bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lyme Neuroborreliosis with Intracranial Hypertension and Erythema Multiforme: A Rare Presentation
Authors: Chhajed Monika , Jain Amit , Gunasekaran Pradeep Kumar , Dhaliwal Navdeep , Saini Lokesh 
Published: July 2022

Abstract
A 9-year-old previously healthy boy presented with high-grade intermittent fever, severe headache associated with neck stiffness for 5 days, rash over trunk and extremities for 4 days, vomiting for 3 days and diplopia for 2 days. There was no history of seizures, abnormal body movements, altered sensorium or focal deficits. On examination, he had maculopapular erythematous rashes over the trunk and extremities and erythema multiforme. He had bilateral abducens nerve palsy and the rest of the cranial nerve, sensory and motor examination was normal. He had neck stiffness and positive Kernig’s sign. Fundus examination showed grade 4 papilledema. Cerebrospinal fluid workup revealed elevated opening pressure, lymphocytic pleocytosis, normal protein and glucose levels. Neuroimaging showed features suggestive of intracranial hypertension. Borrelia IgM and IgG antibodies came positive. The uniqueness of our case lies with two rare presenting manifestations of Lyme neuroborreliosis in the same child.
Phylogeography ofKisauraRoss (Trichoptera: Philopotamidae) of the Japanese Archipelago and the character displacement evolution observed in a secondary contact area between genetically differentiated intra-specific lineages
Authors: Suzuki Tomoya , Kuhara Naotoshi , Tojo Koji 
Published: July 2022

AbstractIn this study we present evidence of an ongoing speciation event in the Japanese Archipelago. The Kisaura nozakii species complex (Philopotamidae) is a group of a small trichopteran insects, and it has been reported that this species has large differences between populations in the copulatory organs (genitalia) of males. Therefore, we conducted molecular phylogenetic analyses based on the mtDNA COI region (658 bp) and genome-wide nDNA single nucleotide polymorphisms (SNPs) (16 254 loci) using the K. nozakii species complex and a sister-species, K. borealis. We also conducted principal component analyses (PCA) based on the forewing length and seven morphological characteristics of the male genitalia. It was revealed that the K. nozakii species complex is composed of multiple allopatrically differentiated genetic lineages. However, two genetic lineages were distributed sympatrically/parapatrically in the western area of the Japanese Archipelago, and the occurrence of ‘character displacement’ in the male genitalia was detected in this area. We consider that the evolutionary event in this species complex has high potential to become a model case for elucidating the processes of speciation and species diversification.
The Analgesic Efficacy of Ultrasound-guided Quadratus Lumborum Block Transmuscular or Posterior Approach After Hip Surgery
Authors: Gong Feipeng , Li Yuxu , Wen Jiabin , Cheng Jinhui , Min Huan 
Published: July 2022

Background:
No review or meta-analysis exists to elucidate the efficacy and safety of quadratus lumborum block (QLB) on the pain intensity, opioid requirement, and mobilization in patients undergoing hip surgery. This systematic review and meta-analysis of randomized controlled trials were designed to compare QLB with no block or placebo (without other nerve/plexus blocks) for patients undergoing hip surgery.

Methods:
Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to June 12, 2021. Only English publications were included. The pain at rest score at 12 postoperative hours was designated as the primary outcome. Secondary outcomes included rest pain at rest scores at 6 and 24 postoperative hours, dynamic pain score at 6, 12, and 24 postoperative hours, total opioid consumption, postoperative nausea and vomiting, and patient satisfaction.

Results:
Seven trials including 514 patients were included. When compared with controls, the QLB technique significantly reduced pain at rest scores at 12 hours after surgery (mean difference −1.15, −1.52 to −0.77, P<0.0001). The secondary outcomes were limited by heterogeneity: secondary pain outcomes and opioid consumption were consistently improved with QLB (P<0.05); patient satisfaction and postoperative nausea and vomiting were similar between the groups based on the Inverse Variance Heterogeneity model (P>0.05). The overall quality of evidence was moderate.

Conclusions:
There is moderate evidence that QLB employment in hip surgery produces significant reduction in pain scores and opioid consumption within 24 hours. QLB appears to be an appropriate option for postoperative analgesia after hip surgery.
Respiratory Effects of the Atypical Tricyclic Antidepressant Tianeptine in Human Models of Opioid-induced Respiratory Depression
Authors: Algera Hyke , van der Schrier Rutger , Cavalla David , van Velzen Monique , Roozekrans Margot , McMorn Alison , Snape Michael , Horrigan Joseph P. , Evans Stuart , Kiernan Bernard , Sarton Elise , Olofsen Erik , Niesters Marieke , Dahan Albert 
Published: July 2022

Background
Animal data suggest that the antidepressant and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor modulator tianeptine is able to prevent opioid-induced respiratory depression. The hypothesis was that oral or intravenous tianeptine can effectively prevent or counteract opioid-induced respiratory depression in humans.

