Pereira Nuno Rui , van Wulfften Palthe Olivier D. , Nelson Sandra B. , Schwab Joseph H. 
Published: February 2017

Study Design.
Retrospective cohort study.

Objective.
The aim of this study was to identify factors independently associated with antibiotic treatment failure in patients with spinal osteomyelitis.

Summary of Background Data.
There are few studies that have identified risk factors for antibiotic treatment failure in medically managed spinal osteomyelitis. Identifying such factors could help to identify patients who can be treated solely with antibiotics.

Methods.
All patients who underwent antibiotic treatment for spinal osteomyelitis in one of our institutions between January 1, 2001 and January 1, 2015 were identified. Patients who underwent surgery before the start of the antibiotic treatment were excluded.

Results.
We included 215 patients with a mean age of 58 years; 63 (29%) patients had failure of antibiotic treatment. Diabetes (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.03–2.79, P = 0.037), fever (HR 1.61, 95% CI 0.93–2.79, P = 0.088), osteomyelitis at an additional site (HR 5.17, 95% CI 2.63–27.9, P = 0.001), and the presence of an epidural abscess (HR 1.91, 95% CI 1.05–3.45, P = 0.033) were associated with failure of antibiotic treatment. In the multivariate Cox regression analysis, diabetes (HR 1.69, 95% CI 1.03–2.79, P = 0.019), osteomyelitis at an additional site (HR 8.26, 95% CI 2.51–27.2, P = 0.001), fever (HR 1.77, 95% CI 1.00–3.12, P = 0.050), and the presence of an epidural abscess (HR 1.82, 95% CI 1.06–3.13, P = 0.030) were independently associated with failure of antibiotic treatment.

Conclusion.
Antibiotic treatment failed in 29% of patients; diabetes, current other osteomyelitis, and having an epidural abscess were independently associated with failure of antibiotic treatment.

Level of Evidence: 3
One-stage Surgical Management for Lumbar Brucella Spondylitis by Posterior Debridement, Autogenous Bone Graft and Instrumentation
Authors: Chen Yangbin , Yang Jun-Song , Li Tao , Liu Peng , Liu Tuan-Jiang , He Li-Min , Qian Li-Xiong , Hao Ding-Jun 
Published: February 2017

Study Design.
Clinical case series.

Objective.
The aim of this study was to explore the efficacy and safety of one-stage debridement, autogenous bone graft, and instrumentation for lumbar brucella spondylitis (LBS) via a posterior approach.

Summary of Background Data.
Reports on LBS are sporadic, and the therapeutic effect and safety of surgical interventions have not been assessed in clinical studies.

Methods.
Between January 2012 and January 2014, 24 consecutive patients with symptomatic LBS who underwent a one-stage operation that combined debridement, autogenous bone graft, and instrumentation via a posterior approach were enrolled. Back pain was measured using the visual analog scale (VAS). The neurological status was evaluated with the American Spinal Injury Association (ASIA) scale. Bone healing was evaluated based on postoperative plain x-ray or computed tomography.

Results.
All cases were followed up for an average of 14.3 + 3.5 months. The VAS scores were significantly improved at every follow-up interval. An improvement of at least one grade level was observed in the ASIA score of each patient. The average time of bone fusion was 6.8 + 1.6 months. Significant improvements of the average segmental Cobb angle was observed from a preoperative value of 18.4° + 4.6° to a last follow-up value of 21.1° ± 3.7°. At the last follow up, the titers of antibodies against the standard tube agglutination test, erythrocyte sedimentation rate, and C-reactive protein were negative for all patients.

Conclusion.
For LBS, systemic antibrucellosis chemotherapy is the cornerstone of treatment. When cauda equine syndrome, radiculopathy, spinal instability, and severe back pain caused by extradural nonabsorbable abscess or progressive collapse are present, surgical intervention is inevitable. One-stage debridement, autogenous bone graft, and instrumentation via a posterior approach could represent an alternative treatment for LBS, and the efficacy and safety of these techniques are satisfactory.

Level of Evidence: 4
Spinal Tissue Loading Created by Different Methods of Spinal Manipulative Therapy Application
Authors: Funabashi Martha , Nougarou François , Descarreaux Martin , Prasad Narasimha , Kawchuk Gregory N. 
Published: February 2017

Study Design.
Comparative study using robotic replication of spinal manipulative therapy (SMT) vertebral kinematics together with serial dissection.

Objective.
The aim of this study was to quantify loads created in cadaveric spinal tissues arising from three different forms of SMT application.

Summary of Background Data.
There exist many distinct methods by which to apply SMT. It is not known presently whether different forms of SMT application have different effects on spinal tissues. Should the method of SMT application modulate spinal tissue loading, quantifying this relation may help explain the varied outcomes of SMT in terms of effect and safety.

Methods.
SMT was applied to the third lumbar vertebra in 12 porcine cadavers using three SMT techniques: a clinical device that applies forces through a hand-held instrument (INST), a manual technique of applying SMT clinically (MAN) and a research device that applies parameters of manual SMT through a servo-controlled linear actuator motor (SERVO). The resulting kinematics from each SMT application were tracked optically via indwelling bone pins. The L3/L4 segment was then removed, mounted in a parallel robot and the resulting kinematics from SMT replayed for each SMT application technique. Serial dissection of spinal structures was conducted to quantify loading characteristics of discrete spinal tissues.

