bluuebunny/crossref_metadata_2025_split huggingface dataset:
The combined effect of indoor climate and psychosocial stressors on subsequent headaches: A prospective study of the general working population in Norway
Authors: Moazami Therese Nitter , Sterud Tom 
Published: October 2024

This prospective panel study explores the link between indicators of poor indoor climate and psychosocial stressors in the work environment with subsequent headaches. A random sample of the Norwegian working population (18 to 66 years) was examined, using self-reported health symptoms and work exposures collected in 2009, 2013 and 2016. This study included repeated measurements of 6681 workers attending at least two consecutive interviews (16,493 observations). The results were analysed using generalized estimating equations (GEEs), adjusting for sex, birth year, occupation, education, baseline mental health and the presence of headache at baseline. Headaches were prevalent in 25.4% of cases, with odds ratios (ORs) increasing with poor indoor climate (ORcontinuous = 1.14, 95% CI: 1.08–1.19) and number of psychosocial stressors (ORcontinuous = 1.09, 95% CI: 1.04–1.14). The OR amongst individuals concurrently exposed to both poor indoor climate and psychosocial stressors was 1.49 (95% CI: 1.26–1.75). Approximately one in five headache cases were attributable to this combined exposure. Measures implemented to reduce the prevalence of headaches in the work environment should consider the combined impact of a poor indoor climate and psychosocial stressors.
Management of Giant Type II Arteriovenous Malformation of the Neck With Heart Failure in a Pediatric Patient With Coil and NLE Embolization: A Case Report
Authors: Funaki Anna , Mori Hideki , Onozawa Shiro , Ouchi Kunie , Takara Yuki , Hitomi Suguru , Takata Hidemi , Tozawa Asami , Izumoto Mamiko , Nakaoka Hiroki 
Published: October 2024

Purpose: Although arteriovenous malformations (AVMs) are typically benign lesions, massive ones can lead to severe complications, including heart failure. Notably, there is no standardized treatment for AVMs. Moreover, management of AVMs can be challenging when these lesions involve vital organ systems, such as the head and neck. In this report, we describe embolization of a massive cervical AVM in a pediatric patient with heart failure. Case report: A 10-year-old boy presented with severe heart failure secondary to a massive AVM in the neck (right side). Despite 3 unsuccessful arterial embolization procedures, venous embolization of the dominant outflow vein using a coil and n-butyl-2-cyanoacrylate, lipiodol, and ethanol proved effective, and symptoms, cerebral natriuretic peptide level (568-29 pg/mL), and echocardiography were significantly improved. Although residual AVM persisted in the right upper extremity for 6 months after surgery, his cardiac function remained preserved, and his activities of daily living have improved. Conclusion: Venous embolization is a valuable treatment modality for type II AVMs with a dominant outflow vein. However, considering the patient burden associated with large AVMs, multiple therapeutic interventions at appropriate intervals and long-term follow-up are important. Clinical Impact We present a pediatric patient with a type II massive arteriovenous malformation (AVM) in the neck and severe heart failure. Despite undergoing 3 arterial embolization procedures, his condition remained unchanged. However, venous embolization of the dominant outflow vein resulted in a significant improvement in symptoms. This case emphasizes the importance of considering multiple and appropriately timed therapeutic interventions, particularly for massive AVMs, to optimize patient outcomes while minimizing treatment burden.
Detection of atrial fibrillation after stroke due to large or small vessel disease: Systematic review and meta-analysis
Authors: Florentin Matilda , Sagris Dimitrios , Tasoudis Panagiotis , Korompoki Eleni , Veltkamp Roland , D’Anna Lucio , Wachter Rolf , Milionis Haralampos , Ntaios George 
Published: October 2024

