bluuebunny/crossref_metadata_2025_split huggingface dataset:
Braces Designed Using CAD/CAM Combined or Not With Finite Element Modeling Lead to Effective Treatment and Quality of Life After 2 Years
Authors: Guy Aymeric , Labelle Hubert , Barchi Soraya , Audet-Duchesne Elisabeth , Cobetto Nikita , Parent Stefan , Raison Maxime , Aubin Carl-Éric 
Published: September 2020

Study Design.
Single-center prospective randomized controlled trial.

Objective.
The aim of this study was to assess the computer-aided design/manufacturing (CAD/CAM) brace design approach, with and without added finite element modeling (FEM) simulations, after 2 years in terms of clinical outcomes, 3D correction, compliance, and quality of life (QoL).

Summary of Background Data..
Previous studies demonstrated that braces designed using a combination of CAD/CAM and FEM induced promising in-brace corrections, were lighter, thinner, and covered less trunk surface. Yet, their long-term impact on treatment quality has not been evaluated.

Methods.
One-hundred twenty adolescent idiopathic scoliosis patients were recruited following Scoliosis Research Society standardized criteria for brace treatment; 61 patients in the first subgroup (CAD) were given braces designed using CAD/CAM; 59 in the second subgroup (CAD-FEM) received braces additionally simulated and refined using a patient-specific FEM built from 3D reconstructions of the spine, rib cage and pelvis. Main thoracic (MT) and thoraco-lumbar/lumbar (TL/L) Cobb angles, sagittal curves, and apical rotations were compared at the initial visit and after 2 years. Patient compliance and QoL were tracked respectively by using embedded temperature sensors and SRS-22r questionnaires.

Results.
Forty-four patients with CAD-FEM braces and 50 with CAD braces completed the study. Average in-brace correction was 9° MT (8° CAD-FEM, 10° CAD, P = 0.054) and 12° TL/L (same for both subgroups, P = 0.91). Out-of-brace 2-year progression from initial deformity was <4° for all 3D measurements. Sixty-six percent of all cases (30 CAD-FEM, 35 CAD) met the ≤5° curve progression criterion, 83% (38 CAD-FEM, 43 CAD) stayed <45°, and 6% (5 CAD-FEM, 1 CAD) underwent fusion surgery. 3D correction, compliance, and QoL were not significantly different between both subgroups (P > 0.05).

Conclusion.
After 2 years, patients with braces designed using CAD/CAM with/without FEM had satisfying clinical outcomes (compared to the BrAIST study), 3D corrections, compliance and QoL. A more comprehensive optimization of brace treatment remains to be accomplished.

Level of Evidence: 2
Novel Nomograms as Aids for Predicting Recurrence and Survival in Chordoma Patients
Authors: Meng Tong , Huang Runzhi , Hu Peng , Yin Huabin , Lin Shaojian , Qiao Suchi , Wang Renkai , Wang Jing , Cai Zhengdong , Huang Zongqiang , Cheng Liming , Song Dianwen 
Published: September 2020

Study Design.
A retrospective data analysis was performed.

Objective.
The aim of this study is to explore the significant prognostic factors and propose new nomograms to facilitate clinical decision-making.

Summary of Background Data.
Chordoma is a rare bone tumor. The clinical features and optimal therapeutic strategies are still uncertain.

Methods.
Chordoma patients treated in four medical centers of mainland China before January 2015 were included. The predictors for local relapse-free survival (LRFS) and overall survival (OS) were identified by the Lasso regression and Cox proportional hazards regression model. Then the nomograms were developed. Their discrimination, calibration, and accuracy were evaluated by the C-index, calibration curve, and receiver operating characteristic curve (ROC), respectively.

Results.
A total of 341 patients were identified and full prognostic variable data were available for 276 patients. A total of 179 patients (64.9%) experienced recurrence and 122 patients (44.2%) died of all causes with a median follow-up time of 57.5 (range, 1–325) months. We identified recurrence-relevant factors of tumor size, tumor location, histology subtype and resection method, and death-relevant factors of tumor size, tumor location, resection method, complication, and postoperative recurrence. The constructed LRFS and OS nomograms showed good calibration and discriminative ability (C index 0.79 and 0.76, respectively). The ROCs suggested decent prediction ability with the 5-year area under curve (AUC) value of 0.868 and 0.786, respectively.

Conclusion.
Based on the multicenter case series of chordoma with a relative long follow-up, we proposed two nomograms to predict the prognosis on the basis of recurrence- and death-relevant factors. These findings could be referenced in the clinical decision-making process and provide additional prognostic information for risk stratification.

Level of Evidence: 4
Sports-related Cervical Spine Fracture and Spinal Cord Injury
Authors: Alas Haddy , Pierce Katherine E. , Brown Avery , Bortz Cole , Naessig Sara , Ahmad Waleed , Moses Michael J. , O’Connell Brooke , Maglaras Constance , Diebo Bassel G. , Paulino Carl B. , Buckland Aaron J. , Passias Peter G. 
Published: September 2020

Study Design.
Retrospective cohort study.

