bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship Between Kyphotic Posture and Falls in Community-Dwelling Men and Women
Authors: Tominaga Ryoji , Fukuma Shingo , Yamazaki Shin , Sekiguchi Miho , Otani Koji , Kikuchi Shin-ichi , Sasaki Sho , Kobayashi Susumu , Fukuhara Shunichi , Konno Shin-ichi 
Published: April 2016

Study Design.
A cohort study using data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study, a population-based prospective cohort study of residents of the towns of Tadami and Minamiaizu in Fukushima Prefecture, Japan.

Objective.
The aim of this study was to clarify the association between kyphotic posture and falls, and to investigate the presence or absence of sex differences.

Summary of Background Data.
In our literature review, we found no studies focusing on sex differences in the association between kyphotic posture and falls.

Methods.
We included subjects aged more than 40 years who participated in annual health check-ups from 2009 to 2010. We analyzed the effects of kyphotic posture, measured using the wall-occiput test (WOT), on falls, adjusting for potential confounders, such as age, body mass index, symptoms of depression, sedative medication, and other comorbidities.

Results.
We enrolled a total of 1418 subjects into primary analyses (593 men, 825 women; mean [standard deviation] age, 68.1 [7.7] yrs). We then stratified subjects into the following groups according to the degree of kyphotic posture: nonkyphotic posture (n = 1138, 80.3%), mild kyphotic posture (n = 172, 12.1%), and severe kyphotic posture (n = 108, 7.6%). We observed no significant difference in the severity of kyphotic posture between men and women (P = 0.18). Overall, 284 subjects (20.0%) experienced at least one fall during the one-year period. After adjustment for potential confounders using a logistic regression model, we observed a significant association between severe kyphotic posture and falls for men [odds ratio (OR) 2.14 (1.01–4.57); P = 0.048]. In contrast, we observed no significant association for women [OR for severe kyphotic posture 0.80 (0.43–1.50), OR for mild kyphotic posture 0.91 (0.53–1.57)].

Conclusion.
We identified a sex difference in the association between kyphotic posture and falls in community-dwelling adults. In particular, severe kyphotic posture might only increase the incidence of falls in men.

Level of Evidence: 3
Atlantoaxial Fusion: Sixteen Years of Epidemiology, Indications, and Complications in New York State
Authors: Derman Peter B. , Lampe Lukas P. , Lyman Stephen , Kueper Janina , Pan Ting Jung , Girardi Federico P. , Albert Todd J. , Hughes Alexander P. 
Published: April 2016

Study Design.
A retrospective state database analysis.

Objective.
The aim of this study was to describe the epidemiology and complications of as well as indications for primary isolated atlantoaxial fusion.

Summary of Background Data.
Atlantoaxial fusion involves unique indications, techniques, and complications. There is limited epidemiologic literature focused specifically on this procedure.

Methods.
New York's Statewide Planning and Research Cooperative System database, an all-payer hospitalization reporting system, was queried to identify all patients undergoing primary isolated atlantoaxial fusion in the state from 1997 to 2012. Demographic and clinical data were extracted and analyzed. United States Census Bureau figures were used to calculate population-adjusted surgical rates.

Results.
One thousand five hundred fifty-nine patients underwent isolated primary atlantoaxial fusion during the study period. The overall population-adjusted annual surgical rate did not change significantly over time. By 2012, individuals aged ≥70 years had the highest incidence of surgery [2.37 per 100,000 population; 95% confidence interval (95% CI) 1.68–3.07]. Medicare was the most common payer (44.0% of claims). Approximately 85% of patients had a Charlson/Deyo Comorbidity Index of zero or one. Over time, a significantly lower proportion of atlantoaxial fusions were attributable to rheumatic disease, and a significantly higher proportion were due to fracture. By 2012, management of fractures was the most common indication for C1-C2 fusion (44.1% of cases). Dysphagia or dysphonia occurred after 0.8% of cases, dural tear after 0.3%, infection after 0.5%, and seroma, hematoma, or hemorrhage after 0.5%. In-hospital mortality was 2.7%, of which 76% had fracture as the surgical indication.

Conclusion.
Isolated atlantoaxial fusions have been performed at a stable, low level over the past 16 years in New York. Although most of these patients are relatively healthy pre-operatively, approximately one in 10 experience an in-hospital complication and nearly 3% die in-hospital. Knowledge of these risks will hopefully spur further efforts to minimize them and allow for more accurate counseling of patients and their families.

