bluuebunny/crossref_metadata_2025_split huggingface dataset:
Planning Brain Tumor Resection Using a Probabilistic Atlas of Cortical and Subcortical Structures Critical for Functional Processing: A Proof of Concept
Authors: Sarubbo Silvio , Annicchiarico Luciano , Corsini Francesco , Zigiotto Luca , Herbet Guillaume , Moritz-Gasser Sylvie , Dalpiaz Chiara , Vitali Luca , Tate Matthew , De Benedictis Alessandro , Amorosino Gabriele , Olivetti Emanuele , Rozzanigo Umberto , Petralia Benedetto , Duffau Hugues , Avesani Paolo 
Published: December 2020

Abstract

BACKGROUND
Functional preoperative planning for resection of intrinsic brain tumors in eloquent areas is still a challenge. Predicting subcortical functional framework is especially difficult. Direct electrical stimulation (DES) is the recommended technique for resection of these lesions. A reliable probabilistic atlas of the critical cortical epicenters and subcortical framework based on DES data was recently published.

OBJECTIVE
To propose a pipeline for the automated alignment of the corticosubcortical maps of this atlas with T1-weighted MRI.

METHODS
To test the alignment, we selected 10 patients who underwent resection of brain lesions by using DES. We aligned different cortical and subcortical functional maps to preoperative volumetric T1 MRIs (with/without gadolinium). For each patient we quantified the quality of the alignment, and we calculated the match between the location of the functional sites found at DES and the functional maps of the atlas.

RESULTS
We found an accurate brain extraction and alignment of the functional maps with both the T1 MRIs of each patient. The matching analysis between functional maps and functional responses collected during surgeries was 88% at cortical and, importantly, 100% at subcortical level, providing a further proof of the correct alignment.

CONCLUSION
We demonstrated quantitatively and qualitatively the reliability of this tool that may be used for presurgical planning, providing further functional information at the cortical level and a unique probabilistic prevision of distribution of the critical subcortical structures. Finally, this tool offers the chance for multimodal planning through integrating this functional information with other neuroradiological and neurophysiological techniques.
Clinical utility of correction factors for febrile young infants with traumatic lumbar punctures
Authors: Rogers Sarah , Gravel Jocelyn , Anderson Gregory , Papenburg Jesse , Quach Caroline , Burstein Brett 
Published: December 2020

Abstract

Objectives
Correction factors have been proposed for traumatic lumbar punctures (LPs) in febrile young infants. However, no studies have assessed their diagnostic utility. We sought to determine the proportion of traumatic LPs safely reclassified as low risk for bacterial meningitis using recently derived white blood cell (WBC) and protein correction factors.

Methods
We retrospectively analyzed traumatic LPs among all febrile infants ≤60 days old at two tertiary paediatric hospitals from 2006 through 2018. Traumatic LPs were defined as ≥10,000 RBCs/mm3. Abnormal cerebrospinal fluid (CSF) WBCs and protein were adjusted downward using a newly derived correction factor (877 red blood cells [RBCs]: 1 WBC), three commonly used correction factors (500 WBCs: 1 RBC; 1,000 WBCs: 1 WBC; peripheral RBCs: WBCs), and a newly derived protein correction factor (1,000 RBCs: 0.011 g/L protein).

Results
There were 437 traumatic LPs including 357 (82%) with pleocytosis and 4 (0.9%) with bacterial meningitis. Overall, fewer infants were classified as having CSF pleocytosis using 877:1 and 1,000:1 ratios (38% and 43%, respectively), with 100% sensitivity and negative predictive value, and improved specificity (63% for 877:1, 58% for 1,000:1 ratios versus 19% for uncorrected counts). Among infants with pleocytosis, 877:1 and 1,000:1 ratios reclassified 191 (54%) and 171 (48%) as normal with no misclassified bacterial meningitis cases. Ratios of 500:1 and peripheral RBC:WBC misclassified 1 infant that had bacterial meningitis. Corrected CSF protein outperformed uncorrected protein in specificity but did not add diagnostic value following WBC-based correction.

Conclusions
Correction ratios of 877:1 and 1,000:1 safely reclassified half of all febrile infants ≤60 days. These corrections should be considered when interpreting CSF results of traumatic LPs.
Fifth metatarsal fractures in skeletally immature patients do not need routine orthopedic surgeon assessment and follow-up
Authors: Meschino Danielle , Adamich John , Rioux Trottier Eliane , Camp Mark 
Published: December 2020

Abstract

Objectives
The aim of this study was to determine the rate of delayed or nonunion of fifth metatarsal fractures in skeletally immature patients. Using this information, we sought to develop an evidence-based clinical care pathway in order to mitigate unnecessary patient radiation exposure, costs to families, and costs to the health system.

