bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic impact of a nutrition education program for the promotion of fruit and vegetable consumption with people with severe mental disorders (DIETMENT)
Authors: Foguet-Boreu Quintí , Vilamala-Orra Mireia , Vaqué-Crusellas Cristina , Roura-Poch Pere , Assens Tauste Montse , Bori Vila Judit , Santos-López Jose Manuel , del Río Sáez Ruben
Published: March 2022

Objectives

The aim of this study is to determine the metabolic impact of a nutrition education program on metabolic parameters and the presence of metabolic syndrome (MetS).

Results

Seventy-four patients were included (mean age, 48.7 years [Standard deviation, SD: 10.8], 55.4% men). The diagnoses of SMD were 37.8% schizophrenia and related disorders; 29.7% bipolar disorder; 25.7% depressive disorder; 4.1% personality disorders; and 2.7% obsessive compulsive disorders. Thirty-seven individuals were distributed in both the intervention group (IG) and the control group (CG). In the IG the presence of MetS was 56.3% and in the CG 46.7%, with no statistically significant difference (p = 0.309). At the end of the study, glomerular filtrate decreased in the IG, body mass index and abdominal perimeter increased in both groups, and there were no changes in metabolic parameters between the groups. Between the baseline and the end of the study, there was no increase in the number of patients diagnosed with MetS (14 at both points); and in the CG the increase was from 8 to 12 (p = 0.005). An intervention based on fruit and vegetable intake could prevent progression to MetS in individuals with SMD, decreasing the likelihood of cardiovascular disease.

Trial registrationThe trial was retrospectively registered on International Standard Randomised Controlled Trial Number (ISRCTN) Register on 11 March 2022 (ISRCTN12024347)
The effect of lesion filling on brain network analysis in multiple sclerosis using structural magnetic resonance imaging
Authors: van der Weijden Chris W. J. , Pitombeira Milena S. , Haveman Yudith R. A. , Sanchez-Catasus Carlos A. , Campanholo Kenia R. , Kolinger Guilherme D. , Rimkus Carolina M. , Buchpiguel Carlos A. , Dierckx Rudi A. J. O. , Renken Remco J. , Meilof Jan F. , de Vries Erik F. J. , de Paula Faria Daniele
Published: March 2022

Background

Graph theoretical network analysis with structural magnetic resonance imaging (MRI) of multiple sclerosis (MS) patients can be used to assess subtle changes in brain networks. However, the presence of multiple focal brain lesions might impair the accuracy of automatic tissue segmentation methods, and hamper the performance of graph theoretical network analysis. Applying “lesion filling” by substituting the voxel intensities of a lesion with the voxel intensities of nearby voxels, thus creating an image devoid of lesions, might improve segmentation and graph theoretical network analysis. This study aims to determine if brain networks are different between MS subtypes and healthy controls (HC) and if the assessment of these differences is affected by lesion filling.

Methods

The study included 49 MS patients and 19 HC that underwent a T1w, and T2w-FLAIR MRI scan. Graph theoretical network analysis was performed from grey matter fractions extracted from the original T1w-images and T1w-images after lesion filling.

Results

Artefacts in lesion-filled T1w images correlated positively with total lesion volume (r = 0.84, p < 0.001) and had a major impact on grey matter segmentation accuracy. Differences in sensitivity for network alterations were observed between original T1w data and after application of lesion filling: graph theoretical network analysis obtained from lesion-filled T1w images produced more differences in network organization in MS patients.

Conclusion

Lesion filling might reduce variability across subjects resulting in an increased detection rate of network alterations in MS, but also induces significant artefacts, and therefore should be applied cautiously especially in individuals with higher lesions loads.
Comparative performance of fully-automated and semi-automated artificial intelligence methods for the detection of clinically significant prostate cancer on MRI: a systematic review
Authors: Sushentsev Nikita , Moreira Da Silva Nadia , Yeung Michael , Barrett Tristan , Sala Evis , Roberts Michael , Rundo Leonardo
Published: March 2022

Objectives

We systematically reviewed the current literature evaluating the ability of fully-automated deep learning (DL) and semi-automated traditional machine learning (TML) MRI-based artificial intelligence (AI) methods to differentiate clinically significant prostate cancer (csPCa) from indolent PCa (iPCa) and benign conditions.

Methods

We performed a computerised bibliographic search of studies indexed in MEDLINE/PubMed, arXiv, medRxiv, and bioRxiv between 1 January 2016 and 31 July 2021. Two reviewers performed the title/abstract and full-text screening. The remaining papers were screened by four reviewers using the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) for DL studies and Radiomics Quality Score (RQS) for TML studies. Papers that fulfilled the pre-defined screening requirements underwent full CLAIM/RQS evaluation alongside the risk of bias assessment using QUADAS-2, both conducted by the same four reviewers. Standard measures of discrimination were extracted for the developed predictive models.

Results

17/28 papers (five DL and twelve TML) passed the quality screening and were subject to a full CLAIM/RQS/QUADAS-2 assessment, which revealed a substantial study heterogeneity that precluded us from performing quantitative analysis as part of this review. The mean RQS of TML papers was 11/36, and a total of five papers had a high risk of bias. AUCs of DL and TML papers with low risk of bias ranged between 0.80–0.89 and 0.75–0.88, respectively.

