bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benchmarks of meaningful impairment on the MSFC and BICAMS
Authors: Benedict Ralph HB , Drake Allison S , Irwin Lauren N , Frndak Seth E , Kunker Katrina A , Khan Anjum L , Kordovski Victoria M , Motl Robert W , Weinstock-Guttman Bianca 
Published: February 2016

Background: Cognitive and motor abilities in multiple sclerosis (MS) are typically quantified using reliable, consensus standard tests validated in the MS population. While these performance measures are associated with vocational disability in parametric analyses, translation of raw scores into anchors reflecting clinically relevant, functional impairment requires further research. Objective: To examine performance-based motor and cognitive outcomes among definitive anchors that designate varying degrees of functional impairment, thereby establishing benchmarks for score interpretation. Methods: We evaluated MS patients and healthy controls, all undergoing a brief test battery. Outcomes were derived from the MS Functional Composite (MSFC) and the Brief International Cognitive Assessment for MS (BICAMS). Functional impairment anchors were (1) disability benefits, (2) employed with negative work events, and (3) employed without problems. Results: All measures yielded statistically significant differences across all levels of work status, after accounting for the effects of age and education. Benchmark values distinguished the functional impairment groups. When evaluated in combination, the Timed 25-Foot Walk and the Symbol Digit Modalities Test were the most robust predictors of functional decline. Conclusion: We have established benchmark scores for popular motor and cognitive tests that are associated with specific degrees of impairment in work status.
Interferon-beta exposure during first trimester is safe in women with multiple sclerosis—A prospective cohort study from the German Multiple Sclerosis and Pregnancy Registry
Authors: Thiel Sandra , Langer-Gould Annette , Rockhoff Milena , Haghikia Aiden , Queisser-Wahrendorf Annette , Gold Ralf , Hellwig Kerstin 
Published: February 2016

Background: Available data suggest that pregnancy exposure to interferon-beta might result in lower mean birth weight and preterm birth. Objective: To determine the effect of interferon-beta exposure during pregnancy on pregnancy outcomes in multiple sclerosis patients. Methods: We compared the pregnancy outcomes of women exposed to interferon-beta with pregnancies unexposed to disease-modifying therapies. Women were enrolled into the German Multiple Sclerosis and Pregnancy Registry. A standardized questionnaire was administered during pregnancy and postpartum. Detailed information on course of multiple sclerosis and pregnancy, concomitant medications, delivery, and outcome of pregnancy was obtained. Results: We collected data on 251 pregnancies exposed to interferon-beta and 194 unexposed to disease-modifying therapies. In all, 246 (98.01%) women discontinued interferon-beta treatment during first trimester. No differences regarding mean birth weight (exposed: 3272.28 ± 563.61 g; unexposed: 3267.46 ± 609.81 g), mean birth length (exposed: 50.73 ± 3.30 cm; unexposed: 50.88 ± 3.45 cm), preterm birth ( p = 0.187), spontaneous abortion ( p = 0.304), and congenital anomalies ( p = 0.197) were observed between the two groups. Conclusions: Interferon-beta exposure during early pregnancy does not influence the mean birth weight, risk of preterm birth, or other adverse pregnancy outcomes. Our study provides further reassurance that interferon-beta treatment can be safely continued up until women become pregnant.
The Standards of Reporting of Neurological Disorders (STROND) checklist: Application to multiple sclerosis
Authors: Fiest Kirsten M , Marrie Ruth Ann , Jette Nathalie , Bennett Derrick A 
Published: February 2016