Methods
We retrospectively reviewed the charts and radiographs of patients who presented to an academic tertiary-care paediatric hospital between 2009 and 2014 with isolated fifth metatarsal fractures.

Results
A total of 114 patients (61 males and 53 females) with mean age of 11.2 (SD 3.0) years old were included in the study. No patients required operative management. There was one case of delayed union and no cases of nonunion. There was no association of these complications with fracture type, location, or mechanism of injury. There was no association of complications with immobilization type or immobilization period. Despite the low complication rate and need for surgery, fracture clinic resource utilization was significant. Fractures were managed with a mean number of 3.1 (SD 0.89) clinic visits and a mean number of 2.7 (SD1.0) radiology department visits where a mean total of 7.9 (SD 3.4) x-rays were performed.

Conclusions
Based on our retrospective review, skeletally immature patients presenting with isolated fifth metatarsal fractures have a very low rate of delayed or nonunion. A selective follow-up strategy will decrease radiation exposure, reduce costs to families and the healthcare system, without compromising clinical outcomes.
Comparison of Five Lists to Identify Potentially Inappropriate Use of Non-Steroidal Anti-Inflammatory Drugs in Older Adults
Authors: Nguyen Thi Ngoc Mai , Laetsch Dana Clarissa , Chen Li-Ju , Holleczek Bernd , Meid Andreas D , Brenner Hermann , Schöttker Ben 
Published: December 2020

AbstractObjectiveTo compare the prevalence of potentially inappropriate non-steroidal anti-inflammatory drugs (NSAIDs) among NSAIDs users defined with frequently used potentially inappropriate medication (PIM) lists and to identify the determinants of their use.Design and SettingCross-sectional survey among community-dwelling older adults from Germany.SubjectsN = 284 NSAIDs users aged 65–89 years.MethodsAll currently regularly or as-needed used drugs were recorded during a home visit. Multivariate logistic regression models were applied to assess the potential determinants of potentially inappropriate NSAIDs use.ResultsPrevalence of potentially inappropriate NSAIDs use was 54.2%, 45.4%, 29.9%, 20.4%, and 3.5% when applying the STOPP, 2019 Beers, EU(7)-PIM, FORTA, and PRISCUS list, respectively. No study participant was identified as a potentially inappropriate NSAIDs user by all five lists simultaneously. The majority (68%) were identified only by one or two lists. Merely the STOPP and Beers criteria had a moderate inter-instrument agreement. Lower pain severity, gout, peptic ulcer (PU), cardiovascular disease (CVD), and chronic kidney disease (CKD) were statistically significantly associated with potentially inappropriate NSAIDs use defined by the STOPP criteria and the latter three conditions also with the 2019 Beers criteria.ConclusionsThe STOPP and Beers criteria may be superior to the other lists because they more frequently identify potentially inappropriate NSAIDs use in conditions implying a high risk for NSAIDs' adverse events (i.e., PUD, CKD and CVD). We developed a harmonized, country-independent PIM list for NSAIDs with the same advantages as observed for the STOOP and 2019 Beers criteria and recommended its use.
What does the COVID-19 pandemic mean for the next decade of onchocerciasis control and elimination?
Authors: Hamley Jonathan I D , Blok David J , Walker Martin , Milton Philip , Hopkins Adrian D , Hamill Louise C , Downs Philip , de Vlas Sake J , Stolk Wilma A , Basáñez Maria-Gloria 
Published: December 2020

Abstract

Background
Mass drug administration (MDA) of ivermectin for onchocerciasis has been disrupted by the coronavirus disease 2019 (COVID-19) pandemic. Mathematical modelling can help predict how missed/delayed MDA will affect short-term epidemiological trends and elimination prospects by 2030.

Methods
Two onchocerciasis transmission models (EPIONCHO-IBM and ONCHOSIM) are used to simulate microfilarial prevalence trends, elimination probabilities and age profiles of Onchocerca volvulus microfilarial prevalence and intensity for different treatment histories and transmission settings, assuming no interruption, a 1-y (2020) interruption or a 2-y (2020–2021) interruption. Biannual MDA or increased coverage upon MDA resumption are investigated as remedial strategies.

