bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Displacement of Humeral Shaft Fractures Is Associated With Failure of Nonoperative Management
Authors: Kim Ye Joon , Taniguchi Kevin , Bowers Mathew R. , Lauder Alexander , Parry Joshua A. 
Published: February 2023

Objectives:
To determine whether the initial radiographic displacement of humeral shaft fractures is associated with failure of nonoperative management.

Design:
Retrospective cohort study.

Setting:
Urban level 1 trauma center.

Patients/Participants:
106 patients with humeral shaft fractures (OTA/AO 12) initially managed nonoperatively.

Intervention:
Functional bracing.

Main Outcome Measurements:
Failure of nonoperative management, defined as conversion to surgery, malunion, and delayed union/nonunion.

Results:
Nonoperative management failed in 33 (31%) of 106 included patients with 27 patients (25%) requiring surgery. On multivariate analysis, female sex [odds ratio (OR): 3.50, 95% confidence interval (CI): 1.09 to 11.21], American Society of Anesthesiologist classification >1 (OR: 7.16, CI: 1.95 to 26.29), initial fracture medial/lateral (ML) translation (OR: 1.09, CI: 1.01 to 1.17, per unit change), and initial fracture anterior–posterior (AP) angulation (OR: 1.09, CI: 1.02 to 1.15, per unit change) were independently associated with failure of nonoperative management. Initial fracture displacement values that maximized the sensitivity (SN) and specificity (SP) for failure included an AP angulation >11 degrees (SN 75%, SP 64%) and ML translation >12 mm (SN 55%, SP 75%). The failure rate in patients with none, 1, or both of these fracture parameters was 3.1% (1/32), 35.6% (20/56), and 66.6% (12/18), respectively.

Conclusions:
Nearly one-third of patients experienced failure of initial nonoperative management. Failure was found to be associated with greater initial fracture AP angulation and ML translation. Fracture displacement cut-off values were established that may be used by surgeons to counsel patients with these injuries.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
State of the Union: Timeliness to Antibiotics in Open Fractures
Authors: Barnard Eric R. , Stwalley Dustin , Miller Anna N. 
Published: February 2023

Objective:
In open fractures, early administration of systemic antibiotics has recently been recognized as a universal recommendation, with the current American College of Surgeons Trauma Center Verification recommendation for administration within 1 hour of facility arrival. We sought to quantify the baseline rate of timely antibiotic administration and the various factors associated with delay.

Methods:
Data from the National Trauma Data Bank were obtained for all patients treated for open fractures in 2019. 65,552 patients were included. Univariate and multivariate analyses were performed, first for patient, prehospital, and hospital factors compared with rate of antibiotic administration within 1 hour of hospital arrival, then with a multivariate analysis of factors affecting these times.

Results:
The overall rate of antibiotic administration within 1 hour of arrival was 47.6%. Patient factors associated with lower rates of timely antibiotics include increased age, Medicare status, and a higher number of comorbidities. Associated prehospital factors included non–work-related injuries, fixed-wing air or police transport, and walk-in arrival method. Patients with lower extremity open fractures were more likely to receive antibiotics within 1 hour of arrival than those with upper extremity open fractures. Traumatic amputations had a higher rate of timely administration (67.3%). ACS trauma Level II (52.5%) centers performed better than Level III (48.3%), Level I (45.5%), and Level IV (34.5%) centers. Multivariate analysis confirmed the findings of the univariate analysis.

Conclusions:
Despite current clinical standards, rates of adherence to rapid antibiotic administration are low. Certain patient, facility, and environmental factors are associated with delays in antibiotic administration and can be a focus for quality improvement processes. We plan to use these data to evaluate how focus on antibiotic administration as this quality standard changes practice over time.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Impact of Increased Time to Surgery in Geriatric Patients With Acetabular Fractures
Authors: Seilern und Aspang Jesse , Zamanzadeh Ryan S. , Bonsu Janice M. , Fraser Helyn G. , Maceroli Michael A. , Ibnamasud Shadman , McKegg Phillip , Boissonneault Adam R. 
Published: February 2023

Objectives:
To explore the association between time to surgery (TTS) and postoperative complications in geriatric patients with acetabular fractures.

Design:
Retrospective cohort study.

Setting:
Level I trauma center.

Patients/Participants:
51 consecutive geriatric patients (60 years of age or older) who presented to a Level 1 trauma center for surgical fixation of an acetabular fracture between 2013 and 2020.