Conclusion

We observed comparable performance of the two classes of AI methods and identified a number of common methodological limitations and biases that future studies will need to address to ensure the generalisability of the developed models.
Recolonization by Indigenous broadleaved species of a conifer plantation (Cupressus spp.) in Northern Iran after 25 years
Authors: Jafarzade Masoud , Ravanbakhsh Hooman , Moshki Alireza , Mollashahi Maryam
Published: March 2022

Key message

A vegetation analysis revealed the extent of recolonization by native vegetation of a 25-year-old Cupressus spp. plantation in northern Iran. A young indigenous Quercus-Carpinus community replaced the conifers in the low-slope areas with deeper, heavier, and more fertile soils.

Context

Reforestation of degraded or clear-cut-harvested lands can modify site conditions, facilitating succession and reestablishing native forests. It is critical to investigate the plantation in terms of vegetation, natural regeneration, and environmental variables to better understand ecological restoration.

Aims

This study examines the recolonization of a Cypress plantation by native vegetation in the deforested Hyrcanian broadleaf forests and determines which edaphic, topographic, and structural variables are correlated to the degree of reconstitution.

Methods

A systematic random sampling method was used to establish 55 plots in a 25-year-old Cupressus plantation, followed by plot classification using TWINSPAN and environment-vegetation analysis using CCA. The classification groups were compared using an analysis of variance. Tested variables included floristic composition, stand structure, regeneration, topography, and soil parameters.

Results

Four vegetation groups were identified based on an analysis of floristic composition. The first group demonstrated the least degree of native forest reconstitution, as planted conifers (Cupressus spp.) were established alongside pioneer broadleaf shrubs, enhancing Zelkova carpinifolia (Pall.) K.Koch regeneration. While most conifers disappeared in the third group, Carpinus betulus L., Zelkova carpinifolia, and Quercus castaneifolia C.A. Mey became dominant. The most influential environmental factors in reestablishing indigenous communities were a low-slope, heavier soil with a higher organic carbon and potassium content.

Conclusion

On low-slope lands with fertile soils, the Hyrcanian native broadleaf forest can recolonize the coniferous plantation; however, on steep lands with poor sandy soils, planted Cupressus trees as well as relatively xerophytic shrubs in the understory may establish.
Heuristic approaches for the car sequencing problems with block batches
Authors: Yu Yingjie , Lu Xiaochun , Zhao Tao , Cheng Minjiao , Liu Lin , Wei Wenchao
Published: March 2022

Motivated by the practical supply chain management of the automobile industry, we study the car sequencing problem (CSP) that minimizes the conflicts occur when sequentially manufacturing cars on an assembly line. The CSP is a well-established problem, subject to the paint batching constraints to decrease the energy consumption for color changeovers and production rate constraints in the assembly shop to ensure a smooth usage of car options. However, the existing solution algorithms to this problem do not take into account the block batches, which desires a consecutive production batch of cars requiring a certain option. This requirement often occurs when specialized labor time window is short in the customized car production scenario, and renders additional complexities to the traditional car sequencing problem. In this paper, we present a novel model to deal with these constraints and simultaneously generate the sequencing and replenishment decisions. Besides, we develop two math-heuristic algorithms to solve the proposed large-scale CSP. The presented heuristics are on the basis of relax-and-fix procedures, fix-and-optimize procedures and adaptive variable neighborhood search. To solve the large-sized instances (commercial solvers, i.e., Cplex, cannot obtain a feasible result within 1 h), we design and implement a reinforced parameter tuning mechanism to dynamically select the parameter values, so as to speed up the search process. The proposed models and heuristics are tested on representative instances generated from the benchmark in the literature (CSPLib), as well as large-sized instances generated from real-world cases. We report on extensive computational experiments and provide basic managerial insights into the planning process.
A framework of evidence-based decision-making in health system management: a best-fit framework synthesis
Authors: Shafaghat Tahereh , Bastani Peivand , Nasab Mohammad Hasan Imani , Bahrami Mohammad Amin , Montazer Mahsa Roozrokh Arshadi , Zarchi Mohammad Kazem Rahimi , Edirippulige Sisira
Published: March 2022

Background

Scientific evidence is the basis for improving public health; decision-making without sufficient attention to evidence may lead to unpleasant consequences. Despite efforts to create comprehensive guidelines and models for evidence-based decision-making (EBDM), there isn`t any to make the best decisions concerning scarce resources and unlimited needs. The present study aimed to develop a comprehensive applied framework for EBDM.

Methods

This was a Best-Fit Framework (BFF) synthesis conducted in 2020. A comprehensive systematic review was done via six main databases including PUBMED, Scopus, Web of Science, Science Direct, EMBASE, and ProQuest using related keywords. After the evidence quality appraisal, data were extracted and analyzed via thematic analysis. Results of the thematic analysis and the concepts generated by the research team were then synthesized to achieve the best-fit framework applying Carroll et al. (2013) approach.

Results

Four thousand six hundred thirteen studies were retrieved, and due to the full-text screening of the studies, 17 final articles were selected for extracting the components and steps of EBDM in Health System Management (HSM). After collecting, synthesizing, and categorizing key information, the framework of EBDM in HSM was developed in the form of four general scopes. These comprised inquiring, inspecting, implementing, and integrating, which included 10 main steps and 47 sub-steps.