Results
Programmes with shorter MDA histories and settings with high pre-intervention endemicity will be the most affected. Biannual MDA is more effective than increasing coverage for mitigating COVID-19’s impact on MDA. Programmes that had already switched to biannual MDA should be minimally affected. In high-transmission settings with short treatment history, a 2-y interruption could lead to increased microfilarial load in children (EPIONCHO-IBM) and adults (ONCHOSIM).

Conclusions
Programmes with shorter (annual MDA) treatment histories should be prioritised for remedial biannual MDA. Increases in microfilarial load could have short- and long-term morbidity and mortality repercussions. These results can guide decision-making to mitigate the impact of COVID-19 on onchocerciasis elimination.
Tuning intrinsic disorder predictors for virus proteins
Authors: Almog Gal , Olabode Abayomi S , Poon Art F Y 
Published: December 2020

Abstract
Many virus-encoded proteins have intrinsically disordered regions that lack a stable, folded three-dimensional structure. These disordered proteins often play important functional roles in virus replication, such as down-regulating host defense mechanisms. With the widespread availability of next-generation sequencing, the number of new virus genomes with predicted open reading frames is rapidly outpacing our capacity for directly characterizing protein structures through crystallography. Hence, computational methods for structural prediction play an important role. A large number of predictors focus on the problem of classifying residues into ordered and disordered regions, and these methods tend to be validated on a diverse training set of proteins from eukaryotes, prokaryotes, and viruses. In this study, we investigate whether some predictors outperform others in the context of virus proteins and compared our findings with data from non-viral proteins. We evaluate the prediction accuracy of 21 methods, many of which are only available as web applications, on a curated set of 126 proteins encoded by viruses. Furthermore, we apply a random forest classifier to these predictor outputs. Based on cross-validation experiments, this ensemble approach confers a substantial improvement in accuracy, e.g., a mean 36 per cent gain in Matthews correlation coefficient. Lastly, we apply the random forest predictor to severe acute respiratory syndrome coronavirus 2 ORF6, an accessory gene that encodes a short (61 AA) and moderately disordered protein that inhibits the host innate immune response. We show that disorder prediction methods perform differently for viral and non-viral proteins, and that an ensemble approach can yield more robust and accurate predictions.
Drilling Speed and Bone Temperature of a Robot-assisted Ultrasonic Osteotome Applied to Vertebral Cancellous Bone
Authors: Lang Zhao , Wang Qilong , Wu Xinfeng , Liu Yajun , He Da , Fan Mingxing , Shi Zhan , Tian Wei 
Published: December 2020

Study Design.
An experimental investigation of a robot-assisted ultrasonic osteotome applied to vertebral cancellous bone.

Objective.
The aim of this study was to investigate the effect of various ultrasonic parameter settings on temperature in the drilling site and penetration time and determine the most suitable parameters for efficient and safe robot-based ultrasonically assisted bone drilling in spinal surgery

Summary of Background Data.
A robot-assisted ultrasonic osteotome device may be safe and effective for spinal drilling.

Methods.
Sixty specimens of bovine vertebral cancellous were randomly assigned to one of six groups, which varied by mode of ultrasonic vibration (L-T and L) and feed rate (one percent [0.8 mm/s], two percent [1.6 mm/s], and three pecent [2.4 mm/s]). Maximum temperature in the drilling site and penetration time was recorded.

Results.
Maximum temperature in the drilling site decreased as output power increased for L-T and L modes, was significantly lower for L-T compared to L mode at each feed rate and power setting, was significantly different at feed rates of 1.6 mm/s versus 0.8 mm/s and 2.4 mm/s versus 0.8 mm/s for L-T mode at an output power of 60 W and 84 W, but was not influenced by feed rate for L mode. Penetration time did not significantly improve as output power increased for both L-T and L modes, was significantly decreased with increased feed rates, but was not significantly different between L-T and L modes.

Conclusion.
The optimal parameters for applying a robot-assisted ultrasonic osteotome to vertebral cancellous bone are L-T mode, maximum output power of 120 W, and maximum feed rate of 2.4 mm/s.

Level of Evidence: 4
“July Effect” Revisited: July Surgeries at Residency Training Programs are Associated with Equivalent Long-term Clinical Outcomes Following Lumbar Spondylolisthesis Surgery
Authors: Chan Andrew K. , Patel Arati B. , Bisson Erica F. , 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 R. , Asher Anthony L. , Virk Michael S. , Kerezoudis Panagiotis , Alvi Mohammed A. , Guan Jian , Choy Winward , Haid Regis W. , Mummaneni Praveen V. 
Published: December 2020

Study Design.
Retrospective analysis of a prospective registry.