Methods
Healthy male and female volunteers participated in two studies that had a randomized, double blind, placebo-controlled, crossover design. First, oral tianeptine (37.5-, 50-, and 100-mg doses with 8 subjects) pretreatment followed by induction of alfentanil-induced respiratory depression (alfentanil target concentration, 100 ng/ml) was tested. Primary endpoint was ventilation at an extrapolated end-tidal carbon dioxide concentration of 55 mmHg (V̇E55). Next, the ability of four subsequent and increasing infusions of intravenous tianeptine (target tianeptine plasma concentrations 400, 1,000, 1,500, and 2,000 ng/ml, each given over 15 min) to counteract remifentanil-induced respiratory depression was determined in 15 volunteers. Ventilation was measured at isohypercpania (baseline ventilation 20 ± 2 l/min). The primary endpoint was minute ventilation during the 60 min of tianeptine versus placebo infusion.

Results
Alfentanil reduced V̇E55 to 13.7 (95% CI, 8.6 to 18.8) l/min after placebo pretreatment and to 17.9 (10.2 to 25.7) l/min after 50-mg tianeptine pretreatment (mean difference between treatments 4.2 (–11.5 to 3.0) l/min, P = 0.070). Intravenous tianeptine in the measured concentration range of 500 to 2,000 ng/ml did not stimulate ventilation but instead worsened remifentanil-induced respiratory depression: tianeptine, 9.6 ± 0.8 l/min versus placebo 15.0 ± 0.9 l/min; mean difference, 5.3 l/min; 95% CI, 2.5 to 8.2 l/min; P = 0.001, after 1 h of treatment.

Conclusions
Neither oral nor intravenous tianeptine were respiratory stimulants. Intravenous tianeptine over the concentration range of 500 to 2000 ng/ml worsened respiratory depression induced by remifentanil.

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Preoperative MRI Reliably Predicts Pedicle Dimensions on Intraoperative CT Images in Structural Main Thoracic Curves in Patients With Adolescent Idiopathic Scoliosis
Authors: Mitchell Stuart L. , Heyer Jessica H. , Baldwin Keith D. , Greenhill Dustin A. , Flynn John M. , Anari Jason B. 
Published: July 2022

Study Design.
A retrospective comparative study.

Objective.
The aim of this study was to compare the length and diameter of thoracic pedicles in patients with adolescent idiopathic scoliosis (AIS) as measured on preoperative magnetic resonance imaging (pMRI) to intraoperative computed tomography (iCT) scan.

Summary of Background Data.
Optimally sized pedicle screw placement during instrumented posterior spinal fusion for AIS can maximize correction and minimize screw pullout. While iCT-guided navigation can quickly estimate screw position and size, this technology is not universally available. Many surgeons utilize pMRI, when obtained, to estimate screw sizes. Data comparing these measurements on pMRI and iCT is limited. We hypothesized that in patients with surgical magnitude AIS, pedicle length, and diameter measured on pMRI would have at least moderate reliability compared to those made on iCT images.

Materials and Methods.
The pMRI and iCT for 60 patients with structural thoracic curves who underwent posterior spinal fusion for AIS at a single center between 2009 and 2017 were analyzed. Bilateral T5–T12 vertebral levels were evaluated for pedicle chord length and pedicle isthmic diameter on both pMRI and iCT. Between-study reliability and interrater reliability was evaluated for each level of the thoracic spine.

Results.
There is good reliability for pedicle length [intraclass correlation coefficient (ICC)=0.8, 95% confidence interval (CI): 0.78–0.83] and diameter (ICC=0.86, 95% CI: 0.84–0.88) between pMRI and iCT. When assessed by level, T6 has the lowest reliability for length (ICC=0.52, 95% CI: 0.33–0.67) and diameter (ICC=0.55, 95% CI: 0.35–0.69). Interrater reliability ranged from moderate-to-good reliability for all pedicle measurements for both length and diameter on pMRI and iCT.

Conclusion.
Pedicle measurements made on pMRI may be used with reasonable reliability to predict pedicle dimensions visualized on iCT, allowing surgeons to preoperatively plan pedicle screw sizes based off magnetic resonance imaging.
Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018
Authors: Kim Kang Woo , Brodeur Peter G. , Mullen Marguerite A. , Gil Joseph A. , Cruz Aristides I. 
Published: July 2022

Objective.
Considering the high rates of opioid usage following orthopedic surgeries, it is important to explore this in the setting of the current opioid epidemic. This study examined acute opioid poisonings in postoperative spine surgery patients in New York and the rates of poisonings among these patients in the context of New York’s 2016 State legislation limiting opioid prescriptions.