Conclusions

The present framework provided a comprehensive guideline that can be well adapted for implementing EBDM in health systems and related organizations especially in underdeveloped and developing countries where there is usually a lag in updating and applying evidence in their decision-making process. In addition, this framework by providing a complete, well-detailed, and the sequential process can be tested in the organizational decision-making process by developed countries to improve their EBDM cycle.
Principles and framework for assessing the risk of bias for studies included in comparative quantitative environmental systematic reviews
Authors: Frampton Geoff , Whaley Paul , Bennett Micah , Bilotta Gary , Dorne Jean-Lou C. M. , Eales Jacqualyn , James Katy , Kohl Christian , Land Magnus , Livoreil Barbara , Makowski David , Muchiri Evans , Petrokofsky Gillian , Randall Nicola , Schofield Kate
Published: March 2022

The internal validity of conclusions about effectiveness or impact in systematic reviews, and of decisions based on them, depends on risk of bias assessments being conducted appropriately. However, a random sample of 50 recently-published articles claiming to be quantitative environmental systematic reviews found 64% did not include any risk of bias assessment, whilst nearly all that did omitted key sources of bias. Other limitations included lack of transparency, conflation of quality constructs, and incomplete application of risk of bias assessments to the data synthesis. This paper addresses deficiencies in risk of bias assessments by highlighting core principles that are required for risk of bias assessments to be fit-for-purpose, and presenting a framework based on these principles to guide review teams on conducting risk of bias assessments appropriately and consistently. The core principles require that risk of bias assessments be Focused, Extensive, Applied and Transparent (FEAT). These principles support risk of bias assessments, appraisal of risk of bias tools, and the development of new tools. The framework follows a Plan-Conduct-Apply-Report approach covering all stages of risk of bias assessment. The scope of this paper is comparative quantitative environmental systematic reviews which address PICO or PECO-type questions including, but not limited to, topic areas such as environmental management, conservation, ecosystem restoration, and analyses of environmental interventions, exposures, impacts and risks.
Rapid and efficient colorimetric sensing of clindamycin and Fe3+ using controllable phyto-synthesized silver/silver chloride nanoparticles by Syzygium cumini fruit extract
Authors: Ebrahimi Atefeh , Samari Fayezeh , Eftekhar Ebrahim , Yousefinejad Saeed
Published: March 2022

The first evidence of a green, single-step, and additive-free process for the fabrication of silver/silver chloride nanoparticles (Ag/AgCl NPs) by fruit extract of Syzygium cumini (S. cumini) without the usage of any stabilizer and halide source was provided. The formation of nanoparticles was optimized to control the shape, size, and stability via various pHs of the reaction mixture, the quantity of fruit extract, temperature, concentrations of silver ion, and reaction time. The optimal conditions were determined: pH = 7.0, the quantity of the leaf extract = 3.0 mL, silver ion concentration = 1.0 mM, temperature = 60 °C, and incubation time = 40 min. As an application in colorimetric sensing, the ability of the prepared Ag/AgCl NPs to sense clindamycin and Fe3+ ion in an aqueous medium was investigated. The SPR band and color of the solution of Ag/AgCl NPs undergo dramatic changes in exposure to clindamycin with new SPR peaks appearing at 500 nm, accompanied by a color change from yellow to pink due to the aggregation of NPs. Under the optimized pH of 3.0, this sensor was shown a linear dynamic range from 10.0 to 100.0 µM with a LOD of 1.2 µM and good linear relationships (R2 = 0.99) for clindamycin. On the other hand, the quenching of the SPR peak at 412 nm was used to monitor the Fe3+ ions with wide linear ranges of 10.0–350.0 µM under the optimized pH (pH = 9) with a LOD of 5.6 µM. In addition, the proposed sensor displayed applicability in the real sample containing clindamycin (in capsules and injection ampoules) and Fe3+ ions (in water samples) detection.

Graphical Abstract
Mendel’s controlled pollination experiments in Mirabilis jalapa confirmed his discovery of the gamete theory of inheritance in Pisum
Authors: Zhang Hui , Zhao Xiaoxi , Zhao Fan , Han Jianshan , Sun Kun
Published: March 2022

The historian studies revealed during Mendel’s later research period when mainly focusing on the constant hybrid in Hieracium, he had to be intervened to conduct the controlled pollination experiments in Mirabilis jalapa. Two letters to Nageli recorded the experimental aim was to disprove Darwin’s opinion regarding three pollen grains required for one fertilization (note: that could completely destroy his previous discovery of segregation inheritance in variable hybrid in Pisum, for it was expressed in a mathematical equation). The experimental results of single pollen grain pollination confirmed the referenced view of one pollen cell uniting one egg cell in plant fertilization; the further pedigree introduction of the single and of the designed two pollen grain experiment succeeded in exemplifying that one hereditary factor carried by one gamete (pollen cell or egg cell) can independently transmit a trait to offspring. Here we coined the observation as the Gamete Theory of Inheritance. Remarkably, in contrast with the bulked pollination experiment, in this system, Mendel could easily manipulate a hereditary factor by merely taking a gamete as a carrier. Then, Mendel’s work in M. jalapa together with the previous Pisum study was able to jointly suppport his second lecture content that regarded “gamete formation, fertilization, and seed development” and also regarded hereditary factors in the processes. All in all, the 1866 paper was published during a rapid burst of interest in hybrid species likely induced by Darwin, and Mendel’s attempts at accommodation of the two incompatible inheritances of segregation in variable hybrids versus of nonsegregation in constant hybrids might be responsible for some historical controversies when understanding his discovery of inheritance.
A cost-effective three-dimensional marine controlled-source electromagnetic survey: Exploring seafloor massive sulfides
Authors: Ishizu Keiichi , Siripunvaraporn Weerachai , Goto Tada-nori , Koike Katsuaki , Kasaya Takafumi , Iwamoto Hisanori
Published: March 2022