Background: Emerging evidence indicates a frequent occurrence of atrial fibrillation (AF) detection among patients with established causes of ischemic stroke unrelated to AF. This systematic review and meta-analysis aimed to evaluate AF detection rates in stroke patients with large or small vessel disease, considering the AF detection modality and duration of cardiac rhythm monitoring. Aims: We conducted a comprehensive search of PubMed and Scopus databases up to 2 March 2024, to identify randomized controlled trials, non-randomized prospective studies, and retrospective studies assessing the frequency of AF detection in stroke patients with large or small vessel disease. The primary outcome of interest was the rate of AF detection. We utilized inverse-variance weights to produce the pooled prevalence (effect size (ES)) and 95% confidence interval (CI) of patients diagnosed with post-stroke AF. Summary of review: In the analysis of 14 eligible studies encompassing 4334 patients, AF was identified in 154 out of 2082 patients with strokes attributed to small or large vessel disease, yielding a pooled prevalence of 6.27% (ES; 95% confidence interval (CI): 3.18–10.17, I2 = 87.83%). Among patients with large vessel disease strokes, AF was diagnosed in 79 out of 1042 patients, accounting for a pooled prevalence of 5.07% (ES; 95% CI: 1.30–10.33, I2 = 77.05%). Similarly, among those with small vessel disease strokes, AF was detected in 75 out of 1040 patients, with a pooled prevalence of 5.03% (ES; 95% CI: 1.96–9.06, I2 = 78.05%). Conclusions: AF is often found in ischemic stroke patients with large or small vessel disease. Detection rates increase with longer cardiac rhythm monitoring. The safety and benefits of oral anticoagulation for these AF episodes are uncertain.
Competence of Senior Otolaryngology Residents with the Bedside Head Impulse Test—Has There Been Improvement After 5 Years of Competency By Design?
Authors: Lelli Danny A. , Rourke Ryan , Tse Darren 
Published: October 2024

Background The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex. It is a critical component of the bedside assessment of dizzy patients and helps differentiate acute stroke from vestibular neuritis. A previous study on senior Otolaryngology residents showed poor competence in performing and interpreting the bHIT and called for specific evaluations in the Competency By Design (CBD) curriculum to remedy this. This study aimed to assess whether those competencies have improved after full implementation of CBD in residency programs. Methods Thirty post-graduate year 4 Otolaryngology residents in Canada were evaluated on the use of the bHIT using a written multiple-choice question (MCQ) examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of bHIT performance were completed by 2 expert examiners (DT, DL) using the Ottawa Clinic Assessment Tool. Results Only 6.7% (rater DT) and 20% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was moderate (0.55, intraclass correlation). Mean scores were 70% (13.4% standard deviation) for video interpretation and 59% (20.6% standard deviation) for multiple-choice questions. Video interpretation scores did not correlate with bHIT ratings (Pearson r = 0.11), but MCQs and bHIT ratings did correlate moderately (Pearson r = 0.52). Comparing to the prior study, residents performed worse on the bHIT (3.14 average score vs 3.64, P < .01) and fewer residents performed the bHIT independently (6.7% vs 22%—rater DT, 20% vs 39%—rater DL). Residents also performed worse on MCQs (58.7% vs 70.9%, P = 0.038), though similarly on video interpretation (70% vs 65%, P = .198). Conclusion Fourth year OTL-HNS residents in Canada are not competent in performing the bHIT. These findings have implications for refining competency-based curricula in the evaluation of critical physical exam skills.
Opioid Prescribing Trends Among Workers’ Compensation Patients Undergoing Foot and Ankle Surgery
Authors: Goodwin Tyler M. , Miles Daniel T. , Murray Richard D. , Wilson Andrew W. , Doty Jesse F. 
Published: October 2024

Background The purpose of this study was to evaluate opioid usage and prescribing trends among workers’ compensation (WC) patients who underwent foot or ankle operative procedures compared with a control group. Methods A retrospective review was conducted for WC and non-WC patients who underwent foot or ankle procedures in a single academic orthopaedic surgery practice. Outcome measures were total morphine milligram equivalents (MME) and number of opioid prescriptions. Results A total of 118 patients were identified, including 51 patients in the WC group and 67 in the non-WC group. After index surgery, 67% (34 of 51) of WC patients had 2 or more additional opioid prescriptions compared to 39% (26 of 67) of non-WC patients (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.4-6.7; P = .003). Collectively, there were greater prescriptions of oxycodone MME (P = .002) and hydrocodone MME (P = .07) in the WC cohort. Conclusions Workers’ compensation patients seem to be prescribed and consume opioids at a higher rate postoperatively. It is important for treating physicians to be aware of these trends, and discussions with patients regarding expected opioid use when planning surgical intervention may be beneficial. Physicians may need to set expectations preoperatively and suggest there are limits on the amount of opioids that can safely be prescribed. Level of Evidence: Level III, Retrospective cohort study, Prognostic
Paper 17: Does Higher Quality CAM Resection Correlate with Better Patient-Reported Outcomes?
Authors: Langley Charlotte , Ma Jie , Licht Felicia , Wong Ivan 
Published: October 2024