Objective.
We utilized the Quality Outcomes Database (QOD) registry to investigate the “July Effect” at QOD spondylolisthesis module sites with residency trainees.

Summary of Background Data.
There is a paucity of investigation on the long-term outcomes following surgeries involving new trainees utilizing high-quality, prospectively collected data.

Methods.
This was an analysis of 608 patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Surgeries were classified as occurring in July or not in July (non-July). Outcomes collected included estimated blood loss, length of stay, operative time, discharge disposition, complications, reoperation and readmission rates, and patient-reported outcomes (Oswestry Disability Index [ODI], Numeric Rating Scale [NRS] Back Pain, NRS Leg Pain, EuroQol-5D [EQ-5D] and the North American Spine Society [NASS] Satisfaction Questionnaire). Propensity score-matched analyses were utilized to compare postoperative outcomes and complication rates between the July and non-July groups.

Results.
Three hundred seventy-one surgeries occurred at centers with a residency training program with 21 (5.7%) taking place in July. In propensity score-matched analyses, July surgeries were associated with longer operative times ( average treatment effect = 22.4 minutes longer, 95% confidence interval 0.9–449.0, P = 0.041). Otherwise, July surgeries were not associated with significantly different outcomes for the remaining perioperative parameters (estimated blood loss, length of stay, discharge disposition, postoperative complications), overall reoperation rates, 3-month readmission rates, and 24-month ODI, NRS back pain, NRS leg pain, EQ-5D, and NASS satisfaction score (P > 0.05, all comparisons).

Conclusion.
Although July surgeries were associated with longer operative times, there were no associations with other clinical outcomes compared to non-July surgeries following lumbar spondylolisthesis surgery. These findings may be due to the increased attending supervision and intraoperative education during the beginning of the academic year. There is no evidence that the influx of new trainees in July significantly affects long-term patient-centered outcomes.

Level of Evidence: 3
Snare Tip Is an Alternative Tool for Colorectal Endoscopic Submucosal Dissection
Authors: Wu Chih-Chien , Chang Min-Chi , Lee Ming-Hung , Hsu Chiao-Hui , Hsu Chao-Wen 
Published: December 2020

BACKGROUND:
Colorectal endoscopic submucosal dissection is typically performed by specialized knife, such as a dual knife. However, it is not covered by Taiwan’s National Health Insurance. In the literature review, using a traditional snare tip for endoscopic submucosal dissection has been reported for stomach lesions only.

OBJECTIVE:
The purpose of this study was to evaluate the outcomes of colorectal endoscopic submucosal dissection using a snare tip.

DESIGN:
We retrospectively reviewed the clinical using of a snare tip compared with a dual knife for colorectal endoscopic submucosal dissection. Postoperative short- and long-term outcomes were investigated after the procedure.

SETTINGS:
This study was conducted at a single tertiary care institution.

PATIENTS:
Patients who could not afford the expense of a specialized knife were included.

MAIN OUTCOME MEASURES:
Dissection time, dissection speed, and perioperative complications were used for short-term outcome measurement. Recurrence-free rate was used for long-term outcome measurement.

RESULTS:
Twenty-one lesions were in the snare tip group and 57 lesions in the dual knife group. The outcomes, including rate of en bloc resection, complication, local recurrence, and recurrence-free interval, between the 2 groups were similar. The mean resected specimen diameter in the dual knife group is larger than the snare tip group (p = 0.041). The dissection time of the snare tip group was shorter than the dual knife group (p = 0.025). However, the dissection speed was significantly slower in the snare tip group than in the dual knife group (p = 0.008).

LIMITATIONS:
This study was a retrospective and single doctor chart review in nature with a limited patient number.

CONCLUSIONS:
The snare tip is an alternative tool for colorectal endoscopic submucosal dissection in a selected population without the support of specialized knives, such as the dual knife. Although the dissection speed is slower using a snare tip, it is still a recommended technique for developing country or low-income patients.
Effects of digital learning in anaesthesiology
Authors: Shih Yu-Chih D. , Liu Chih-Chung , Chang Chuen-Chau , Lee Yuan-Wen 
Published: December 2020

BACKGROUND
Digital methods of instruction have proven to be effective in assisting learning in many fields at various levels. However, none of the meta-analyses have studied the effects of digital learning vs. traditional learning in the field of anaesthesiology.

