bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shoulder Motion Overestimated by Mallet Scores
Authors: Lovette Madison , Chafetz Ross S. , Russo Stephanie A. , Kozin Scott H. , Zlotolow Dan A. 
Published: July 2024

Background:
Brachial plexus birth injuries (BPBI) occur in up 0.4 to 4.6 per 1000 live births. Weakness about the shoulder and development of glenohumeral joint contractures are common sequalae of BPBI. Shoulder function in children with BPBI is frequently assessed using the modified Mallet classification to evaluate upper extremity motion deficits. The purpose of this study was to assess the accuracy of the abduction, external rotation, and hand-to-mouth Mallet classification scores in children with BPBI using motion capture.

Methods:
A retrospective study of 107 children with BPBI who underwent motion capture assessment and Mallet scores on the same date were reviewed. Motion capture measurements were used to calculate humerothoracic elevation and external rotation joint angles in the abduction/hand-to-mouth and external rotation positions, respectively. The humerothoracic joint angles were converted to the corresponding Mallet scores. Discrepancies between the Mallet scores determined by clinicians and those determined by motion capture were assessed.

Results:
For abduction, 24.3% of Mallet scores were misclassified during clinical examination. Of the misclassified scores, 22 were overestimated by 1 point and 4 were underestimated by 1 point compared with motion capture. For external rotation, 72.9% of Mallet scores were misclassified during clinical examination. Only 5 patients had an HT elevation that was less than 40 degrees, with 4 of them (80%) having a Mallet hand-to-mouth score of 4. There were no differences in proportion of patients with HT elevation less than 40 degrees who had a Mallet score of 4 or a Mallet score less than 4.

Conclusions:
There was better agreement in global abduction Mallet scores compared with external rotation and hand-to-mouth Mallet scores. This difference was likely due to the complex compensatory strategies that patients employ while performing external rotation and hand-to-mouth positions. The inaccuracy of the clinically determined Mallet scores is alarming given that they are frequently utilized to assist with surgical indications and are commonly used as outcome measures.

Level of Evidence:
Level IV Case series
Recovery Trajectories of Patient-reported Outcomes After Surgery for Degenerative Cervical Myelopathy
Authors: Banerjee Anjishnu , Yang Yushan , Wang Marjorie C. , Vedantam Aditya 
Published: July 2024

Study Design:
Retrospective study.

Objective:
The aim of this study was to identify recovery trajectory clusters after surgery for degenerative cervical myelopathy (DCM), as well as to determine clinical and imaging characteristics associated with functional recovery trajectories.

Background:
Accurate prediction of postsurgical neurological recovery for the individual patient with DCM is challenging due to varying patterns of functional recovery. Latent class Bayesian models can model individual patient patterns and identify groups of patients with similar phenotypes for personalized prognostication.

Methods:
A prospective single-center study of 70 consecutive patients with DCM undergoing elective cervical spine decompression for DCM between 2010 and 2017 was performed. Outcomes were recorded using the modified Japanese Orthopedic Association (mJOA), Neck Disability Index (NDI), and the Short Form–36 Physical Component Score (SF-36 PCS) at 3, 6, 12, and 24 months. Recovery trajectories were constructed based on unsupervised Bayesian latent class modeling. Clinical and imaging predictors of recovery trajectories were also determined.

Results:
Recovery after surgery for DCM showed 3 distinct recovery trajectory clusters for each outcome. The commonest recovery trajectory was sustained improvement for the mJOA (41.1%), stagnation for the NDI (60.3%), and stability for the SF-36 PCS (46.6%). Age, duration of symptoms, and baseline disability were the strongest predictors of each recovery trajectory. Degree of cord compression, neck pain, and intramedullary T2-hyperintensity were predictive of NDI and SF-36 PCS but not mJOA recovery trajectory. Sex was associated with the NDI recovery trajectory but not SF-36 PCS and mJOA recovery trajectories.