Objective.
Assess trends in sports-related cervical spine trauma using a pediatric inpatient database.

Summary of Background Data.
Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury (SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking.

Methods.
The Kid Inpatient Database was queried for patients with external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped for cervical spine injury (CSI) type, including C1–4 and C5–7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4–9), pre-adolescents (Pre, 10–13), and adolescents (14–17). Kruskall-Wallis tests with post-hoc Mann-Whitney U's identified differences in CSI type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries.

Results.
A total of 38,539 patients were identified (12.76 years, 24.5% F). Adolescents had the highest rate of sports injuries per year (P < 0.001). Adolescents had the highest rate of any type of CSI, including C1–4 and C5–7 fracture with and without SCI, dislocation, and SCIWORA (all P < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18×, C1-4 fx w/ SCI by 7.57×, C5-7 fx w/o SCI 4.11×, C5-7 w/SCI 3.63×, cervical dislocation 1.7×, and cervical SCIWORA 2.75×, all P < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (P < 0.001), and were associated with more SCIWORA (1.6% vs. 1.0%, P = 0.012), and football injuries increased odds of SCI by 1.56×. Concurrent TBI was highest in adolescents at 58.4% (pre: 26.6%, child: 4.9%, P < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports (odds ratio: 2.35 [1.77–3.11], P < 0.001).

Conclusion.
Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of CSI with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries.

Level of Evidence: 3
Cardiometabolic Profiles and Change in Neighborhood Food and Built Environment Among Older Adults
Authors: Shiba Koichiro , Hanazato Masamichi , Aida Jun , Kondo Katsunori , Arcaya Mariana , James Peter , Kawachi Ichiro 
Published: September 2020

Background:
The association between neighborhood environment and health may be biased due to confounding by residential self-selection. The displacement of disaster victims can act as a natural experiment that exposes residents to neighborhood environments they did not select, allowing for the study of neighborhood effects on health.

Methods:
We leveraged data from a cohort of older adults 65 years of age or older living in Iwanuma, Japan, located 80 km west of the 2011 Great East Japan Earthquake and Tsunami. Surveys were conducted 7 months before the disaster, as well as 2.5 and 5.5 years afterward, and linked with medical records. We classified each individual’s type of exposure to neighborhood environment based on proximity to local food and recreation destinations and walkability.

Results:
Fixed-effect models indicated that change in the exposure type from low to high urban density was associated with increased body mass index (0.46 kg/m2; 95% confidence interval [CI] = 0.20, 0.73), waist circumference (1.8 cm; 95% CI = 0.56, 3.0), low-density lipoprotein cholesterol (11 mg/dl; 95% CI = 5.0, 17), and decreased high-density lipoprotein cholesterol (−3.1 mg/dl; 95% CI = −5.0, −1.3). We observed similar trends when we analyzed only the individuals who experienced postdisaster relocation to temporary homes.

Conclusions:
Increased proximity to food outlets was simultaneously correlated with greater walkability and accessibility to recreational destinations; however, any protective association of physical activity-promoting built environment appeared to be offset by proximity to unhealthy food outlets, especially fast-food restaurants and bars.
LONGITUDINAL ELLIPSOID ZONE DYNAMICS AFTER MACULAR HOLE REPAIR IN THE DISCOVER STUDY
Authors: Sevgi Duriye Damla , Yee Philina S. , Srivastava Sunil K. , Le Thuy K. , Abraham Joseph R. , Reese Jamie , Ehlers Justis P. 
Published: September 2020

Purpose:
To evaluate association of the baseline macular hole (MH) geometric features and longitudinal ellipsoid zone integrity with the visual acuity outcome after surgical repair.

Methods:
This was a post-hoc analysis of eyes in the DISCOVER study undergoing vitrectomy repair for MH. Anatomical and functional data were collected through one year postoperatively. An automated retinal layer segmentation platform was used for the assessment of outer retinal metrics and volumetric reconstruction of MH. Association of longitudinal ellipsoid zone features and baseline MH height, width, and volume with VA outcomes were investigated.

Results:
Eighty-four eyes with MH were included. The mean baseline VA was 20 of 114 and increased to 20 of 45 (P < 0.001) at postoperative Month 12 (N = 45). Successful MH closure was achieved in 98.8% of cases. Ellipsoid zone integrity metrics significantly improved from baseline (P = 0.002) and postoperative Month 1 (P < 0.001) to post-operative Month 12. Ellipsoid zone metrics independently correlated with VA at all follow-up visits (P < 0.05). Increased baseline MH width and volume negatively correlated with the VA at postoperative Month 12 (P < 0.001). Preoperative VA and EZ integrity on optical coherence tomography were predictors for postoperative VA.

Conclusion:
Baseline MH volumetric parameters and EZ parameters were associated with VA outcomes after repair.
VARYING OPTICAL COHERENCE TOMOGRAPHY APPEARANCE OF THE INNER CHOROID WITH AGE
Authors: Spaide Richard F. , Ledesma-Gil Gerardo , Mullins Robert F. 
Published: September 2020

Purpose:
To investigate the reflectivity of the structural optical coherence tomography images of the inner choroid as it relates to potential structural composition.