OBJECTIVE
We conducted a meta-analysis to review the role of digital learning in anaesthesiology by comparing the effect sizes of the involved studies.

DESIGN
A systematic review and meta-analysis of randomised controlled trials and assessment of the quality of evidence by the Medical Education Research Study Quality Instrument.

DATA SOURCES
Educational databases (EBSCOhost and LearnTechLib) and medical databases (PubMed, Embase and Cochrane) were searched from January 1998 to February 2019.

ELIGIBILITY CRITERIA
We conducted a search by using key words related to digital learning and anaesthesiology. Articles that compared traditional instruction and digital instruction methods for learners in anaesthesiology were considered.

RESULTS
The 15 studies involved 592 trainees from the field of anaesthesiology. Considering substantial heterogeneity (I
2 = 73%), a random-effect model was used. Pooled effect size presented a standardised mean deviation of 0.79, P < 0.001, indicating a statistically significant difference between traditional and digital learning groups, favouring the digital learning group. Results of subgroup analyses showed that using clinical performance to measure learning outcomes exhibited no heterogeneity, digital learning method was more consistent and effective for anaesthetic professionals, and the digital learning method was more effective than traditional learning method in the studies teaching the instructional contents of echocardiography and clinical scenarios.

CONCLUSION
The current study demonstrated positive effects of digital instruction in the field of anaesthesiology. Training through digital materials may assist professional training between the stages of didactic training and clinical training.
RECALCITRANT CYSTOID MACULAR EDEMA? BILATERAL INTRARETINAL HYPOREFLECTIVE SPACES ON SD-OCT AS A PRESENTATION OF A PITUITARY MACROADENOMA
Authors: Wu Andres , Wu Lihteh 
Published: December 2020

Purpose:
To report a case of a pituitary macroadenoma that presented with bilateral intraretinal hyporeflective spaces located primarily in the inner nuclear layer on the macular SD-optical coherence tomography.

Methods:
Case report.

Results:
Based on the findings of a macular SD-optical coherence tomography, a 53-year-old man was considered as having cystoid macular edema secondary to a retinovascular condition. He was treated with intravitreal vascular endothelial growth factor inhibitors and corticosteroids with no improvement. Confrontation visual fields suggested a bitemporal defect. MRI confirmed the presence of a nonsecreting pituitary macroadenoma compressing the optic chiasm.

Conclusion:
Not all intraretinal hyporeflective spaces in the optical coherence tomography are secondary to a retinal vascular condition. Hyporeflective spaces in the inner nuclear layer on optical coherence tomography imaging that do not leak on fluorescein angiography may be secondary to optic atrophy from chiasmal compression.
MULTI-MODAL IMAGING IN DIFFUSE SUBRETINAL FIBROSIS WITH UVEITIS SYNDROME
Authors: Moll-Udina Aina , Alba-Linero Carmen , Llorenç Victor , Adán Alfredo 
Published: December 2020

Purpose:
To describe clinical features including multimodal imaging in a case of diffuse subretinal fibrosis and uveitis syndrome.

Methods:
A young patient presented with counting fingers in both eyes due to posterior uveitis and unresponsive to systemic corticosteroids. Ultra-wide field pseudo-color and autofluorescence imaging, optical coherence tomography angiography (OCT-A), en-face OCT-A, and spectral-domain optical coherence were performed.

Results:
Clinical examination revealed a bilateral fibrosis plaque in both fovea and macular multifocal choroidal lesions associated, with no vitritis. Ultra-wide field-autofluorescence allowed us to determine activity showing a hyperfluorescent pattern. En-face OCT-A at the level of the ellipsoid layer showed multiple hyperreflective lesions surrounding a hyperreflective fibrosis plaque in both eyes, which improved and stabilized during the follow-up. Optical coherence tomography angiography at the level of retina pigmentary epithelium-choriocapillaris revealed neocapillary network changes along the chronification of the disease. The patient required the addition of intravitreal dexamethasone implants (Ozurdex) to control the acute rebounds and anti-TNFα to control the underlying inflammatory process.

Conclusion:
This is the first diffuse subretinal fibrosis with uveitis syndrome reported with a complete En-face OCT-A and OCT-A examination. This multi-modal imaging will improve the monitoring of the disease's activity and the chronicity changes.