Conclusion:
Using prospective data and a data-driven approach, we identified 3 distinct recovery trajectory clusters and associated factors for mJOA, NDI, and SF-36 PCS in the first 24 months after surgery for DCM. Our results can enhance personalized clinical prognostication and guide patient expectations at different time points after surgery for DCM.
Calcaneo-Achilles Allograft Shoulder Interposition Arthroplasty, Novel Technique for Superior Escape Post Hemiarthroplasty for Failed rTSA: A Case Report
Authors: Swenson Riley , Brahme Indraneel S. , Weatherby David J. , Cole Peter A. 
Published: July 2024

Background:
Reverse total shoulder arthroplasties have become common in orthopaedics to treat osteoarthritis in patients with rotator cuff deficiency. Complications of revision hemiarthroplasty from reverse total shoulder arthroplasty include anterosuperior escape, which is defined as a deficiency of the coracoacromial arch that allows the humeral head to migrate proximally. A 58-year-old woman, with superior escape and massive destruction of the shoulder suspensory complex after hemiarthroplasty conversion from a reverse total shoulder arthroplasty (rTSA), presented to our clinic with chronic, disabling shoulder pain.

Materials and Methods:
The patient underwent a novel salvage procedure with a calcaneo-achilles allograft fixed to the remaining glenoid through the proximal humeral shaft. The goal of this procedure was to preserve as much function in the patient’s arm as possible and reduce her chronic shoulder pain.

Results:
The patient continued to follow up in our clinic for 1 year postoperatively. She noted complete relief of pain by 6 weeks postoperatively. She also denied any neurologic symptoms in her operative extremity. Her patient-reported outcomes indicated major improvement in her preoperative symptoms.

Conclusion:
A calcaneal-achilles bone tendon allograft interposition arthroplasty may be a viable solution for failed conversion of rTSA to hemiarthroplasty or problems of end-stage arthritis with superior escape and destruction of the shoulder girdle.
Binge drinking at time of bariatric surgery is associated with liver disease, suicides, and increases long-term mortality
Authors: Alvarado-Tapias Edilmar , Martí-Aguado David , Gómez-Medina Concepción , Ferrero-Gregori Andreu , Szafranska Justyna , Brujats Anna , Osuna-Gómez Rubén , Guinart-Cuadra Albert , Alfaro-Cervelló Clara , Pose Elisa , Ventura-Cots Meritxell , Clemente Ana , Fernández-Carrillo Carlos , Contreras Cynthia , Cabezas Joaquin , López-Pelayo Hugo , Arab Juan Pablo , Argemi Josepmaria , Bataller Ramon 
Published: July 2024

Background and Aims:
Alcohol use disorder has been reported in patients undergoing bariatric procedures, but the pattern of alcohol consumption has not been evaluated. We investigated the prevalence, risk factors, and impact of binge drinking (BD) at the time of surgery and during follow-up.

Methods:
A prospective, longitudinal study of subjects undergoing bariatric surgery was included in the LABS-2 registry between 2006 and 2009. Participants with AUDIT questionnaire at the time of surgery and a minimum of 12 months follow-up were included. BD was defined as consuming ≥5 drinks on at least 1 occasion in the previous month. Liver biopsies were obtained during bariatric procedures in not all cases. Survival analysis was performed with the adjusted Cox regression model and competing risk.

Results:
A total of 2257 subjects were included, with a median follow-up of 79 months. The prevalence of BD at time of surgery was 12%, and it raised up to 23% during follow-up. Patients with BD predominantly had a binge eating disorder (OR=1.35 [95% CI: 1.04–1.76]), regularly consumed fast food [OR=1.4 (95% CI: 1.07–1.85)] and used other drugs (OR=2.65 [95% CI: 1.74–4.04]). Within liver biopsies evaluation, BD showed higher hepatic iron deposits (OR=3.00 [95% CI: 1.25–7.21]). BD at the time of surgery was associated with a higher risk of BD during follow-up (OR=10.49 [95% CI: 7.86–14.00]) and long-term mortality (HR: 3.21 [95% CI: 1.67–6.18]). Specific causes of death in these patients with BD were liver disease (p=0.020), suicide (p=0.015), neoplasms (p=0.034), and respiratory (p=0.025).