Objectives: The relationships between CAM resection quality and patient-reported outcomes (PROs) are unknown in the literature. This study aimed to investigate the correlation of CAM resection quality with patient’s self-reported International Hip Outcome Tool (iHOT) scores collected annually post-surgery. Methods: A retrospective analysis was conducted including patients who underwent primary hip arthroscopy for femoroacetabular impingement (FAI) between 2012 and 2019. Inclusion criteria were pre-operative radiographic signs of CAM-type impingement (alpha angle > 55 °) and post-operative plain radiographs. Exclusion criteria were radiographic signs of a pincer or mixed impingement, history of femoral neck or proximal femur fracture, and treatment of concomitant hip pathologies. The following data were collected: demographic information, radiographic findings, and iHOT scores. CAM resection quality data were categorized based on findings from three plain radiographs (anteroposterior (AP) pelvis, frog leg lateral, and 45° Dunn views). High quality resections were defined as those post-operative alpha angle <55°. Results: This study included 148 participants who underwent CAM resection. From Frog leg views, 88% of patients had high-quality resections and presented superior post-operative iHOT scores compared to the 12% of patients with poor resection quality during the 1-year to 5-year follow-up period. Likewise, from Dunn views 82% of patients with a high-quality CAM resection displayed a similar trend in post-operative iHOT scores compared to 18% of patients with poor resection quality on Dunn views. However, this positive association between resection quality and post-operative iHOT scores was not evident in AP imaging. With AP views, 82% of patients with high-quality resections did not show a significant difference in iHOT scores compared to 18% of patients with poor resection quality. Conclusions: This study found that high quality CAM resection from arthroscopic surgery correlated with better iHOTs up to 5-years post-surgery from the Dunn and frog leg radiographic imaging views.
Paper 18: The Pendulum Has Swung: A 14-Year Analysis of Patients Presenting for Failed Hip Arthroscopy Shows Rising Incidence of Cam Over-Resection and Decreasing Incidence of Under-Resection
Authors: Domb Benjamin , Padilla Paulo , Kingham Yasemin , Padmanabhan Saiswarnesh , Carbone Andrew , Maldonado David 
Published: October 2024

Background: There is a paucity of literature regarding prevalence of femoral resection in the setting of revision hip arthroscopy. Few studies have examined different types of resections and their presentation. Purpose: To describe the prevalence of femoral resection types in the setting of revision hip arthroscopy for residual femoroacetabular impingement syndrome (FAIS) symptomatology. Methods: A search of the institutional prospective registry was performed for patients who presented for evaluation of failed previous arthroscopy between February 2008 and June 2022, and subsequently underwent revision arthroscopy. AP and Dunn view radiographs were reviewed from our study population. On the basis of measurements on both radiographs, patients were divided into 3 categories: overresection (OR) in which the resection measured 5% or more of the femoral head diameter, underresection (UR) in which residual CAM morphology was found (alpha angle >60°), and neutral resection, alpha angle less than 60° and no overresection. Both AP and Dunn radiographs were used to identify over- and under- resections. Results: A total of 622 hips were reviewed and measured on both AP and Dunn radiographs. Of the 622 hips, there were 373 right and 249 left hips. The average age was 33.7 ± 12.0, and the average body mass index (BMI) was 26.0 ± 5.2. Three hundred sixty-five hips were classified as UR and 265 hips as OR.  The mean prevalence rates from 2008 to 2022 for neutral resection, over-resection and under-resection were 48.1%, 20.3%, and 31.6%, respectively. The prevalence rates of UR have decreased since 2008, while prevalence rates of OR have increased concomitantly. The steadily decreasing prevalence rates of UR was negatively correlated with the increasing OR ((R=-0.829,  P<.0001), as well as with neutral resections (R=-0.735,  P=0.002). The ratio of UR to OR reversed entirely, from 4:1 in 2010, to 1: 2.3 ( P < 0.00001) in 2020. Conclusions: Amongst patients presenting for failed hip arthroscopy over the last 14 years, the pendulum has swung from under-resection towards over-resection. Indeed, as of 2020, over-resections were more than twice as common as under-resections. This may be a result of heightened awareness in FAIS, and previous literature emphasizing the risks of under-resection. As we gain increased understanding of the risks of over-resection, the findings of this study highlight the importance of achieving an anatomical spherical resection.
Paper 21: Anatomic Medial Ulnar Collateral Ligament Reconstruction with Internal Brace Augmentation in Throwing Athletes
Authors: Camp Christopher , Jurgensmeier Kevin , Boos Alex , Hintz Christian , Dines Joshua 
Published: October 2024