Main Outcome Measurement:
The primary and secondary outcomes were 30-day postoperative complications and length of hospital stay (LOS), respectively. TTS was determined by time between arrival to ED and time of surgery, with a threshold of 48 hours (early vs. delayed TTS group).

Results:
Nineteen patients (37.3%) had ≥1 postoperative complications. Patients in the delayed TTS group had 5× higher odds of developing ≥1 complications (odds ratio: 4.86, confidence interval: 1.48–15.96). There were no 30-day mortalities in either group. Patients in the delayed TTS group had an average LOS of 19 days compared with early TTS patients who had an average LOS of 12 days (P = 0.040).

Conclusion:
Geriatric patients with acetabular fractures with delayed TTS had increased postoperative complications and LOS. These data suggest that expedited care may have a similar protective effect in geriatric patients with acetabular fractures, as it does in the acute hip fracture population.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Patterns of Vertebral Bone Marrow Edema in the Normal Healing Process of Lumbar Interbody Fusion: Baseline Data for Diagnosis of Pathological Events
Authors: Hasegawa Yuichi , Kanayama Masahiro , Oha Fumihiro , Shimamura Yukitoshi , Tsujimoto Takeru , Hashimoto Tomoyuki , Iwasaki Norimasa 
Published: February 2023

Study Design.
Retrospective investigation using a prospectively collected database.

Objective.
To examine the appearance and characteristics of vertebral bone marrow edema (BME) in the normal healing of lumbar interbody fusion.

Summary of Background Data.
Although BME in pathological spinal conditions has been well-documented, the patterns and characteristics of BME in the normal healing process of spinal fusion remains unexplored.

Materials and Methods.
We reviewed imaging from 225 patients with normal healing following posterior lumbar interbody fusion or transforaminal lumbar interbody fusion. BME was identified on magnetic resonance imaging at the third postoperative week and categorized with respect to its appearance, including assessment of area and extension within the relevant vertebrae.

Results.
Three hundred eighty-nine of the 450 instrumented vertebrae (86.4%) displayed evidence BME. All instances of BME were associated with the area of contact with the endplate. The average extent of BME was 32.7±1.0%. BME within normal healing following interbody fusion could be categorized into four types: no edema (13.6%), anterior corner (36.6%), around-the-cage focal (48.0%), and diffuse (1.8%). Anterior corner BME was significantly associated with instances of single cage placement than in dual cages (42.6% vs. 24.7%, P=0.0002). Single cages had a significantly higher rate of BME than dual cages (92.0% vs. 75.3%, P<0.0001). The extent of BME was significantly greater in the single cage cohort (36.9% vs. 24.2% in dual cages, P<0.0001).

Conclusions.
This serves as the first study demonstrating the patterns of BME associated with normal healing following lumbar interbody fusion procedures. Anterior corner BME and around-the-cage focal BME were the most common patterns encountered, with diffuse BME a relatively rare pattern. These findings might contribute to the better differentiation of postoperative pathological events from normal healing following lumbar interbody fusion.

Level of Evidence.
4.
Female Sex and Supine Proximal Lumbar Lordosis Are Associated With the Size of the LLIF “Safe Zone” at L4-L5
Authors: Fourman Mitchell S. , Alluri Ram K. , Sarmiento J. Manuel , Lyons Keith W. , Lovecchio Francis C. , Araghi Kasra , Dalal Sidhant S. , Shinn Daniel J. , Song Junho , Shahi Pratyush , Melissaridou Dimitra , Carrino John A. , Sheha Evan D. , Iyer Sravisht , Dowdell James E. , Qureshi Sheeraz S. 
Published: February 2023

Study Design.
Retrospective chart review

Objective.
Identify demographic and sagittal alignment parameters that are independently associated with femoral nerve position at the L4-L5 disk space.

Summary of Background Data.
Iatrogenic femoral nerve or lumbar plexus injury during lateral lumbar interbody fusion (LLIF) can result in neurological complications. The LLIF “safe zone” is the anterior half to two third of the disk space. However, femoral nerve position varies and is inconsistently identifiable on magnetic resonance imaging. The safe zone is also narrowest at L4-L5.