A 3D marine controlled-source electromagnetic (CSEM) survey for mapping hydrocarbons uses dozens of ocean-bottom electric (OBE) receivers deployed in a grid pattern and several transmitter towlines. This study considers seafloor massive sulfides (SMS) exploration, and the horizontal survey scale of SMS is a few kilometers, which is small compared with hydrocarbon surveys of tens of kilometers. If we apply a 3D CSEM survey using a receiver deployment on grids to map SMS, high survey costs will be incurred despite the small survey size. We have developed a cost-effective 3D marine CSEM survey that uses fewer receivers than the survey with a receiver deployment on grids to reduce survey costs for SMS. This CSEM survey uses a line of OBE receivers in the center of the survey area and several transmitter towlines. Numerical tests demonstrate that our survey (seven OBE receivers) using 80% fewer receivers than the survey with a receiver deployment on grids (35 OBE receivers) is able to accurately map SMS, obtaining a performance similar to that of the receiver deployment on grids. Then, we explore SMS in the Ieyama hydrothermal area off Okinawa, southwest Japan, using our 3D CSEM survey with a line of six OBE receivers and three transmitter towlines. The resulting 3D resistivity distribution from the observed data highlights three potential SMS zones consisting of 0.2 ohm-m low resistivity embedded into 1 ohm-m sediment.
Amplitude-variation-with-offset inversion using P- to S-wave velocity ratio and P-wave velocity
Authors: Chen Fubin , Zong Zhaoyun , Yang Yaming , Gu Xingyu
Published: March 2022

The estimation of P- to S-wave velocity ratio (PSR) in the subsurface has many applications in gas-bearing reservoir prospecting, lithology discrimination, and anomalous pore-pressure prediction. Conventionally, it is estimated with the P- and S-wave velocities/moduli/impedances that are directly obtained from prestack seismic data using the existing reflection coefficient equation (e.g., the Aki-Richards approximation). However, this indirect inversion method creates cumulative errors for the estimated PSR results. To eliminate cumulative errors, we first develop a novel generalized elastic impedance that has more explicit physical meaning compared to conventional elastic impedance. Then, we derive a linear P-wave reflection coefficient equation in terms of the PSR, P-wave velocity, and density under the assumption of weak contrast. Furthermore, a robust amplitude-variation-with-offset inversion method is constructed with the proposed reflection coefficient equation in the Bayesian framework. Cauchy and Gaussian probability distributions are used as the prior probability distribution of the model parameter and likelihood function, respectively, to predict the maximum posterior probability solution for PSR, P velocity, and density. Synthetic and field examples illustrate that the proposed direct inversion method performs with higher accuracy compared with the indirect method that inverts for the P- and S-wave velocities and also illustrate the feasibility of our method for inverting the three parameters even with strong noise. Our inverted results conform to the drilling results, which validate the robustness of the proposed direct inversion method.
Fermenting a Twenty–First Century California Wine Industry
Authors: Geraci Victor W.
Published: March 2022

At the start of the twenty-first century, California wineries entered a new vinti-business (vertical integration of grape farming, wine production, and wine distribution) era based on the needs of a global wine economy by adapting historic survival lessons learned from their past. This agricultural success story illuminates the entrepreneurial energy and able instincts of California farmers who replicated, with modern twists, the big business canons of Gilded Age agricultural capitalism. Whether it be the Phyloxera outbreak in the 1880s Los Angeles region of Southern California, World War I, Prohibition, the Great Depression, the Second World War, and finally neoprohibition, wine entrepreneurs rebuilt each time by returning to nineteenth-century capitalist tenets intrinsic in a market economy. Successful wineries found ways to achieve the most efficient economy-of-scale operations through their use of science, promotion of sustainable agriculture, aggressive marketing, protection of wine’s image from attacks by neoprohibitionists, and courtship of government agencies for money and favorable policies. After managing domestic production and sales, forward-thinking viticultural entrepreneurs then expanded their operations into the twenty-first century global market-place much like their predecessors from the century before.
Plantation Empire: How Sugar and Tobacco Planters Built Their Industries and Raised an Empire
Authors: Menard Russell R.
Published: March 2022

This essay develops an American approach to the rise of the English Atlantic during the seventeenth century. It argues that productivity gains in plantation agriculture fueled an extraordinary expansion of commerce as planters raising tobacco, sugar, and rice improved their efficiency and were able to lower prices. Lower prices made the products of American plantations affordable to an ever-growing number of European consumers. The increased consumption fueled the expansion of the American plantation colonies, transformed the Atlantic into an English inland sea, and led to the creation of the first British Empire; one of the great commercial successes of the Early Modern Era. The essay also interrogates the concept of productivity gains in a slave economy, arguing that what are often interpreted as improvements in productivity were in fact increases in labor inputs as planters squeezed slaves harder. This raises the question, then, of whether productivity gains (or increased labor inputs) signal that planters were forward-looking entrepreneurs or backward seigneurs?
"The Extension Service Is Not an Integration Agency": The Idea of Race in the Cooperative Extension Service
Authors: Harris Carmen V.
Published: March 2022