Objectives: Injury to the Medial Ulnar Collateral Ligament (MUCL) is a common setback experienced by many throwing athletes often requiring reconstruction with 12-18 months of rehabilitation. Current reconstructive techniques fail to anatomically restore the MUCL which may contribute to the prolonged course of rehabilitation. In recent years, we described an anatomic MUCL reconstruction with internal brace augmentation which demonstrated improved biomechanical strength when compared to the docking technique in cadaveric specimens. The purpose of this study was to evaluate the postoperative course of both amateur and professional throwing athletes that underwent anatomic MUCL reconstruction with internal brace augmentation. We hypothesized that throwers would return to the same level of play and that return to play (RTP) would be a shorter duration compared to current reported outcomes. Methods: In this surgical technique, the native MUCL is formally repaired. The graft and a suture tape are folded over a suspensory loop and secured in a socket of the medial epicondyle of the humerus to maximize tendon to bone contact. On the ulnar side, the graft and internal brace are secured proximally by two suture anchors on either side of the sublime tubercle and further secured across the sublime tubercle ridge distally to re-create the anatomic triangular insertion of the native ligament. All surgeries were performed by a single surgeon. Patient reported outcomes in addition to date of RTP, level of play, and functional outcomes were retrospectively gathered. All patients initially followed an Accelerated Rehabilitation Protocol and were converted to a Standard Paced protocol if setbacks were encountered. Results: A total of 26 baseball players underwent primary (n=23) or revision (n=3) MUCL reconstruction with the Anatomic Technique. Of these, 15 were professional and 11 were amateur athletes. 92% of throwers returned to play at a mean of 9.9 months following reconstruction. 89% were able to advance through the accelerated postoperative protocol without issues and 85% returned to the same role and level of play. Post injury KJOC scores improved from 41 to 86.9 and SANE scores improved from 32.5 to 95.5. No significant difference was identified in pre-injury versus post-reconstruction throwing velocity, ball spin rate, or horizontal/vertical ball movement. Conclusions: Anatomic reconstruction of the MUCL with internal bracing is a viable option for MUCL injuries. Advantages include increased tendon-bone contact of the reconstruction, multiple fixation points, and anatomic restoration of the MUCL. This technique allowed an expedited return to sport for these baseball athletes.
Poster 155: An Ultrasound and Clinical Evaluation in Patients Following Treatment for Proximal Humerus Fractures: Reverse Versus Anatomical Total Shoulder Arthroplasty
Authors: Gaj Eduardo , Pagnotta Susanna , Criseo Natale , Maggiori Alessandro , Forsythe Brian , Gamsarian Vahram , Mirle Vikranth , Khazi-Syed Daanish , Chang Joshua , Giallorenzi Maria Agostina , De Carli Angelo 
Published: October 2024