Methods.
An analysis of patients with symptomatic lumbar spine pathology and magnetic resonance imaging with a visibly identifiable femoral nerve evaluated at a single large academic spine center from January 1, 2017, to January 8, 2020, was performed. Exclusion criteria were transitional anatomy, severe hip osteoarthritis, coronal deformity with cobb >10 degrees, > grade 1 spondylolisthesis at L4-L5 and anterior migration of the psoas.
Standing and supine lumbar lordosis (LL) and its proximal (L1-L4) and distal (L4-S1) components were measured. Femoral nerve position on sagittal imaging was then measured as a percentage of the L4 inferior endplate. A stepwise multivariate linear regression of sagittal alignment and LL parameters was then performed. Data are written as estimate, 95% CI.

Results.
Mean patient age was 58.2±14.7 years, 25 (34.2%) were female and 26 (35.6%) had a grade 1 spondylolisthesis. Mean femoral nerve position was 26.6±10.3% from the posterior border of L4. Female sex (−6.6, −11.1 to −2.1) and supine proximal lumbar lordosis (0.4, 0.1–0.7) were independently associated with femoral nerve position.

Conclusions.
Patient sex and proximal LL can serve as early indicators of the size of the femoral nerve safe zone during a transpsoas LLIF approach at L4-L5.
Cross-Cultural Adaptation and Psychometric Validation of the Hindi Version of the Neck Disability Index in Patients With Chronic Neck Pain
Authors: Geete Dipti Baban , Mhatre Bhavana Suhas , Vernon Howard 
Published: February 2023

Study Design.
Translation and psychometric testing.

Objectives.
To cross-culturally adapt the Neck Disability Index (NDI) into the Hindi language, the local language of India, and to investigate the psychometric properties of the Neck Disability Index-Hindi (NDI-H) version in patients with neck pain.

Summary of Background Data.
The NDI is the most used self-reported outcome measure for neck pain. The previous NDI-H version did not obtain advance permission from Mapi trust to translate this scale. As a result, this scale’s availability is limited.

Materials and Methods.
Following established guidelines, the NDI was translated and culturally adapted into Hindi. A total of 120 chronic neck pain patients (20 for cognitive interviews and 100 for psychometric testing) participated in this study. The content validity, construct validity, internal consistency, test-retest reliability, and responsiveness of the NDI-H were all evaluated. The intraclass correlation coefficient was computed to determine test-retest reliability. Internal consistency was assessed using Cronbach α. The NDI’s factor structure was investigated using principal component factor analysis. The Neck Pain and Disability Scale, Numeric Pain Rating Scale, and Anxiety and Depression scales were used to test criterion validity. The receiver operating characteristic curve analysis was used to determine the cut-off point and the area under the curve.

Results.
The NDI-H demonstrated good test-retest reliability (intraclass correlation coefficient = 0.92) and excellent internal consistency (Cronbach α = 0.90). The one-factor structure was revealed by the factor analysis. The NDI has a strong relationship with the Neck Pain and Disability Scale and Numeric Pain Rating Scale, as well as the Anxiety and Depression scales. The cut-point for detecting a change was 9.3.

Conclusions.
The NDI was successfully translated into Hindi in this study. The NDI-H is a reliable and valid and responsive instrument that can be used to treat patients with chronic neck pain in clinical and research settings.
Diaphragm Neurostimulation Mitigates Ventilation-Associated Brain Injury in a Preclinical Acute Respiratory Distress Syndrome Model
Authors: Bassi Thiago G. , Rohrs Elizabeth C. , Fernandez Mr. Karl C. , Ornowska Ms. Marlena , Nicholas Ms. Michelle , Wittmann Ms. Jessica , Gani Mr. Matt , Evans Mr. Doug , Reynolds Steven C. 
Published: February 2023

CONTEXT:
In a porcine healthy lung model, temporary transvenous diaphragm neurostimulation (TTDN) for 50 hours mitigated hippocampal apoptosis and inflammation associated with mechanical ventilation (MV).

HYPOTHESIS:
Explore whether TTDN in combination with MV for 12 hours mitigates hippocampal apoptosis and inflammation in an acute respiratory distress syndrome (ARDS) preclinical model.

METHODS AND MODELS:
Compare hippocampal apoptosis, inflammatory markers, and serum markers of neurologic injury between never ventilated subjects and three groups of mechanically ventilated subjects with injured lungs: MV only (LI-MV), MV plus TTDN every other breath, and MV plus TTDN every breath. MV settings in volume control were tidal volume 8 mL/kg and positive end-expiratory pressure 5 cm H2O. Lung injury, equivalent to moderate ARDS, was achieved by infusing oleic acid into the pulmonary artery.