Level of Evidence: 4
Analysis of Segmental Mobility Following a Novel Posterior Apical Short-Segment Correction for Adolescent Idiopathic Scoliosis
Authors: Hosseini Pooria , Nnadi Colin , Rehák Ľuboš , Repko Martin , Grevitt Michael , Aydinli Ufuk , Carl Allen , Pawelek Jeff , Crandall Dennis , Akbarnia Behrooz A. 
Published: April 2016

Study Design.
A prospective, nonrandomized, multicenter study.

Objectives.
The purpose of this study was to evaluate the amount of motion present at instrumented but unfused segments and at motion segments adjacent to the instrumentation following application of a new posterior apical short-segment correction technique for correcting adolescent idiopathic scoliosis (AIS).

Summary of Background Data.
High-density pedicle screw instrumentation and posterior arthrodesis of all instrumented levels is the most common surgical treatment for AIS stabilization. The consequence of long fusion is an abnormal load on adjacent levels with an increased risk of future adjacent segment degeneration.

Methods.
This new system applied translational and derotational forces over a short apical segment. The short apical region was prepared for fusion while maintaining motion of unfused vertebral segments. Radiographic data were collected pre-operatively, at surgery, and at 3, 6, and 12 months after surgery.

Results.
Twenty-one female patients, mean age of 14.2 years (10.6–16.9 years) with Lenke 1A/1B curves, were enrolled. The range of motion in the unfused instrumented segment was significantly higher than the apical fused segment (11 vs. 0.9, P < 0.001). The range of motion of unfused vertebral levels distal to the construct at one year did not differ significantly from their respective pre-op values. When the analysis was extended to understand the impact of lower instrumented vertebra (LIV) on motion of unfused segments distal to the construct, it appeared that (1) the change in motion from pre-op to 12 months post-op as a function of LIV is not statistically significant; and (2) The motion of the unfused distal vertebral segments at 12 months does not statistically increase with a lower LIV.

Conclusion.
Through one year, this novel technique achieved and maintained similar AIS correction to current posterior fusion techniques while maintaining the mobility of unfused motion segments with less implant density.

Level of Evidence: 4
Fontan Fenestration Closure Prior to Posterior Spinal Fusion in Patients With Single-Ventricle Heart Disease
Authors: Schwartz Matthew C. , Nykanen David , Fleishman Craig , Munro Hamish M. , Phillips Jonathan , Knapp Raymond D. , Felix Donald 
Published: April 2016

Study Design.
Case series.

Objective.
To describe transcatheter closure of the Fontan fenestration prior to posterior spinal fusion in two children to prevent paradoxical venous air embolism during the operation.

Summary of Background Data.
Scoliosis is common among patients with single-ventricle congenital heart disease who have undergone Fontan operation and spinal surgery can offer physiologic benefits. Venous air embolism is a rare, but important reported complication during spinal surgery performed in the prone position. Patients with Fontan circulation can have significant right to left shunting via a patent Fontan fenestration that can increase the risk of paradoxical systemic embolization of any entrained venous air.

Methods.
We retrospectively reviewed the charts of two patients with single-ventricle congenital heart disease who had undergone fenestrated Fontan operation and underwent transcatheter fenestration closure prior to spinal fusion.

Results.
Two patients with Fontan circulation underwent successful transcatheter fenestration closure with Amplatzer Ductal Occluder II devices. Five to 6 months after closure, both underwent uncomplicated posterior spinal fusion.

Conclusion.
Transcatheter closure of the Fontan fenestration prior to spinal fusion in two with Fontan circulation and scoliosis is a rare, but important indication for fenestration closure that warrants emphasis.

Level of Evidence: N/A
Potential Involvement of Obesity-Associated Chronic Inflammation in the Pathogenesis of Idiopathic Spinal Epidural Lipomatosis
Authors: Fujita Nobuyuki , Hosogane Naobumi , Hikata Tomohiro , Iwanami Akio , Watanabe Kota , Shiono Yuta , Okada Eijiro , Ishikawa Masayuki , Tsuji Takashi , Shimoda Masayuki , Horiuchi Keisuke , Nakamura Masaya , Matsumoto Morio , Ishii Ken 
Published: April 2016