Objectives: Anatomic Total Shoulder Arthroplasty (ATSA) and Reverse Total Shoulder Arthroplasty (RTSA) are both viable treatment options for complex proximal humerus fractures. With its principal role as an abductor and internal rotator in a native joint, the subscapularis potentially plays an important functional and stability role postoperatively. Although less studied in RTSA, studies have found that failure of subscapularis repair is associated with anterior instability, and decreased range of motion (ROM), strength, and outcome scores following ATSA. The purpose of our study is to evaluate and compare the postoperative clinical, radiographic, and patient-reported outcomes following subscapularis reattachment in patients treated with either ATSA or RTSA. Methods: Sixty-eight consecutive patients with proximal humeral fractures were prospectively enrolled in the study between June 2015 and May 2020 (RTSA = 40; TSA = 28). Ultrasound scans of the subscapularis were performed postoperatively, and the subscapularis muscle cross-sectional area (iSMCSA) and contralateral subscapularis muscle cross-sectional area (cSMCSA) were measured. The ratio of the 2 values (iSMCSA/cSFCSA) was utilized to standardize values. Patient-reported outcomes (PROs) and ROM were evaluated at the final follow-up. Results: Demographically, there was no significant difference between age, arm dominance, surgical laterality, diabetes, or hypertension between the patient groups (Table 1). The RTSA group demonstrated higher PROs compared to TSA patients: Constant Score (p = .0007), Quick Dash (p = .0005), and ASES score (p = .09). ROM was better in the RTSA cohort, with statically significant values with internal rotation (p = .022 abduction), external rotation (p = .02 adduction and p = .01 abduction), abduction (p = 0.02), and forward flexion (p = .003). Radiographic ultrasound findings illustrated greater reduction in size of the subscapularis in the TSA cohort when compared to the contralateral, nonoperative subscapularis (40% vs 27%; p = 0.002). Reduction of subscapularis size of >35% occurred in 2 RTSA (7%) and 8 TSA patients (44%) (p = 0.01) (Table 2). Conclusions: Subscapularis repair following RTSA demonstrated better results compared to subscapularis repair following TSA, providing better PROs and ROM. Subscapularis muscle tissue decreased 50% more in the ATSA versus RTSA patients (40% vs 27%). Subscapularis condition demonstrated no correlation with functional outcome in RTSA.
Poster 182: Pain and Quality of Life Scores Following Hip Arthroscopy for Femoroacetabular Impingement are More Related to Mental Health Than Hip Pathology
Authors: Steiner Quinn , Watson Andrew , Mosiman Samuel , Spiker Andrea 
Published: October 2024

Objectives: Symptom severity in patients with femoroacetabular impingement (FAI) has been demonstrated to have a stronger association with mental health status than pathology. However, there is limited data on the relationship between mental health status and postoperative outcomes in FAI patients. This study aims to evaluate the relationship of mental health status and structural hip pathology to pain and quality of life. Methods: This was a retrospective review of patients from a single surgeon’s hip outcomes registry. Mental health status was evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Anxiety and PROMIS-Depression scores. Pain was evaluated with Single Assessment Numerical Evaluation Score for Activities of Daily Living (SANE ADL) while quality of life (QOL) was evaluated with the International Hip Outcome Tool (iHOT-12). Repeated measures mixed modeling was used to evaluate the association between hip pathology (size of labral tear, grade of chondral damage, preoperative alpha angle), pain, QOL, anxiety, and depression pre- and postoperatively. Results: A total of 337 patients were included in this study. The degree of preoperative alpha angle, intra-operative cartilage damage and size of labral tear did not influence postoperative improvements in pain or QOL (p>0.05). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (anxiety estimate: -0.608, SE (0.079), p<0.0001), (depression estimate: -0.677, SE (0.086), p<0.0001), and lower iHOT-12 scores (anxiety estimate: -0.709, SE (0.069), p<0.0001), (depression estimate: -0.706, SE (0.077), p<0.0001). These associations were seen both preoperatively and up to 2 years postoperatively. Furthermore, anxiety and depression do not appear to moderate the relationship between hip pathology and patient outcomes. Conclusions: All patients had similar improvements in pain scores and QOL following hip arthroscopy for FAI suggesting this surgery is beneficial for varying degrees of hip pathology. Additionally, preoperative anxiety and depression are associated with greater pain and decreased QOL both pre- and postoperatively regardless of the degree of hip pathology. This may suggest a need for pre- and postoperative psychological interventions in patients with anxiety and depression, and clinicians should prioritize mental health treatment at or above the level of the hip pathology itself.