RESULTS:
Hippocampal apoptosis, microglia, and reactive-astrocyte percentages were similar between the TTDN-every-breath and never ventilated groups. The LI-MV group had a higher percentage of these measures than all other groups (p < 0.05). Transpulmonary driving pressure at study end was lower in the TTDN-every-breath group than in the LI-MV group; systemic inflammation and lung injury scores were not significantly different. The TTDN-every-breath group had considerably lower serum concentration of homovanillic acid (cerebral dopamine production surrogate) at study end than the LI-MV group (p < 0.05). Heart rate variability declined in the LI-MV group and increased in both TTDN groups (p < 0.05).

INTERPRETATIONS AND CONCLUSIONS:
In a moderate-ARDS porcine model, MV is associated with hippocampal apoptosis and inflammation, and TTDN mitigates that hippocampal apoptosis and inflammation.
Treatment of More Than Moderate Ischemic Mitral Regurgitation in Patients Undergoing Left Ventricular Reconstruction
Authors: Tiemuerniyazi Xieraili , Song Yangwu , Ma Hanping , Xu Fei , Zhao Wei 
Published: February 2023

Objective:
While evidence-based clinical guidelines recommend chordal-sparing mitral valve replacement, rather than mitral valve repair, in patients with severe ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting, there are no similar recommendations for patients undergoing left ventricular reconstruction (LVR). This study aimed to compare the clinical outcomes of mitral valve repair and replacement in patients undergoing LVR complicated by more than moderate IMR.

Methods:
In this single-center cohort study, a total of 74 consecutive patients who underwent LVR and mitral valve surgery (repair group: 59; replacement group: 15), during the period from March 2000 to March 2021 at Fuwai Hospital (Beijing, China) were retrospectively enrolled. Survival rates were calculated with the Kaplan-Meier method and compared using the log-rank test. Univariate Cox analysis was performed to evaluate possible confounders, followed by adjustment in multivariate analysis. The primary outcome was survival free of major adverse cardiovascular and cerebrovascular events (MACCE).

Results:
Median follow-up time was 59.4 months. Compared with mitral valve replacement, mitral valve repair was associated with increased risk of perioperative use of ventricular assist device (22.0% vs. 0, P = 0.045). There was no difference in overall survival (hazard ratio (HR), 1.10; 95% confidence interval (CI), 0.31–3.93; P
logrank = 0.888) and MACCE-free survival (HR, 1.54; 95% CI, 0.65–3.65; P
logrank = 0.319), even after multivariate Cox regression (HR, 1.35; 95% CI, 0.37–4.88; P
Cox = 0.646; and HR, 1.41; 95% CI, 0.57–3.44; P
Cox = 0.455, respectively). Furthermore, while no differences were observed in ejection fraction and left ventricular end-diastolic diameter on follow-up echocardiography, mitral valve repair was associated with an increased risk of recurrent mitral regurgitation (P = 0.041).

Conclusions:
In patients undergoing LVR complicated by more than moderate IMR, both concomitant mitral valve repair and replacement can be successfully achieved with comparable overall and MACCE-free survival outcomes; however, mitral valve replacement may be superior to mitral valve repair for persistent correction of mitral dysfunction.
Fostering “Reflection-On-Practice” Through a Multisource Feedback and Peer Coaching Pilot Program
Authors: Curran Vernon , Fleet Lisa , Whitton Cynthia 
Published: February 2023

Introduction:
Reflective practice involves thinking about one's practice and often involves using data to effect such reflection. Multisource feedback (MSF) involves evaluation by peers, patients, and coworkers. Coaching has been identified as a key aspect of MSF with peer coaching involving two or more colleagues working together to reflect on current practices and share ideas. We introduced a pilot MSF and peer coaching program with a goal to evaluate its effect on fostering reflective practice.

Methods:
Physician participants completed a 360-degree assessment of their practices, followed by peer coaching sessions. Peer coaches were oriented to an evidence-based theory-driven feedback model (R2C2) to support coaching skills development. A mixed-methods evaluation study was undertaken, including pre to post surveys of readiness for self-directed learning, a postevaluation survey of participant satisfaction, and semistructured participant interviews.

Results:
Thirty four (N = 34) participants completed the 360-degree assessment, and 22 participants took part in two coaching meetings. Respondents reported significant improvement to aspects of their readiness for self-directed learning (P <.05), including knowing about learning strategies to achieve key learning goals, knowing about resources to support one's own learning, and being able to evaluate one's learning outcomes. Overall, respondents felt empowered to “reflect” on their practices, affirm what they were doing well, and, for some, identify opportunities for further and ongoing professional development.