Methods.
Claims for adult patients who received specific orthopedic spine procedures in the outpatient setting were identified from 2009 to 2018 in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were followed to determine if they presented to the emergency department for acute opioid poisoning postoperatively. Multivariable logistic regression was performed to evaluate the effect of patient demographic factors on the likelihood of poisoning. The impact of the 2016 New York State Public Health Law Section 3331, 5. (b), (c) limiting opioid analgesic prescriptions was also evaluated by comparing rates of poisoning prelegislation and postlegislation enactment.

Results.
A total of 107,456 spine patients were identified and 321 (0.3%) presented postoperatively to the emergency department with acute opioid poisoning. Increased age [odds ratio (OR)=0.954, P<0.0001] had a decreased likelihood of poisoning. Other race (OR=1.322, P=0.0167), Medicaid (OR=2.079, P<0.0001), Medicare (OR=2.9, P<0.0001), comorbidities (OR=3.271, P<0.0001), and undergoing multiple spine procedures during a single operative setting (OR=1.993, P<0.0001) had an increased likelihood of poisoning. There was also a significant reduction in rates of postoperative acute opioid poisoning in patients receiving procedures postlegislation with reduced overall likelihood (OR=0.28, P<0.0001).

Conclusion.
There is a higher than national average rate of acute opioid poisonings following spine procedures and increased risk among those with certain socioeconomic factors. Rates of poisonings decreased following a 2016 legislation limiting opioid prescriptions. It is important to define factors that may increase the risk of postoperative opioid poisoning to promote appropriate management of postsurgical pain.
Simultaneous Hypercorrection of Lowest Instrumented Vertebral Tilt and Main Thoracic Curve is Associated With Progression of Residual Lumbar Curve in Adolescent Idiopathic Scoliosis
Authors: Chen I-Hsin , Chen Chih-Wei , Hu Ming-Hsiao , Wang Po-Yao , Yeh Yu-Cheng , Lee Yuan-Fuu , Lai Po-Liang , Yang Shu-Hua 
Published: July 2022

Study Design.
A retrospective cohort study.

Objective.
To determine radiographic parameters, including the lowest instrumented vertebral (LIV) tilt, related to the postoperative magnitude and progression of residual lumbar curves (LCs) in adolescent idiopathic scoliosis patients who underwent posterior spinal fusion with LIV at or above L1.

Summary of Background Data.
Although several guidelines have been proposed for thoracic curve fusion, factors related to the postoperative magnitude and potential progression of unfused LCs remained undetermined. The effect of the LIV tilt on residual LCs is also unclear.

Materials and Methods.
Patients with Lenke type 1 to 4 curves who underwent posterior spinal fusion with LIV at or above L1 with a minimum follow-up period of 2 years were evaluated. Prediction models for residual LCs were developed using multivariate linear regressions with selected radiographic parameters. Subgroup analyses, followed by sensitivity tests, were then performed for variables best predicting the progression of residual LCs.

Results.
A total of 130 patients were included. Multivariate linear regression analysis showed that the immediate postoperative LIV-tilt angle was associated with the immediate postoperative LCs and the prediction model for residual LCs, with high accuracy (R=0.93 and 0.77, respectively). Sensitivity tests revealed immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53% as predictors for progression of residual LCs, and they reached moderate discrimination when combined together as one criterion (odds ratio=16.3, 95% confidence interval=5.3–50.1; sensitivity=89%, specificity=67%, positive predicted value=51%, negative predicted value=94%).

Conclusion.
The current study revealed that LIV tilt, as an operable factor during surgery, is not only a determinant in prediction models showing high correlation with the magnitude of postoperative LCs but a predictor for progression of residual LCs. “Immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53%,” as a united criterion, could serve as a predictor for progression of residual LCs.
The T4-L1-Hip Axis
Authors: Hills Jeffrey , Lenke Lawrence G. , Sardar Zeeshan M. , Le Huec Jean-Charles , Bourret Stephane , Hasegawa Kazuhiro , Wong Hee-Kit , Hey Hwee Weng Dennis , Liu Gabriel , Riahi Hend , Chelli-Bouaziz Mouna , Kelly Michael P. 
Published: July 2022

Study Design.
This is a cross-sectional cohort.

Objective.
The aim was to describe sagittal plane alignment and balance in a multinational cohort of nondegenerated, asymptomatic adults.

Summary of Background Data.
Current sagittal alignment targets were developed using correlations between radiographic and quality-of-life measures in spinal deformity patients, rather than disease-free samples leading to relatively poor accounting for variance within a population.