Study Design.Multicenter case-control study.Objective.To characterize the pathogenesis of idiopathic spinal epidural lipomatosis (SEL).Summary of Background Data.SEL is often associated with the history of steroid use or endocrine disorders; however, the pathogenesis of idiopathic SEL remains poorly understood.Methods.Sixteen patients who underwent lumbar decompression surgery due to severe idiopathic SEL were included in the study (L group, 15 men and 1 woman; mean age, 71.5 yrs). Fifteen patients without SEL, who underwent decompression surgery for lumbar canal stenosis, were selected as controls (C group, 14 men and 1 woman; mean age, 70.3 yrs). The following parameters were analyzed in these two groups: body mass index (BMI), medical history, histology, the size of adipocytes in the epidural fat (EF) tissues, and the expression level of the transcripts for adiponectin, leptin, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8.Results.The mean BMI of the L group was significantly higher than that of the C group (29.1vs.25.2 kg/m2,P = 0.006), and there was a significant correlation between BMI and the width of EF in both groups. The average adipocyte size in the EF was significantly larger in the L group than in the C group (2846.8vs.1699.0 μm2,P = 0.017). Furthermore, the expression levels of the transcripts for TNF-α and IL-1β in the L group were significantly higher than those in the C group [2.59-fold increase (P = 0.023) and 2.60-fold increase (P = 0.015), respectively].Conclusion.Our data suggest that the pathogenesis of idiopathic SEL is associated with obesity. In addition, the increased expression of two major inflammatory cytokines in the EF in the L group may indicate that SEL is causally related to chronic inflammation.Level of Evidence:3
Preventive Effect of Dynamic Stabilization Against Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion
Authors: Tachibana Naohiro , Kawamura Naohiro , Kobayashi Daiki , Shimizu Takaki , Sasagawa Takeshi , Masuyama Shigeru , Hirao Yujiro , Kunogi Junichi 
Published: April 2016

Study Design.
Retrospective cohort study.

Objective.
To investigate the effects of dynamic stabilization with sublaminar taping (ST) on the upper segment adjacent to posterior lumbar interbody fusion (PLIF).

Summary of Background Data.
Hybrid procedures such as dynamic stabilization for adjacent segment in addition to spinal fusion have been developed for reduction of the mechanical stress and prevention of adjacent segment pathology (ASP). However, a few reports are available on hybrid procedures and their efficacy is still controversial.

Methods.
Of the 116 patients who underwent L4/5 PLIF between August 2006 and September 2012, 76 patients with minimum 2-year follow up were included in this study. Fifty three patients underwent L4/5 PLIF with hybrid procedure using ST on L3 lamina (group U), and 23 patients underwent conventional L4/5 PLIF (group C). The adjacent segment degeneration (ASDeg) was determined by measurements of radiograph, computed tomography, and magnetic resonance imaging; the adjacent segment disease (ASDis) was evaluated on medical records.

Results.
The incidence of ASDeg at L3/4 segment of group U (3.7%) was significantly less than that of group C (30.4%) (P = 0.003), although there were no significant differences at L2/3 (group U, 7.5%; group C, 13%) or L5/S1 segment (group U, 5.7%; group C, 8.7%). On the other hand, no significant difference was found between two groups in the incidence of ASDis in L2/3 to L5/S1 levels, and no patient underwent reoperation. Bivariable and multivariable logistic regression analyses for L3/4 segment ASDeg revealed that the difference of surgical procedure was the only significant factor.

Conclusion.
The current study showed that L4/5 PLIF with hybrid procedure using ST on L3 lamina significantly reduced the incidence of L3/4 ASDeg as compared with the conventional L4/5 PLIF without compromising L2/3 or L5/S1 segment. Although further studies and longer follow up are necessary, the hybrid procedure is expected to be effective for preventing ASP.

Level of Evidence: 4
Entrapment of the Flexor Digitorum Profundus in the Callus after a Closed Distal Radial Fracture
Authors: Thione Alessandro , Cavadas Pedro C. , Rubi Carlo G. 
Published: April 2016

Summary:
A 17-year-old boy sustained a closed distal radius fracture; a closed reduction and external fixation was performed. After failed rehabilitation for digital flexion restriction, a surgical exploration was decided, revealing entrapment of flexor digitorum profundus in the bony callus; tendons were freed, obtaining a full range of motion.
A Prospective Comparison of Noninvasive Methods in the Assessment of Liver Fibrosis and Esophageal Varices in Pediatric Chronic Liver Diseases
Authors: Voutilainen Silja , Kivisaari Reetta , Lohi Jouko , Jalanko Hannu , Pakarinen Mikko P. 
Published: April 2016

Goals and Background:
We compared liver stiffness (LS), the aspartate aminotransferase-to-platelet ratio index (APRi), and the platelet-to-spleen size z score ratio (P/SZC) in the prediction of liver fibrosis and esophageal varices in children.