Background: Descriptive epidemiological studies documenting the incidence and prevalence of multiple sclerosis (MS) and studies that report morbidity, mortality, and economic burden provide essential information for patients, healthcare providers, and policymakers. However, the quality of reporting of observational studies is often poor, limiting the ability to evaluate the validity of the findings. The Standards of Reporting of Neurological Disorders (STROND) reporting guideline comprises recommendations and a 15-item checklist of reporting items to aid high-quality reporting of incidence and prevalence studies of neurological disorders. Methods: We explain the basic reporting items of the STROND checklist for the methods, results, and discussion sections in the context of the MS literature and searched for examples of good reporting of those items. Results: We identified examples of good reporting of the basic reporting items from previous systematic reviews of the descriptive epidemiologic literature in MS. Conclusion: The adoption of the STROND reporting guidelines should improve the quality of reporting of descriptive epidemiological studies in MS. Along with efforts to improve methodological aspects of epidemiological studies and harmonization of data collection efforts, improved reporting could contribute to furthering our understanding of the epidemiology of MS.
Genetic overlap between multiple sclerosis and several cardiovascular disease risk factors
Authors: Wang Yunpeng , Bos Steffan D , Harbo Hanne F , Thompson Wesley K , Schork Andrew J , Bettella Francesco , Witoelar Aree , Lie Benedicte A , Li Wen , McEvoy Linda K , Djurovic Srdjan , Desikan Rahul S , Dale Anders M , Andreassen Ole A 
Published: February 2016

Background: Epidemiological findings suggest a relationship between multiple sclerosis (MS) and cardiovascular disease (CVD) risk factors, although the nature of this relationship is not well understood. Objective: We used genome-wide association study (GWAS) data to identify shared genetic factors (pleiotropy) between MS and CVD risk factors. Methods: Using summary statistics from a large, recent GWAS (total n > 250,000 individuals), we investigated overlap in single nucleotide polymorphisms (SNPs) associated with MS and a number of CVD risk factors including triglycerides (TG), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, body mass index, waist-to-hip ratio, type 2 diabetes, systolic blood pressure, and C-reactive protein level. Results and conclusion: Using conditional enrichment plots, we found 30-fold enrichment of MS SNPs for different levels of association with LDL and TG SNPs, with a corresponding reduction in conditional false discovery rate (FDR). We identified 133 pleiotropic loci outside the extended major histocompatibility complex with conditional FDR < 0.01, of which 65 are novel. These pleiotropic loci were located on 21 different chromosomes. Our findings point to overlapping pathobiology between clinically diagnosed MS and cardiovascular risk factors and identify novel common variants associated with increased MS risk.
Multiple medication (polypharmacy) and chronic kidney disease in patients aged 60 and older: a pharmacoepidemiologic perspective
Authors: Sutaria Ankit , Liu Longjian , Ahmed Ziauddin 
Published: February 2016

Background: Few studies have examined whether there was an independent association between multiple medication use and risk of chronic kidney disease (CKD), with adjustment for cardiometabolic factors. In the study, we aimed to examine this association using a nationally representative sample in CKD patients aged 60 and older. Methods: In the study, subjects aged ⩾60 years ( n = 1306) who participated in the 2011–2012 National Health and Nutrition Examination Survey were analyzed cross-sectionally. CKD was defined using the CKD Epidemiology Collaboration (CKD-EPI) equation i.e. estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. Patients with multiple medications were classified as those having five or more prescription medications per day. All data analysis was performed using SAS 9.3 version. Results: The prevalence of CKD among age group ⩾80 years, age group 70–79 years and age group 60–69 years were 73.26%, 55.76% and 27.03% respectively ( p < 0.001). About half of hypertension (HTN) and diabetic patients aged ⩾60 years had CKD. The prevalence of CKD in patients with cardiovascular disease (CVD) was 60.57%. The logistic regression model without adjustment reflects that those on multiple medications (⩾5 medications/day) had 1.53 (1.02–2.31) times as likely (53% increase) to have CKD compared with those on <5 medications/day. After adjustment for age, CVD, HTN and diabetes mellitus (DM), the odds of CKD for multiple medications appeared to have a protective effect, although it did not reach statistical significance. The adjusted odds ratio [95% confidence interval (CI)] was 0.89 (95% CI: 0.60–1.34); it showed an 11% decreased odds of CKD in patients who were taking multiple medications. The adjusted odds ratio for patients with CVD was 1.38 (95% CI: 0.97–1.98), HTN 1.13 (95% CI: 0.80–1.6), DM 1.78 (95% CI: 1.26–2.51) in age group 70–79 years 3.2 (95% CI: 2.1–4.87) and in age ⩾80 years 6.98 (95% CI: 4.02–12.11) compared with age group 60–69 years old, respectively. Conclusion: We did not find significant independent association between use of multiple medications and CKD. The switchover of odds for multiple medication suggested a confounding effect of covariates; further prospective studies are required to find the individualized effect of multiple medications on CKD.
Pen Devices for Insulin Self-Administration Compared With Needle and Vial
Authors: Lasalvia Pieralessandro , Barahona-Correa Julián Esteban , Romero-Alvernia Diana Marcela , Gil-Tamayo Sebastián , Castañeda-Cardona Camilo , Bayona Juan Gabriel , Triana Juan José , Laserna Andrés Felipe , Mejía-Torres Miguel , Restrepo-Jimenez Paula , Jimenez-Zapata Juliana , Rosselli Diego 
Published: February 2016