Conclusions:
The prevalence of BD in patients undergoing bariatric surgery is high and increases the risk of postoperative liver disease, suicides, and long-term mortality.
Functional connectivity associations with menstrual pain characteristics in adolescents: an investigation of the triple network model
Authors: Payne Laura A. , Seidman Laura C. , Napadow Vitaly , Nickerson Lisa D. , Kumar Poornima 
Published: July 2024

Abstract
Menstrual pain is associated with deficits in central pain processing, yet neuroimaging studies to date have all been limited by focusing on group comparisons of adult women with vs without menstrual pain. This study aimed to investigate the role of the triple network model (TNM) of brain networks in adolescent girls with varied menstrual pain severity ratings. One hundred participants (ages 13-19 years) completed a 6-min resting state functional magnetic resonance imaging (fMRI) scan and rated menstrual pain severity, menstrual pain interference, and cumulative menstrual pain exposure. Imaging analyses included age and gynecological age (years since menarche) as covariates. Menstrual pain severity was positively associated with functional connectivity between the cingulo-opercular salience network (cSN) and the sensory processing regions, limbic regions, and insula, and was also positively associated with connectivity between the left central executive network (CEN) and posterior regions. Menstrual pain interference was positively associated with connectivity between the cSN and widespread brain areas. In addition, menstrual pain interference was positively associated with connectivity within the left CEN, whereas connectivity both within the right CEN and between the right CEN and cortical areas outside the network (including the insula) were negatively associated with menstrual pain interference. Cumulative menstrual pain exposure shared a strong negative association with connectivity between the default mode network and other widespread regions associated with large-scale brain networks. These findings support a key role for the involvement of TNM brain networks in menstrual pain characteristics and suggest that alterations in pain processing exist in adolescents with varying levels of menstrual pain.
Association between perception of harm and valence of shoulder movement images with disability levels related to chronic shoulder pain
Authors: Tozzo Marcela Camargo , Reis Felipe J.J. , Alaiti Rafael Krasic , Hotta Gisele Harumi , Oliveira Anamaria Siriani de 
Published: July 2024

Abstract
Recent studies highlight an interplay between pain perception and emotional responses. This necessitates a thorough investigation into how beliefs and motivational influences respond to visual stimuli of movements. Such an analysis is crucial for understanding the extent to which these factors contribute to disability levels associated with shoulder pain. We aimed to investigate the relationship between the perception of harm and the valence in images depicting shoulder movements and determine how these perceptions are linked to disability levels associated with shoulder pain. This cross-sectional study recruited 42 individuals with chronic shoulder pain. Participants were presented with 58 shoulder movements images. Each participant evaluated these images for emotional valence and arousal using the self-assessment manikin. For every image, they provided their level of avoidance, fear, and perception of harm in a numerical scale. We measured disability levels and pain catastrophizing using the Shoulder Pain and Disability Index and the Pain Catastrophizing Scale. A direct acyclic graph was used. Multiple linear regression analysis was conducted with shoulder disability as the dependent variable and perception of harm and valence as independent variables, adjusted for the confounders catastrophizing and arousal. This analysis resulted in a significant model (F
4,37 = 11.44; adjusted R
2 = 0.547; P < 0.01). The perception of harm to shoulder movement (β = 0.11; P < 0.001; 95% confidence interval = 5.6-11.8) was significantly associated with the level of shoulder disability, whereas valence did not show a significant association (β = 0.26; P = 0.15; 95% confidence interval = 1.7-10.8). The perception of harm associated with shoulder movements images during daily activities was associated with disability. Individuals who believe that shoulder movements are harmful have greater disability.
Perceived Social Isolation Among Patients With Multiple Sclerosis Suffering From Disease-Induced Pain and Disability
Authors: KHATOONI Marzieh , DEHGHANKAR Leila , BAHRAMI Mahdie , PANAHI Rahman , HAJNASIRI Hamideh 
Published: July 2024

ABSTRACT

Background
Patients with multiple sclerosis (MS) face a wide range of symptoms, including physical disability, imbalance, motor disorders, and acute and chronic pain. The psychosocial consequences of these symptoms may limit social well-being and quality of life in these patients.

Purpose
The aim of the study was to assess self-perceived social isolation among patients with MS and its relationship with pain intensity and disability status.

Methods
This cross-sectional study was conducted on 200 patients with MS referred to neurology wards and clinics, the MS Association, and rehabilitation centers. Data collection tools used included a demographic information form, Numeric Pain Rating Scale, Expanded Disability Status Scale, and Social Isolation Questionnaire.