Study:
LS, APRi, SZC, and P/SZC were prospectively determined in 99 unselected consecutive children, who underwent liver biopsy for the follow-up of chronic liver disorders. LS was assessed by transient elastography. The spleen size was evaluated as the SD from age-specific and gender-specific normative values. Varices were assessed endoscopically (n=64). Biopsies were staged according to Metavir.

Results:
The median patient age was 6.0 (interquartile range, 1.8 to 12.9) years. Underlying diagnoses included intestinal failure (n=31), biliary atresia (n=24), and others (n=44). LS showed the strongest correlation with the fibrosis stage (r=0.639, P<0.001) compared with P/SZC (r=−0.427, P=0.003), APRi (r=0.419, P=0.001), or SZC (r=0.396, P=0.004). LS clearly performed the best in predicting fibrosis with area under the receiver operator curve (AUROC) values of 0.789 [95% confidence interval (CI), 0.698-0.879; P<0.001] for any (Metavir≥1), and 0.831 (95% CI, 0.745-0.918; P<0.001) for significant (Metavir≥2) fibrosis. For the prediction of the presence of esophageal varices, APRi had a higher AUROC of 0.832 (95% CI, 0.730-0.934; P<0.001), when compared with LS, SZC, or P/SZC with AUROCs of 0.818 (95% CI, 0.706-0.930; P<0.001), 0.795 (95% CI, 0.683-0.904; P=0.001), and 0.760 (95% CI, 0.610-0.909; P=0.004), respectively.

Conclusions:
LS performed the best in predicting liver fibrosis, whereas APRi had the highest predictive accuracy for esophageal varices. An LS value over 7.7 kPa identified significant liver fibrosis with high accuracy, whereas low APRi ascertained the absence of esophageal varices.
MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules
Authors: Qian Haizhen , Li Shihong , Ji Ming , Lin Guangwu 
Published: April 2016

Purpose
To compare the MRI findings of benign and malignant solitary hypovascular hepatic nodules and identify the differentiating features.

Materials and methods
A total of 135 patients with solitary hypovascular hepatic lesions up to 3 cm (mass forming intrahepatic cholangiocarcinoma, n=29; metastases, n=26; inflammatory pseudotumors and solitary necrotic nodule, n=48; and hemangioma, n=32) were assessed. MRI findings were analyzed, and lesions were scored for peripheral and intratumoral appearance and enhancement patterns.

Results
Univariate and multivariate analyses showed that the most common findings for benign lesions were subcapsular, sharp margin, homogeneous, marked high signal on T2WI, mild hyperintensity on T2WI, increasing intensity of peripheral globular enhancement, and persistent central septum-like linear enhancement on delayed phase (P<0.05). An area under the curve of 0.955 was obtained for differentiating malignant from benign nodules using the combined imaging features of ill-defined margins, heterogeneity, decreasing intensity of peripheral rim-like enhancement, and central increasing intensity of patchy enhancement. Interobserver agreement was good, ranging from 0.72 to 1.00.

Conclusion
MRI may be a useful noninvasive method for determining whether hypovascular hepatic nodules are malignant or benign.
Aluminum and Phthalates in Calcium Gluconate
Authors: Yokel Robert A. , Unrine Jason M. 
Published: April 2016