Objectives: Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS. Methods: A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done. Results: In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36. Conclusions: There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.
Hypoglycemia-Associated EEG Changes in Prepubertal Children With Type 1 Diabetes
Authors: Hansen Grith Lærkholm , Foli-Andersen Pia , Fredheim Siri , Juhl Claus , Remvig Line Sofie , Rose Martin H. , Rosenzweig Ivana , Beniczky Sándor , Olsen Birthe , Pilgaard Kasper , Johannesen Jesper 
Published: February 2016

Background: The purpose of this study was to explore the possible difference in the electroencephalogram (EEG) pattern between euglycemia and hypoglycemia in children with type 1 diabetes (T1D) during daytime and during sleep. The aim is to develop a hypoglycemia alarm based on continuous EEG measurement and real-time signal processing. Method: Eight T1D patients aged 6-12 years were included. A hyperinsulinemic hypoglycemic clamp was performed to induce hypoglycemia both during daytime and during sleep. Continuous EEG monitoring was performed. For each patient, quantitative EEG (qEEG) measures were calculated. A within-patient analysis was conducted comparing hypoglycemia versus euglycemia changes in the qEEG. The nonparametric Wilcoxon signed rank test was performed. A real-time analyzing algorithm developed for adults was applied. Results: The qEEG showed significant differences in specific bands comparing hypoglycemia to euglycemia both during daytime and during sleep. In daytime the EEG-based algorithm identified hypoglycemia in all children on average at a blood glucose (BG) level of 2.5 ± 0.5 mmol/l and 18.4 (ranging from 0 to 55) minutes prior to blood glucose nadir. During sleep the nighttime algorithm did not perform. Conclusions: We found significant differences in the qEEG in euglycemia and hypoglycemia both during daytime and during sleep. The algorithm developed for adults detected hypoglycemia in all children during daytime. The algorithm had too many false alarms during the night because it was more sensitive to deep sleep EEG patterns than hypoglycemia-related EEG changes. An algorithm for nighttime EEG is needed for accurate detection of nocturnal hypoglycemic episodes in children. This study indicates that a hypoglycemia alarm may be developed using real-time continuous EEG monitoring.
Pediatric Return to Sports After Spinal Surgery
Authors: Christman Tyler , Li Ying 
Published: February 2016