Results
The mean scores of 4.66 (SD = 1.15) for disability and 4.18 (SD = 2.22) for pain intensity both indicated moderate levels of both. Of the sample, 21.5% (43 patients) reported no pain, 22.5% (n = 45) reported mild pain, 35% (n = 70) reported moderate pain, and 21% (n = 42) reported intense pain. The average social isolation score was 63.52 (SD = 3.32), which is higher than the theoretical average. Of the sample, 44.5% reported low social isolation, whereas 55.5% indicated high social isolation. Gender, duration of MS, economic status, disability status, and pain intensity were all found to be significantly associated with social isolation in patients with MS (all ps < .05).

Conclusions
Based on the findings, comprehensive support plans are necessary to improve psychosocial well-being, social life, and quality of life in patients with MS.
Outcomes of clinical decision support systems in real-world perioperative care: a systematic review and meta-analysis
Authors: Cai Jianwen , Li Peiyi , Li Weimin , Zhu Tao 
Published: July 2024

Background:
Although clinical decision support systems (CDSS) have been developed to enhance the quality and efficiency of surgeries, little is known regarding the practical effects in real-world perioperative care.

Objective:
To systematically review and meta-analyze the current impact of CDSS on various aspects of perioperative care, providing evidence support for future research on CDSS development and clinical implementation.

Methods:
This systematic review and meta-analysis followed the Cochrane Handbook and PRISMA statement guidelines, searching databases up to 2 February 2024, including MEDLINE, PubMed, Embase, Cochrane, and Web of Science. It included studies on the effectiveness of CDSS in assisting perioperative decision-making, involving anesthesiologists, doctors, or surgical patients, and reporting at least one outcome such as complications, mortality, length of stay, compliance, or cost.

Results:
Forty studies met inclusion criteria, analyzing outcomes from 408 357 participants, predominantly in developed countries. Most perioperative CDSS use was associated with improved guideline adherence, decreased medication errors, and some improvements in patient safety measures such as reduced postoperative nausea and vomiting and myocardial injury. However, reported results varied widely, and no significant improvement in postoperative mortality was observed.

Conclusion:
The preliminary findings of this review offer an overview of the potential use of CDSS in real-world perioperative situations to enhance patient and anesthesiologist outcomes, but further researches with broader outcome dimensions, involving more stakeholders, and with longer follow-up periods are warranted for the critical evaluation of CDSS and then in better facilitate clinical adoption.
A systematic review and meta-analysis of morbidity and pancreatic fistula after distal pancreatectomy with versus without prophylactic intra-abdominal drainage
Authors: Klaiber Ulla , Collins Philip M. , Trinkler Simon , Gustorff Charlotte , Schindl Martin , Sahora Klaus , Leonhardt Carl-Stephan , Strobel Oliver 
Published: July 2024

Background:
The omission of a prophylactic intra-abdominal drainage has been under debate in pancreatic surgery due to the high-risk of complications and especially of postoperative pancreatic fistula (POPF). Recently, the second randomized controlled trial (RCT) and two propensity score-matched comparative studies assessing risks and benefits of a no-drainage policy versus prophylactic drainage after distal pancreatectomy (DP) have been published. This systematic review with meta-analysis provides an updated summary of the available evidence on this topic.

Methods:
RCTs and nonrandomized comparative studies (NCS) investigating outcomes of no drainage versus drainage after DP were searched systematically in MEDLINE, Embase, and CENTRAL. Random effects meta-analyses were performed, and the results presented as weighted odds ratios (OR) or mean differences with their corresponding 95% CI. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and NCS.

Results:
Two RCTs and six NCS with a total of 3610 patients undergoing DP were included of whom 1038 (28.8%) patients did not receive prophylactic drainage. A no-drainage policy was associated with significantly lower risks of POPF (OR 0.38, 95% CI: 0.25–0.56; P<0.00001), reduced major morbidity (OR 0.64, 95% CI: 0.47–0.89; P=0.008), less reinterventions (OR 0.70, 95% CI: 0.52–0.95; P=0.02), and fewer readmissions (OR 0.69, 95% CI: 0.54–0.88; P=0.003) as well as shorter length of hospital stay (mean differences −1.74, 95% CI: −2.70 to −0.78; P=0.0004). Subgroup analyses including only RCTs confirmed benefits of the no-drainage policy.