ABSTRACTBackground:Aluminum contamination of parenteral nutrition solutions has been documented for 3 decades. It can result in elevated blood, bone, and whole body aluminum levels associated with neurotoxicity, reduced bone mass and mineral content, and perhaps hepatotoxicity. The primary aluminum source among parenteral nutrition components is glass‐packaged calcium gluconate, in which aluminum concentration in the past 3 decades has averaged approximately 4000 μg/L, compared with <200 μg/L in plastic container‐packaged calcium gluconate. A concern about plastic packaging is leaching of plasticizers, including phthalates, which have the potential to cause endocrine (male reproductive system) disruption and neurotoxicity.Methods:Aluminum was quantified in samples collected periodically for more than 2 years from 3 calcium gluconate sources used to prepare parenteral nutrition solutions; 2 packaged in glass (from France and the United States) and 1 in plastic (from Germany); in a recently released plastic‐packaged solution (from the United States); and in the 2 glass containers. Phthalate concentration was determined in selected samples of each product and leachate of the plastic containers.Results:The initial aluminum concentration was approximately 5000 μg/L in the 2 glass‐packaged products and approximately 20 μg/L in the plastic‐packaged product, and increased approximately 30%, 50%, and 100% in 2 years, respectively. The aluminum concentration in a recently released Calcium Gluconate Injection USP was approximately 320 μg/L. Phthalates were not detected in any calcium gluconate solutions or leachates.Conclusions:Plastic packaging greatly reduces the contribution of aluminum to parenteral nutrition solutions from calcium gluconate compared with the glass‐packaged product.
Pediatric Irritable Bowel Syndrome Patient and Parental Characteristics Differ by Care Management Type
Authors: Hollier John M. , Czyzewski Danita I. , Self Mariella M. , Weidler Erica M. , Smith E. O'Brian , Shulman Robert J. 
Published: April 2016

ABSTRACTObjectives:This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS).Methods:A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assembled from a single metropolitan health care system. Baseline socioeconomic status (SES) and clinical symptom measures were gathered. Various instruments measured participant and parental psychosocial traits. Study outcomes were stratified by GI referral versus primary pediatrics care. Two separate analyses of SES measures and GI clinical symptoms and psychosocial measures identified key factors by univariate and multiple logistic regression analyses. For each analysis, identified factors were placed in unadjusted and adjusted multivariate logistic regression models to assess their impact in predicting GI referral.Results:Of the 239 participants, 152 were referred to pediatric GI, and 87 were managed in primary pediatrics care. Of the SES and clinical symptom factors, child self‐assessment of abdominal pain duration and lower percentage of people living in poverty were the strongest predictors of GI referral. Among the psychosocial measures, parental assessment of their child's functional disability was the sole predictor of GI referral. In multivariate logistic regression models, all selected factors continued to predict GI referral in each model.Conclusions:Socioeconomic environment, clinical symptoms, and functional disability are associated with GI referral. Future interventions designed to ameliorate the effect of these identified factors could reduce unnecessary specialty consultations and health care overutilization for IBS.
Clinical Characteristics Associated With Treatment-Resistant Bipolar Disorder
Authors: Parker Gordon B. , Graham Rebecca K. 
Published: April 2016

Abstract
There has been limited consideration and empirical studies on treatment-resistant bipolar disorder (TRBD). This exploratory study was designed to identify factors contributing to TRBD in patients with a bipolar (I or II) disorder. Patients were categorized with “low,” “medium,” or “high” levels of treatment resistance based on a) the total number of psychiatric medications received and, for a second analysis, b) the number of mood stabilizer medications received. The study identified a number of factors associated with TRBD, such as being female and older and having an older age at illness onset, a higher incidences of family depression, less likelihood of being in paid employment, a higher number of lifetime stressors, medical conditions and comorbid anxiety disorders, a different personality and temperament profile, and more regular use of benzodiazepines. There were few factors associated with TRBD when defined by number of mood stabilizers trialed. Potential explanations for these findings were explored.
Personal Recovery as a Protective Factor Against Suicide Ideation in Individuals With Schizophrenia
Authors: Jahn Danielle R. , DeVylder Jordan E. , Drapalski Amy L. , Medoff Deborah , Dixon Lisa B. 
Published: April 2016

Abstract
Suicide rates are elevated in individuals with schizophrenia, yet evidence is mixed regarding the roles of positive and negative symptoms as risk factors for suicide in this population, suggesting that there may be other influential variables. One such variable may be personal recovery. Therefore, the purpose of this study was to test the hypothesis that personal recovery would moderate the relationship between symptoms of schizophrenia and suicide ideation. This hypothesis was tested in a sample of 169 individuals diagnosed with schizophrenia or schizoaffective disorder using a Poisson regression model. Results suggested that there was no significant interaction between recovery and symptoms of schizophrenia. However, recovery was a significant predictor of suicide ideation after controlling for psychiatric symptoms. These findings indicate that recovery is associated with lower suicide ideation and thus may protect against it. Thus, recovery should be assessed, and potentially intervened upon, to reduce suicide risk in individuals with schizophrenia.