Discussion:
MSF and peer coaching emerged as key elements in enabling reflective practice by facilitating reflection on one's practice and conversations with one's peers to affirm strengths and opportunities for strengthening practice through self-directed professional development.
Long-term effect of a large dose of iodinated contrast in patients with mild thyroid dysfunction: a prospective cohort study
Authors: Si Hailong , Chen Kangyin , Qin Qin , Liu Yuanyuan , Zhao Bingrang 
Published: February 2023

Abstract

Background:
More than 75 million procedures with intravascular iodine-based contrast media (ICM) are performed worldwide every year, and some patients undergoing these procedures do not have normal thyroid function. The long-term effects of ICM in patients with mild thyroid dysfunction (TD) are unclear.

Methods:
This prospective cohort study was conducted in China. Patients with stable angina pectoris with total triiodothyronine (TT3) reduction, normal thyroid-stimulating hormone, and reverse triiodothyronine (rT3) were enrolled and divided into high-dose (≥100 mL ICM) and low-dose groups (<100 mL ICM). We dynamically investigated the trends in thyroid function, rT3, and thyroid antibodies 1 year after ICM exposure.

Results:
A total of 154 patients completed 6 months of follow-up and 149 completed 1 year of follow-up. Thyroglobulin antibody (TGAB) levels were elevated in 41 (26.6%) patients before ICM exposure, 11 (7.1%) of whom also had elevated thyroid peroxidase antibody levels. Transient subclinical TD occurred 6 months after ICM exposure; 75.5% of post-operative TD occurred in the high-dose group. One patient developed severe hypothyroidism with myxedema, requiring drug intervention 1 year after ICM exposure. The level of rT3 showed no statistically significant changes during post-operative follow-up (P = 0.848). The TGAB level decreased at 6th month (P < 0.001), but increased at 1 year after ICM exposure (P = 0.002).

Conclusions:
Patients with T3 reduction are at risk of transient subclinical TD and hypothyroidism after a single large dose of ICM. Follow-up of this population at 9–12 months after ICM exposure is warranted.
Epidemiological characteristics of pulmonary tuberculosis in patients with pneumoconiosis based on its social determinants and risk factors in China: a cross-sectional study from 27 provinces
Authors: Wang Huanqiang , Dai Huaping , He Jiayu , Lyu Xiangpei , Zhang Xinran , Li Tao 
Published: February 2023

Abstract

Background:
Patients with pneumoconiosis have an elevated risk of contracting pulmonary tuberculosis (PTB) and need particular attention. However, extensive population-based studies on the prevalence of PTB in patients with pneumoconiosis have not been reported in China since 1992. This study aimed to investigate the epidemiological characteristics of PTB in patients with pneumoconiosis based on its social determinants and risk factors in China.

Methods:
Based on the Commission on Social Determinants of Health (CSDH) framework, data were obtained from a questionnaire survey of patients with pneumoconiosis from China's 27 provinces (autonomous regions, municipalities) from December 2017 to June 2021. By chi-square and multivariate logistic regression analyses, the epidemiological characteristics of PTB in the patients were identified based on its prevalence and odds ratio (OR) and associated social determinants and risk factors. The population attributable fractions (PAFs) of significant risk factors were also calculated.

Results:
The prevalence of PTB in patients with pneumoconiosis (n = 10,137) was 7.5% (95% confidence interval [CI]: 7.0–8.0%). Multivariate logistic regression analysis showed that risk factors included in-hospital exposure to patients with PTB (OR = 3.30, 95% CI: 2.77–3.93), clinically diagnosed cases (OR = 3.25, 95% CI: 2.42–4.34), and northeastern regions (OR = 2.41, 95% CI: 1.76–3.31). In addition, lack of work-related injury insurance (WRII), being born in a rural area, being unemployed, living in western regions, household exposure to patients with PTB, smoking, being underweight, complications of pulmonary bullae or emphysema, hospitalization history, and former drinkers among the rural patients were also statistically significant risk factors. Being born in a rural area, lack of WRII and in-hospital exposure to patients with PTB had higher PAFs, which were 13.2% (95% CI: 7.9–18.5%), 12.5% (95% CI: 8.3–16.7%), and 11.6% (95% CI: 8.8–14.3%), respectively.

Conclusion:
The prevalence of PTB in pneumoconiosis remains high in China; it is basically in line with the CSDH models and has its characteristics.