This article is an institutional history of the development of race policy within the federal Cooperative Extension Service. It demonstrates that the popular belief in African-American inferiority and pragmatic political compromises aimed at creating a bureaucracy serving the nation’s agricultural constituency and ensuring its longevity, led to a conscious marginalization of African-American interests within the program. Federal extension officials not only tolerated, but actively supported, discrimination within the southern branches of the service. African-American leadership protested against the adverse effects of racial policies in the Extension Service from the very beginning. While there were some limited positive gains in the number of staff and availability of services for rural African Americans, these changes did not challenge the suzerainty of whites over the program. In the post-World War II era--especially after 1950--African Americans confronted white extension leadership. Extension officials hid behind a bureaucratic façade and a flawed interpretation of the federal-state cooperative agreement to delay institutional restructuring. Political appointees pushed the service toward policies of racial justice; however, extension leadership continued to move slowly on fundamental transformation. As a result, the adjustments did not lead to a fundamental re-thinking of race policy in the service and ultimately contributed to the disappearance of the African-American extension force to a significant degree.
The World Union of Documentary and the Early Cold War
Authors: Lovejoy Alice
Published: March 2022

This essay traces the evolution of the idea of “international documentary” during the early Cold War through the history of the World Union of Documentary (1947–50), an association spearheaded by documentarian Joris Ivens that aimed to articulate a common purpose for postwar documentary and to facilitate the international exchange of films, professionals, and knowledge in the field. I investigate the links between the association and contemporaneous international initiatives, chiefly film festivals and the peace movement, focusing throughout on Eastern Europe, where the World Union was headquartered for most of its existence. Indeed, the association's history is inextricable from that of Ivens's 1949 film about the East European “new democracies,” The First Years (Pierwsze lata). Both projects, I argue, were impeded not only by the polarized political atmosphere of the period but also by complex political, administrative, and generational dynamics within the documentary community and the international Left.
New Media, Neo-Media: The Brief Life of Socialist Television in Ghana
Authors: Blaylock Jennifer
Published: March 2022

Television in Ghana was born at a radical time when Africans across the continent were boldly inventing systems of governance resistant to imperialism and racial inequality. Alongside the formation of the new state, the new medium was designed to help realize visions of Pan-Africanism and African socialism promoted by Kwame Nkrumah. With the February 24, 1966, coup d’état seven months after its first broadcast, Ghanaian socialist television ended. Based on archival research and interviews with Ghanaian television pioneers, in this essay I argue that this Afrofuturist segment of Ghana's media past provides a counternarrative to new media discourse from the colonial era that positioned Africa as the passive receiver of television. I show how transnational influences were actively adapted to theorize the new medium in opposition to racial capitalism and propose that media archaeologies attuned to Afrofuturism may reorient the field toward social and political justice in the present.
111 Comparison of Hounsfield Units Versus T-Score in Predicting Postoperative Proximal Junctional Kyphosis
Authors: Mallory Noah , Moranville Robert , Gibbs David C. , Keister Alex , Munjal Vikas , Maggio Dominic , Grossbach Andrew J. , Viljoen Stephanus , Farhadi Francis
Published: March 2022

INTRODUCTION:

Vertebral body (VB) bone quality is generally estimated indirectly via femoral neck dual-energy x-ray absorptiometry (DEXA) to counsel patients on their risk for development of proximal junctional kyphosis (PJK) after thoraco-lumbar fusion for adult spinal deformity. It is currently unknown whether direct measurement of VB bone quality through Hounsfield unit analysis (HUs) can successfully stratify patients on their risk of delayed complications.

METHODS:

108 patients who underwent surgery for ASD were enrolled. Demographic characteristics, radiologic measurements, complication profile, and clinical outcomes were recorded both pre- and post-operatively. A Youden J-statistic was calculated based on an ROC analysis of the UIV Hounsfield unit data to give a single HU threshold to segregate patients into either a high or low HU group. Patient groups were then compared with respect to the mentioned clinical and radiographic outcome measures.

RESULTS:

Youden statistic revealed a HU threshold value of 126.8 for maximal group stratification. Significant change in proximal junctional cobb angle (PJCA) was observed between the low and high HU groups at one and two years (p < 0.0001 and p = 0.0001 respectively). This was not similarly seen in hip or spine DEXA analysis (p > 0.05).