Conclusion:
A no-drainage policy is associated with reduced POPF and morbidity and can therefore be recommended as standard procedure in patients undergoing DP.
Efficacy and safety of robotic surgery versus open surgery for hilar cholangiocarcinoma: a systematic review and meta-analysis
Authors: Hu Manqin , Xu Dingwei , Zhang Yan , Li Ao , Li Xincheng , Huang Jie 
Published: July 2024

Objective:
The aim is to assess and contrast the effectiveness and safety of employing robotic surgery versus traditional open surgery in managing cases of hilar cholangiocarcinoma.

Methods:
Computer searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Database to identify case–control studies comparing robotic surgery with traditional open surgery in the treatment of hilar cholangiocarcinoma from inception until July 2023. References from retrieved articles were reviewed to broaden the search. This review was prospectively registered in the PROSPERO database (PROSPERO ID: CRD42024527511) and reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. The primary outcome measures included operation time, intraoperative blood transfusion rate, R0 resection rate, lymph node metastasis rate, incidence of postoperative complications, and postoperative hospital stay. Data analysis was performed using RevMan 5.4 software, calculating combined odds ratios (OR), mean differences (MD), and 95% CI.

Results:
A total of 4 studies encompassing 267 patients diagnosed with hilar cholangiocarcinoma (177 males and 90 females, mean age of (58.8±5.7) years) were included in this analysis. Among these, 165 patients underwent open surgery, while 102 patients underwent robotic surgery. The results of the meta-analysis demonstrated comparable outcomes between the two groups. Specifically, the operation time between the robotic surgery and open surgery cohorts did not significantly differ (MD=−103.96, 95% CI: −216.90 to 8.98, P=0.070). Additionally, the intraoperative blood transfusion rate (OR=1.32, 95% CI: 0.43–4.07, P=0.630), R0 resection rate (OR=1.41, 95% CI: 0.71–2.81, P=0.330), and lymph node metastasis rate (OR=1.62, 95% CI: 0.46–5.63, P=0.450) showed no significant differences between the groups. Similarly, there were no statistically significant disparities observed in the incidence of postoperative complications (OR=0.60, 95% CI: 0.28–1.31, P=0.200) and postoperative hospital stay (MD=2.17, 95% CI: −11.56 to 15.90, P=0.760).

Conclusion:
In the treatment of hilar cholangiocarcinoma, robotic surgery demonstrates comparable safety and feasibility to traditional open surgery. However, due to the limited quantity and quality of the included studies, these conclusions warrant validation through additional high-quality investigations.
Shared Decision-Making About Returning to Sport After Recovery From Pediatric Concussion: Clinician Perspectives
Authors: Kroshus-Havril Emily , Opel Douglas J. , Jinguji Thomas M. , Steiner Mary Kathleen , Senturia Kirsten , MacDonald James P. , Master Christina L. , Giza Christopher C. , Burton Monique S. , Quitiquit Celeste , Krabak Brian J. , Kotch Jeanette P. , Rivara Frederick P. 
Published: July 2024

Objective:
Describe how sports medicine clinicians support decision making about sport participation after concussion recovery with adolescent patients and their parents. Specific areas of inquiry related to how clinicians framed the decision, what factors they considered in how they approached the decision process, and how they navigated discordance within families.

Design:
Qualitative study.

Setting:
Tertiary care sports medicine clinics at 4 children's hospitals in the United States.

Participants:
Individual interviews were conducted with 17 clinicians practicing in sports medicine settings.

Interventions:
N/A.

Main Outcome Measures:
Semi-structured interviews explored clinician approaches to supporting decision making, with the question guide informed by components of the Ottawa Decision Support Framework.

Results:
Clinicians routinely incorporated aspects of shared decision making (SDM) into their conversations with families. This included ensuring all parties were informed about risk and aligned behind a shared value of adolescent well-being. Mediation strategies were used to manage discordance between adolescents and their parents, and between parents. These strategies aimed to facilitate a decision that was adolescent centered. When clinicians believed that there was a medical benefit to modifying the adolescent's sport participation practices, or when they did not believe the athlete was psychologically ready to return to the sport in which they were injured, they initiated conversations about alternative activities. In such situations, they used persuasive communication practices to encourage families to strongly consider this option.

Conclusion:
The strengths and strategies used by sports medicine clinicians in this study provide a foundation for guidance or intervention development aimed at supporting SDM after concussion with adolescents and their families.