Context: Pediatric patients who undergo spinal surgery are frequently involved in sporting activities. Return to play is often an important postoperative concern for the patient and family. Evidence Acquisition: A PubMed search was conducted for articles in the English language on return to play after treatment of pediatric acute disc herniation, degenerative disc disease, spondylolysis, spondylolisthesis, and scoliosis from 1980 to 2015. Reference lists were reviewed for additional pertinent articles. We included articles that focused on return to sports after surgical treatment of these conditions in this review. Study Design: Clinical review. Level of Evidence: Level 4. Results: There are no published guidelines, and most of the literature in this area has focused on return to play after spinal injury rather than after spinal surgery. Most children and adolescents have excellent outcomes with minimal pain at 1 year after lumbar discectomy. The majority of surgeons allow return to full activity once pain-free range of motion and strength are regained, typically at 8 to 12 weeks postoperatively. Pediatric patients with spondylolysis have good outcomes after direct pars repair. Satisfactory outcomes have been demonstrated after fusion for low- and high-grade spondylolisthesis. Most surgeons allow return to noncontact sports by 6 months after surgical treatment of spondylolysis and spondylolisthesis. Return to contact and collision sports is controversial. After posterior spinal fusion for scoliosis, most surgeons allow return to noncontact sports by 3 months and return to contact sports between 6 months and 1 year. Return to collision sports is controversial. Conclusion: There is little evidence to guide practitioners on return to sports after pediatric spinal surgery. Ultimately, the decision to allow any young athlete to resume sports participation after spinal injury or surgery must be individualized.
Course Setting as a Prevention Measure for Overuse Injuries of the Back in Alpine Ski Racing
Authors: Spörri Jörg , Kröll Josef , Fasel Benedikt , Aminian Kamiar , Müller Erich 
Published: February 2016

Background: A combination of frontal bending, lateral bending, and torsion in the loaded trunk has been suggested to be a mechanism leading to overuse injuries of the back in Alpine ski racing. However, there is limited knowledge about the effect of course setting on the aforementioned back-loading patterns. Purpose: To investigate the effect of increased gate offset on the skier’s overall trunk kinematics and the occurring ground-reaction forces and to compare these variables between the competition disciplines giant slalom (GS) and slalom (SL). Study Design: Controlled laboratory study. Methods: Ten top-level athletes were divided into GS and SL groups. Both groups performed a total of 240 GS and 240 SL turns at 2 different course settings. The overall trunk movement components (frontal bending, lateral bending, and torsion angle) were measured using 2 inertial measurement units fixed on the sacrum and sternum. Total ground-reaction forces were measured by pressure insoles. Results: In SL, ground-reaction force peaks were significantly lower when the gate offset was increased, while in GS, no differences between course settings were observed. During the turn phase in which the highest spinal disc loading is expected to occur, the back-loading patterns in both GS and SL included a combination of frontal bending, lateral bending, and torsion in the loaded trunk. SL was characterized by shorter turns, lower frontal and lateral bending angles after gate passage, and a trend toward greater total ground-reaction force peaks compared with GS. Conclusion: Course setting is a reasonable measure to reduce the skier’s overall back loading in SL but not in GS. The distinct differences observed between GS and SL should be taken into account when defining discipline-specific prevention measures for back overuse injuries. Clinical Relevance: To reduce the magnitude of the overall back loading, in SL, minimal gate offsets should be avoided. Prevention measures in GS might particularly need to control and/or reduce the magnitude of frontal and lateral bending in the loaded trunk, whereas prevention measures in SL might especially need to mitigate the short and high total ground-reaction force peaks.
Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy
Authors: Ogawa Hiroyasu , Matsumoto Kazu , Ogawa Takahiro , Takeuchi Kentaro , Akiyama Haruhiko 
Published: February 2016