CONCLUSION:

Assessment of bone quality via pre-operative measurement of the UIV VB HU can predict post-operative changes in PJCA. UIV HUs < 126.8 are associated with 2.8x elevated risk of developing post-operative PJK. Current standard of care measurement of bone quality via femoral neck DEXA is of more limited utility compared to HU analysis.
113 Clinical Presentation Phenotypes of Patients Operated for Lumbar Spondylolisthesis: An Analysis of the Quality Outcomes Database
Authors: Chan Andrew K. , Wozny Thomas A. , Bisson Erica F. , Pennicooke Brenton H. , Bydon Mohamad , Glassman Steven D. , Foley Kevin T. , Shaffrey Christopher I. , Potts Eric A. , Shaffrey Mark E. , Coric Domagoj , Knightly John J. , Park Paul , Wang Michael Y. , Fu Kai-Ming G. , Slotkin Jonathan , Asher Anthony L. , Virk Michael S. , Kerezoudis Panagiotis , Alvi Mohammed A. , Guan Jian , Haid Regis W. , Mummaneni Praveen V.
Published: March 2022

INTRODUCTION:

Trials of lumbar spondylolisthesis are difficult to compare due to heterogeneity in the populations studied.

METHODS:

This is a study of the prospective Quality Outcomes Database Spondylolisthesis Registry, including patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Twenty-four-month patient-reported outcomes (PROs) were compared. A k-means clustering analysis—an unsupervised machine learning algorithm—was used to identify clinical presentation phenotypes.

RESULTS:

Overall, 608 patients were identified, of which 507 (83.4%) had 24-month follow up. Clustering revealed 2 distinct cohorts. Cluster 1 (high-disease-burden) was younger, had higher BMI and ASA grades, and globally worse baseline PROs. Cluster 2 (intermediate-disease-burden) was older, had lower BMI and ASA grades, and intermediate baseline PROs. Baseline radiographic parameters were similar (p > 0.05). In multivariable adjusted analyses, mean 24-month ODI, NRS-back pain, NRS-leg pain, and EQ-5D were markedly worse for the high-disease-burden cluster (adjusted p < 0.001). However, the high-disease-burden cluster demonstrated greater 24-month improvements for ODI, NRS-back pain, and EQ-5D (adjusted-p < 0.05) and a higher proportion reaching ODI minimal clinically important difference (MCID) (adjusted-p = 0.001). High-disease-burden cluster had lower satisfaction (adjusted-p = 0.02).

CONCLUSION:

We define two distinct phenotypes—those with high- versus intermediate-disease-burden—operated for lumbar spondylolisthesis. Those with high-disease-burden were less satisfied, had a lower quality of life, and more disability, more back pain, and more leg pain than those with intermediate-disease-burden, but had greater magnitudes of improvement in disability, back pain, quality of life and more often reached ODI MCID.
128 Genome-wide Association Study Reveals Genetic Risk Factors for Trigeminal Neuralgia
Authors: Hale Andrew T. , Akinnusotu Oluwatoyin , He Jing , Sale Rebecca , Wang Janey , Bastarache Lisa , Gamazon Eric R.
Published: March 2022

INTRODUCTION:

Trigeminal neuralgia (TN) is a debilitating neuropathic pain disease. While many clinical risk factors have been associated with TN, the genetic basis is largely unknown and no genome-wide association studies (GWAS) have been performed. Here we perform the first GWAS for TN and conduct a fixed-effect meta-analysis including 1,188 TN cases from BioVU, FinnGen, and the UK Biobank.

METHODS:

Age, sex, and five genotype-based principal components were used as covariates in logistic regression models to identify TN-associated single nucleotide polymorphisms (SNPs). Fixed-effect meta-analysis was performed using METAL. Genome-wide significance was defined as p < 5.0 x 10-8. Linkage disequilibrium (LD, r2) was determined using the LD matrix tool.

RESULTS:

We identify an intergenic locus on chromosome 1p22.2 flanked by ZNF326 and SNORD3G containing 5 SNPs (rs77449572, rs543311093, rs35117749, rs71666259, and rs116010656) reaching genome-wide significance (p < 5.0 x 10-8), with the SNP rs77449572 as the sentinel variant (p = 1.72 x 10-9). A number of SNPs in the locus are in moderate LD, as highlighted by the heatmap of r2 values. Haploreg analysis identifies rs77449572 which overlaps an enhancer element in cortex-derived neurospheres. In addition, rs71666259 and rs116010656 overlap enhancer elements in embryonic stem cells (HUES48), suggesting potential functional consequences of this locus. We also identify a second locus on chromosome 5q35.1 containing sentinel variant rs62376947 reaching genome-wide significance (p = 2.49 x 10-8). As the Q-Q plot confirms, there is no global inflation in the test statistic (no early separation of the expected from the observed), suggesting that population stratification has been adequately accounted for. The LocusZoom plots show the magnitude of the genome-wide significant associations in the 1p22.2 locus and the 5q35.1 locus.

CONCLUSION:

To our knowledge, we perform the first GWAS of TN, identifying risk loci reaching genome-wide significance.
131 Multi-Institutional Study on MRI-guided Laser Interstitial Thermal Therapy for Corpus Callosotomy (MRIgLITT-CC): Technique Variation, Ablation Coverage, and Need for Additional Surgery
Authors: Pindrik Jonathan A. , Makoshi Ziyad A. , Salehi Afshin , Mallela Arka , Abel Taylor , Smyth Matthew D.
Published: March 2022

INTRODUCTION:

MRI-guided laser interstitial thermal therapy for corpus callosotomy (MRIgLITT-CC) offers palliation of intractable drop events and atonic, tonic, and generalized tonic-clonic seizures.