Materials and Methods.
Sagittal balance was defined using vertebral body tilt and spinopelvic alignment was defined as the vertebral pelvic angles from C2 to L5 (vertebral pelvic angle=vertebral tilt+pelvic tilt). Associations with pelvic incidence (PI) were assessed using linear regression. Multivariable linear regression was used to estimate a normal L1-S1 lordosis, adjusting for PI and the L1 pelvic angle (L1PA). Correlation between the L1 and T4 pelvic angles was assessed to define a normal thoracic alignment conditioned on lumbar alignment.

Results.
Among 320 volunteers from 4 continents, median age was 37% and 60% were female. C2 tilt was independent of PI with minimal variation. PI was inadequate for estimating a normal lumbar lordosis (L1-S1, r
2=0.3), but was strongly associated with the lumbar pelvic angles (L1PA, r
2=0.58). Defining lumbar lordosis as a function of PI and L1PA resulted in high explained variance (R
2=0.74) and the T4 pelvic angle had near perfect correlation with the L1PA (r=0.9).

Conclusions.
We defined normal sagittal balance and spinopelvic alignment in a disease-free international volunteer cohort. Four parameters are either fixed or directly modifiable in surgery and can define a normal thoracic and lumbar alignment: the L1-S1 lordosis defined as a function of PI and the L1PA; and the T4 pelvic angle is nearly equivalent to the L1PA, aligning the T4-L1-hip axis.
Treatment Failure in Vertebral Osteomyelitis
Authors: Yagdiran Ayla , Jochimsen Dorothee , Kernich Nikolaus , Herden Jan , Eysel Peer , Eberhardt Kirsten A. , Jung Norma 
Published: July 2022

Study Design.
Retrospective cohort study.

Objective.
The aim was to compare the influence of 2 common vertebral osteomyelitis (VO) causing pathogens on treatment failure within the first year of diagnosis.

Summary of Background Data.
VO is mainly caused by Staphylococcus aureus (SA), while enterococci and streptococci (ENST) are also responsible for a significant proportion of VO, particularly in elderly patients. Data on VO caused by SA show a tendency for worse outcome, whereas data on VO caused by ENST are scarce. For this purpose, our study compares characteristics of patients with VO caused by SA or ENST in order to analyze risk factors for treatment failure.

Methods.
We conducted a retrospective monocentric study including VO patients from 2008 to 2020. Primary outcome was treatment failure defined as death or relapse within 1 year (T1). We compared patients diagnosed with VO caused by Staphylococcus aureus including MRSA to patients diagnosed with VO caused by Enterococcus and Streptococcus species, which were combined into one group. Polymicrobial infections were excluded. We employed multiple logistic regression analysis to adjust for confounding. To account for moderation, the model was repeated with an included interaction term.

Results.
Data of 130 VO patients (SA=95; ENST=35) were available at T1. Treatment failure occurred in 37% of SA patients and 23% of ENST patients. On multivariate analysis SA [odds ratio (OR): 3.12; 95% confidence interval (CI): 1.09–10.53; P=0.046], Charlson comorbidity index (OR: 1.31; 95% CI: 1.11–1.58; P=0.002) and infectious endocarditis (IE; OR: 4.29; 95% CI: 1.23–15.96; P=0.024) were identified as independent risk factors for treatment failure.

Conclusion.
In our cohort every third patient with VO caused by SA or ENST dies within 1 year. Our findings indicate that patients with VO caused by SA, concomitant IE and/or a high Charlson comorbidity index score may be at elevated risk for treatment failure. These findings can be used to individualize patient care and to direct clinical surveillance. This could include echocardiography evaluating for the presence of IE in patients with VO caused by gram-positive pathogens.
Marijuana Use and its Effect on Clinical Outcomes and Revision Rates in Patients Undergoing Anterior Cervical Discectomy and Fusion
Authors: Lambrechts Mark J. , D’Antonio Nicholas D. , Toci Gregory R. , Karamian Brian A. , Farronato Dominic , Pezzulo Joshua , Breyer Garrett , Canseco Jose A. , Woods Barrett , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory R. 
Published: July 2022

Study Design.
A retrospective cohort study.

Objective.
To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period.

Summary of Background Data.
A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown.

Methods.
All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period.

Results.
Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P<0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) (P=0.001), Neck Disability Index (P=0.003), Visual Analogue Scale (VAS) Arm (P=0.044) and VAS Neck (P=0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β=−4.62, P=0.096), Neck Disability Index (β=9.51, P=0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β=−1.16, P=0.694), VAS Arm (β=0.06, P=0.944), or VAS Neck (β=−0.44, P=0.617).

Conclusion.
Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs.

Level of Evidence.
Levwl III