Background: Medial opening wedge high tibial osteotomy (HTO) is a well-established surgery for medial compartment knee osteoarthritis (OA) wherein the lower extremity is realigned to shift the load distribution from the medial compartment of the knee to the lateral compartment. However, this surgery is known to affect the posterior tibial slope angle (PTSA), which could lead to abnormal knee kinematics and instability, and eventually to knee OA. Although PTSA control is as important as coronal realignment, few appropriate measurements for this parameter have been reported. The placement of a wedge spacer might have an effect on PTSA. Purpose: To elucidate the relationship between the PTSA and the direction of insertion of a wedge spacer. Study Design: Case series; Level of evidence, 4. Methods: This study assessed 43 knees from 34 patients who underwent medial opening wedge HTO for knee OA. Pre- and postoperative lateral radiographs of the knee as well as postoperative computed tomography scans were performed to evaluate the relationship among PTSA, wedge insertion angle (WIA), and opening gap ratio (distance of the anterior opening gap/distance of the posterior opening gap at the osteotomy site). Results: The PTSA significantly increased from 9.0° ± 2.8° preoperatively to 13.2° ± 4.1° postoperatively ( P < .001), resulting in a mean ΔPTSA of 4.7° ± 4.5°. The mean opening gap ratio was 0.86 ± 0.11, and the mean WIA was 25.9° ± 8.4°. The WIA and opening gap ratio were both highly correlated with ΔPTSA ( r = 0.71 and 0.72, respectively), implying that a smaller WIA or smaller gap ratio leads to less increase in posterior slope. Conclusion: The direction of wedge insertion is highly correlated with PTSA increase, which suggests that the PTSA can be controlled for by adjusting the direction of wedge insertion during surgery. Clinical Relevance: Study results suggest that it is possible to adjust the PTSA by controlling the WIA during surgery. Proper attention to WIA can avoid an iatrogenic increase in posterior tibial slope.
Assessment of Intraoperative Intra-articular Morphine and Clonidine Injection in the Acute Postoperative Period After Hip Arthroscopy
Authors: Cogan Charles J. , Knesek Michael , Tjong Vehniah K. , Nair Rueben , Kahlenberg Cynthia , Dunne Kevin F. , Kendall Mark C. , Terry Michael A. 
Published: February 2016

Background: Previous authors have suggested that intra-articular morphine and clonidine injections after knee arthroscopy have demonstrated equivocal analgesic effect in comparison with bupivacaine while circumventing the issue of chondrotoxicity. There have been no studies evaluating the effect of intra-articular morphine after hip arthroscopy. Purpose: To evaluate the efficacy of intra-articular morphine in combination with clonidine on postoperative pain and narcotic consumption after hip arthroscopy surgery for femoroacetabular impingement. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed on 43 patients that underwent hip arthroscopy for femoroacetabular impingement at a single institution between September 2014 and May 2015. All patients received preoperative celecoxib and acetaminophen, and 22 patients received an additional intra-articular injection of 10 mg morphine and 100 μg of clonidine at the conclusion of the procedure. Narcotic consumption, duration of anesthesia recovery, and perioperative pain scores were compared between the 2 groups. Results: Patients who received intra-articular morphine and clonidine used significantly less opioid analgesic (mEq) in the postanesthesia recovery (median difference, 17 mEq [95% CI, –32 to –2 mEq]; P = .02) compared with the control group. There were no differences in time spent in recovery before hospital discharge or in visual analog pain scores recorded immediately postoperatively and at 1 hour after surgery. Conclusion: Intraoperative intra-articular injection of morphine and clonidine significantly reduced the narcotic requirement during the postsurgical recovery period after hip arthroscopy. The reduction in postsurgical opioids may decrease adverse effects, improve overall pain management, and lead to better quality of recovery and improved patient satisfaction.
Fibrin deposition following bile duct injury limits fibrosis through an αMβ2-dependent mechanism
Authors: Joshi Nikita , Kopec Anna K. , Ray Jessica L. , Cline-Fedewa Holly , Nawabi Atta , Schmitt Timothy , Nault Rance , Zacharewski Timothy R. , Rockwell Cheryl E. , Flick Matthew J. , Luyendyk James P. 
Published: February 2016

Key Points
Fibrin engagement of leukocyte integrin-αMβ2 restricts bile duct hyperplasia and inhibits periductal fibrosis. Periductal fibrosis following bile duct injury is inhibited by leukadherin-1, an allosteric activator of integrin-αMβ2 fibrin binding.