METHODS:

This multi-institutional retrospective study included pediatric patients with medically intractable epilepsy undergoing MRIgLITT-CC. Surgical details, post-operative radiographic results, and need for additional epilepsy surgery were recorded. Percent coverages of the intended ablation zones (anterior, complete, or posterior corpus callosotomy) were estimated from MRI. Data were summarized using descriptive statistics and compared using Chi-square tests.

RESULTS:

A total of 27 subjects (18 male, 9 female) with mean age 13 years +/- 5 years (4 years, 21 years) underwent planned complete (13, 48%), anterior (11, 41%), or posterior (3, 11%) MRIgLITT-CC. Planned complete MRIgLITT-CC entailed 2 (1/13, 8%), 3 (6/13, 46%), or 4 (6/13, 46%) trajectories with 100% (8/13, 62%) or 95-99% (5/13, 38%) coverage of the planned callosal ablation zone. Anterior MRIgLITT-CC cases included 1 (1/11, 9%), 2 (8/11, 73%), or 3 (1/11, 9%) trajectories to achieve 100% (7/11, 64%), 95-99% (2/11, 18%), 90-94% (1/11, 9%), or <90% (1/11, 9%) coverage of the planned callosal ablation zone. There were no significant differences in percent coverage of intended ablation zone as a function of trajectory number (p = 0.6). Three subjects (11%) required repeat callosal surgery while four subjects (15%) underwent additional vagus nerve stimulator (VNS) insertion during clinic follow-up (mean 11.7 months +/-10.6 months; [0.4 months, 37.1 months]). The need for repeat callosal surgery differed significantly between subjects with 100% and less than 100% ablation coverage (0/16 vs. 3/11, p = 0.03).

CONCLUSION:

In this multi-institutional study, MRIgLITT-CC yielded 100% or 95-99% coverage of the intended callosal ablation zone in most subjects. Trajectory variation between centers did not impact percent coverage of the intended ablation zone. Few subjects required repeat callosal surgery, particularly those with less than 100% ablation zone coverage, or additional VNS insertion.
153 An International Multicenter Matched Cohort Analysis of Incidental Meningioma Progression During Active Surveillance or After Stereotactic Radiosurgery: The IMPASSE Study
Authors: Sheehan Jason P. , Pikis Stylianos , Islim Abdurrahman , Mathieu David , Liscak Roman , Tripathi Manjul , Kondziolka Douglas S. , Bowden Greg N. , Lunsford L. Dade , Jenkinson Michael D.
Published: March 2022

INTRODUCTION:

The optimal management of patients with an incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and SRS management of asymptomatic meningioma patients.

METHODS:

Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups.

RESULTS:

In unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (p<0.001; OR 56.860 (95% CI 26.253–123.150)). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (p=0.764; OR 0.890 (95% CI 0.416–1.904)). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (p<0.001; OR 94.461 (95% CI 23.082-386.568)). In matched cohorts, new neurological deficits were noted in 2.3% of SRS treated and 3.2% of conservatively managed patients (p=0.475; OR 0.700 (95% CI 0.263–1.863)).

CONCLUSION:

SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.
155 TERT Promoter Mutation Analysis for Blood-based Diagnosis and Monitoring of Gliomas
Authors: Yekula Anudeep , Muralidharan Koushik , Balaj Leonora , Carter Bob S.
Published: March 2022

INTRODUCTION:

Liquid biopsy offers a minimally invasive tool to diagnose and monitor the heterogeneous molecular landscape of tumors over time and therapy. Detection of TERT promoter mutations (C228T, C250T) in cfDNA has been successful for some systemic cancers but has yet to be demonstrated in gliomas, despite the high prevalence of these mutations in glioma tissue (>60% of all tumors).

METHODS:

Here, we developed a novel digital droplet PCR (ddPCR) assay that incorporates features to improve sensitivity and allows for the simultaneous detection and longitudinal monitoring of two TERT promoter mutations (C228T and C250T) in cfDNA from the plasma of patients with glioma.

RESULTS:

In baseline performance in tumor tissue, the assay had perfect concordance with an independently performed clinical pathology laboratory assessment of TERT promoter mutations in the same tumor samples [95% confidence interval (CI), 94%-100%]. Extending to matched plasma samples, we detected TERT mutations in both discovery and blinded multi-institution validation cohorts with an overall sensitivity of 62.5% (95% CI, 52%-73%) and a specificity of 90% (95% CI, 80%-96%) compared with the gold-standard tumor tissue-based detection of TERT mutations. Upon longitudinal monitoring in 5 patients, we report that peripheral TERT-mutant allele frequency reflects the clinical course of the disease, with levels decreasing after surgical intervention and therapy and increasing with tumor progression.

CONCLUSION:

Our results demonstrate the feasibility of detecting circulating cfDNA TERT promoter mutations in patients with glioma with clinically relevant sensitivity and specificity.
161 Return to Work Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System
Authors: Ayling Oliver G. S. , Dea Nicolas , Charest-Morin Raphaële , Fisher Charles
Published: March 2022

INTRODUCTION:

Canada has a universal health care system that is funded by the government. In contrast, the United States utilizes a combined public and private payer system where patients may directly access specialists.

METHODS:

Surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry and were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study.Patient reported outcomes (PROs) and return to work were compared at 3 months and 1 year post-operatively were analyzed.