Results.
In terms of load magnitude, SMT application with MAN and SERVO created greater forces than INST in all conditions (P < 0.05). Additionally, MAN and SERVO created comparable posterior forces in the intact specimen, but MAN created greater posterior forces on IVD structures compared to SERVO (P < 0.05).

Conclusion.
Specific methods of SMT application create unique vertebral loading characteristics, which may help explain the varied outcomes of SMT in terms of effect and safety.

Level of Evidence: N/A
Cardiorespiratory Function Does Not Improve 2 Years After Posterior Surgical Correction of Adolescent Idiopathic Scoliosis
Authors: Lorente Alejandro , Barrios Carlos , Burgos Jesús , Hevia Eduardo , Fernández-Pineda Luis , Lorente Rafael , Rosa Bárbara , Pérez-Encinas Cristina 
Published: February 2017

Study Design.
A prospective evaluation of cardiorespiratory function following spinal fusion in adolescent idiopathic scoliosis (AIS).

Objective.
To evaluate the cardiopulmonary function during exercise in patients with severe AIS, before and 2 years after undergoing a posterior spinal fusion.

Summary of Background Data.
After surgical correction of scoliosis, a greater cardiorespiratory adaptation to exercise would be expected from correction of the rib cage associated with the spine deformity. However, there is no clear evidence regarding whether tolerance to maximum exercise improves in the medium term after surgery in patients with severe curves.

Methods.
We include patients with AIS proposed for posterior surgical correction aging between 12 and 17 years. Every patient had a Cobb angle >45° and a Lenke type 1A scoliosis. Cardiac and respiratory functional measures, such as heart rate and blood pressure, maximum oxygen consumption (VO2max), eliminated volume of carbon dioxide (VCO2), quotient between ventilation and volume of exhaled carbon dioxide (VE/CO2), respiratory exchange rate, ventilatory capacity at maximal exercise (VEmax), were recorded before and 2 years after surgery.

Results.
Twenty patients were included in our study, 15 girls and 5 boys, with an average age of 13 years. The main scoliotic curve was corrected in the coronal plane in an average of 71.9%. The maximal aerobic power expressed by body weight normalized VO2max was found preoperatively to have an average of 30.9 ± 6.2 mL/kg/minute, indicating a poor aerobic capacity, which did not improve at final follow-up, decreasing to a mean value of 29.3 ± 5.7 but without statistical significance. However, the percentages of curve correction showed a statistically significant correlation with VO2max (r = 0.534; P < 0.05).

Conclusion.
Patients with severe adolescent idiopathic scoliosis Lenke type 1A showed limited cardiorespiratory tolerance to maximum exercise that did not improve 2 years after surgery.

Level of Evidence: 3
Nutritional Status as an Adjunct Risk Factor for Early Postoperative Complications Following Posterior Cervical Fusion
Authors: Lee Nathan J. , Kothari Parth , Kim Jun S. , Phan Kevin , Di Capua John , Shin John , Cho Samuel K. 
Published: February 2017

Study Design.
Retrospective study on prospectively collected data.

Objective.
The aim of this study was to study the impact of nutritional status, as measured by serum albumin level, on patient outcomes following posterior cervical fusion (PCF) surgery.

Summary of Background Data.
Malnutrition is a potential modifiable risk factor that has garnered an increasing amount of attention within orthopedics in recent years. There is evidence to suggest the role of nutritional status in lumbar and ACDF surgery, yet the data for PCF are still lacking.

Methods.
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was queried by current procedure terminology (CPT) from 2010 to 2014. Bivariate analyses were performed to compare the preoperative characteristics between those with normal albumin and hypoalbuminemia. Postoperative complications and outcomes were similarly analyzed for those with and without low albumin levels. Stepwise multivariate logistic regression models were employed to determine whether hypoalbuminemia was an independent risk factor for short-term patient outcomes and complications.

Results.
There were 1573 cases with measured albumin levels (42.4%). The mean (standard deviation) serum albumin level was 3.9 (0.6). Among these patients, 265 (16.8%) cases had hypoalbuminemia. The adjusted analyses demonstrated that patients with hypoalbuminemia had a significantly higher risk for length of stay >5 days (odds ratio [OR] = 3.8; 95% confidence interval [CI] = 2.8–5.1; P < 0.0001). In addition, hypoalbuminemia was an independent risk factor for any complications (OR = 2.7; 95% CI = 1.9–3.7; P < 0.0001), pulmonary complications (OR = 2.3; 95% CI = 1.2–4.5; P = 0.010), intra/postoperative blood transfusions (OR = 3.2; 95% CI = 2.1–4.9; P < 0.0001), sepsis (OR = 4.0; 95% CI = 1.7–9.2; P = 0.001), and venous thromboemoblism (OR = 3.6; 95% CI = 1.5–8.5; P = 0.004).

Conclusion.
These findings implicate that a baseline serum albumin <3.5 g/dL may serve as a valuable prognostic measure for the development of several complications following PCF surgery.

Level of Evidence: 3