RESULTS:

The CSORN cohort consisted of 157 patients and the SPORT cohort was made up of 397 patients that were actively working at the time of surgery. The rate of depression (9.1% vs. 16.5%, p = 0.016) and symptom duration greater than 6 months were higher in the CSORN cohort (23.4% vs. 73.2%, p < 0.0001). 100% of the CSORN cohort had public insurance compared to 1% in the SPORT cohort (p < 0.001) and patients in the CSORN group were more likely to have compensation claims (17.8% vs. 9.1%, p = 0.0049). CSORN patients had better baseline ODI and SF36/12-PCS scores (ODI: 50.9 ± 19.7 vs. 45.8 ± 14.9, p = 0.0031; SF36/12 PCS: 29.9 ± 7.9 vs. 35.7 ± 7.4, p < 0.001). At 3 months post-operatively the rate of patients that had returned to work was significantly lower in the CSORN cohort (47.8% vs. 72.8%, p < 0.0001), but was not different at 12-months post-operatively (86.7% vs. 91.6%, p = 0.11). Membership in the CSORN cohort and compensation claims were significant independent predictors of not returning to work at 3-months post-operatively on multivariable logistic regression (OR 0.16, 95% CI 0.09-0.29, p < 0.001; OR 0.47, 95% CI 0.26-0.85, p = 0.012).

CONCLUSION:

Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) had a lower rate of return to work at 3 months but not 1 year post-operatively compared to the United States cohort (SPORT) despite better disability scores prior to surgery.
169 Individual Differences in Postoperative Recovery Trajectories for Adult Symptomatic Lumbar Scoliosis
Authors: Greenberg Jacob K. , Bridwell Keith , Landman Joshua , Bess Shay , Smith Justin S. , Lenke Lawrence , Shaffrey Christopher I. , Kelly Michael
Published: March 2022

INTRODUCTION:

The Adult Symptomatic Lumbar Scoliosis-1 (ASLS-1) trial demonstrated the overall benefit of ASLS surgery. However, the extent to which individuals differ in their postoperative recovery trajectories is unknown.

METHODS:

We included adult patients that underwent surgical treatment as part of the ASLS-1 study. We used multilevel models to analyze postoperative recovery trajectories in Oswestry Disability Index (ODI) and Scoliosis Research Society-22 (SRS-22) sub-scores, which were measured every three months until two years after surgery. The impact of baseline disability was measured using the conditional R2, which measured the variance explained by allowing each patient to have their own intercept (i.e., baseline disability). In addition, we created multilevel, multivariable models that identified the most influential trajectory moderators, including radiographic, comorbidity, pain/function, demographic, and surgical factors. The performance of these models was quantified using the marginal R2, which represented the amount of variability in ODI/SRS-22 collectively explained by each model.

RESULTS:

Among 178 included patients, there was substantial variability in recovery trajectories. Applying the average trajectory to each patient explained 15% of the variability in ODI and 21% of the variability in SRS sub-scores. However, accounting for differences in baseline disability levels explained an additional 56-57% of the variability in recovery trajectories. The final model predicting recovery trajectory for ODI explained 50% of the variability in recovery trajectories. The final model for SRS-22 explained 57% of the variability in recovery trajectories.

CONCLUSION:

ASLS patients have highly variable postoperative recovery trajectories, largely related to differences in baseline disability but also impacted by moderators such as number of levels fused.
170 An Integrated Voice Recognition and Natural Language Processing Platform to Automatically Extract Thoracolumbar Injury Classification Score (TLICS) Features from Radiology Reports
Authors: Bhandarkar Archis R. , Onyedimma Chiduziem , Jarrah Ryan , Fu Sunyang , Liu Hongfang , Bydon Mohamad
Published: March 2022

INTRODUCTION:

Many predictive models have been reported in the literature for clinical outcomes after spine surgery. However, the real-time implementation of these predictive scores in clinical practice is limited by the time intenstive nature of manually abstracting relevant predictors from the electronic health record. Natural language processing (NLP) provides a framework to automate data abstraction for commonly used predictive scores in spine surgery.

METHODS:

We retrieved and annotated the radiology reports of all Mayo Clinic patients with an International Classification of Diseases(ICD)-9/10 code corresponding to a fracture of the thoracolumbar spine between January 2005 and October 2020. Annotated data was used to train an n-gram NLP model using machine learning (ML) methods including random forest(RF), stepwise linear discriminant analysis (sLDA), k-nearest neighbors (kNN), and penalized logistic regression (pLR) models.

RESULTS:

1,085 spine radiology reports were included in our analysis consististing of 868 to train our ML-NLP model and 217 for validation. Our dataset included 483 compression, 401 burst, 103 translational/rotational, and 98 distraction fractures. 103 reports had documented an injury of the PLC. The overall accuracy of the RF model for fracture morphology feature detection was 76.96% versus 65.90% in the stepwise LDA, 50.69% in the kNN, and 62.67% in the pLR. The overall accuracy to detect PLC integrity was highest in the RF model at 83.41% versus 70.97% in sLDA, 70.05% in kNN, and 67.74% in pLR model. Our RF model was implemented in the backend of a web application where users can dictate reports and have TLICS score features be automatically extracted.

CONCLUSION:

We have developed a robust ML-NLP model for extracting TLICS score features from radiology reports, which we deployed in a convenient web application that can be integrated prospectively into clinical practice and scaled to other commonly used predictive scores.