Methods:
The reflectivity of slab images 29 to 49 µm and 45 to 65 µm below the retinal pigment epithelium, obtained with the Zeiss Plex Elite 9000, was evaluated. The mean and SD of a group of subjects with no ocular disorders were determined. Binarization of the images was performed and a threshold level established at the mean plus one SD for each slab depth. The proportion of area binarized was evaluated with generalized estimating equations. Representative histologic images obtained from autopsy donors were stained with Masson's trichrome, a staining method helpful in evaluating collagen and ground substance of tissue.

Results:
There were 67 eyes of 38 subjects with a mean age of 44.5 (range 22–82) years. Using generalized estimating equations, age was found to be a significant predictor for the proportion of binarized pixels in both the 29 to 49 µm (P = 0.034) and the 45 to 65 µm (P < 0.001) slabs. The histologic specimens illustrated the loss of ground substance with increasing compaction of collagen fibers in the choroidal stroma with advancing age.

Conclusion:
The reflectivity from the inner choroid is not uniform and changes with age. As suggested by the histologic specimens, we propose the optical coherence tomography reflectance from the inner choroid is related, in part, to the packing density of collagen fibers present there.
MULTIMODAL IMAGING OF CRB1 RETINITIS PIGMENTOSA WITH A PERIPHERAL RETINAL TUMOR
Authors: Corvi Federico , Juhn Alexander , Corradetti Giulia , Nguyen Tieu Vy , Fawzi Amani A. , Sarraf David , Sadda SriniVas R. 
Published: September 2020

Purpose:
To report the multimodal imaging findings of a patient with gene-crumbs 1–associated retinitis pigmentosa (RP) characterized by preservation of para-arteriolar retinal pigment epithelium and a peripheral retinal tumor.

Methods:
A 27-year-old woman was referred to our center because of progressive decreased vision in both eyes with a diagnosis of gene-crumbs 1–associated RP. Fundus examination was remarkable for attenuated retinal vessels and bone spicule migration that was bilateral and symmetric. In addition, an elevated yellow–white mass with dilated retinal vessels was noted in the superotemporal midperiphery of the retina in the left eye without any associated exudation.

Results:
Diffuse retinal pigment epithelium mottling was present but spared the area along the retinal arterioles. Swept-source optical coherence tomography showed diffuse outer retinal atrophy. Optical coherence tomography angiography of the peripheral lesion illustrated extensive vascularity and a possible retinal feeder vessel communicating with the tumor at its inferior margin. The phenotype of the lesion showed overlap with a vasoproliferative tumor or an astrocytic hamartoma. Over a period of 5 years of follow-up, the peripheral tumor was unchanged. No significant progression of the peripheral retinal degeneration was evidenced by autofluorescent imaging over this time period although the central acuity continued to decrease.

Conclusion:
Gene-crumbs 1–associated RP may be characterized by preservation of the para-arteriolar retinal pigment epithelium and slow progression and may also feature a benign peripheral retinal tumor.
Albumin Saturated With Fatty Acids Prevents Decompensation in a Rat Hemorrhagic Shock Trauma Model With Tourniquet and Hypotensive Resuscitation
Authors: Penn Alexander H. , Dubick Michael A. , Torres Filho Ivo P. 
Published: September 2020

ABSTRACT
Decompensation is a major prehospital threat to survival from trauma/hemorrhage shock (T/HS) after controlling bleeding. We recently showed higher than expected mortality from a combat-relevant rat model of T/HS (27 mL/kg hemorrhage) with tourniquet (TQ) and permissive hypotensive resuscitation (PHR) with Plasmalyte. Mortality and fluid requirements were reduced by resuscitation with 25% albumin presaturated with oleic acid (OA-sat) compared with fatty-acid -free albumin or Plasmalyte. The objective of this follow-up analysis was to determine the role of decompensation and individual compensatory mechanisms in those outcomes. We observed two forms of decompensation: slow (accelerating fluid volumes needed to maintain blood pressure) and acute (continuous fluid administration unable to prevent pressure drop). Combined incidence of decompensation was 71%. Nearly all deaths (21 of 22) were caused by acute decompensations that began as slow decompensations. The best hemodynamic measure for predicting acute decompensation was diastolic arterial pressure. Decompensation was due to vascular decompensation rather than loss of cardiac performance. Albumin concentration was lower in decompensating groups, suggesting decreased stressed volume, which may explain the association of low albumin on admission with poor outcomes after trauma. Our findings suggest that acute decompensation may be common after trauma and severe hemorrhage treated with TQ and PHR and OA-sat albumin may benefit early survival and reduce transfusion volume by improving venous constriction and preventing decompensation.
Effect of Early Central Venous Catheterization on Mortality Among Patients with Severe Sepsis: A Nationwide Inpatient Database Study
Authors: Edakubo Shunsuke , Inoue Norihiko , Fushimi Kiyohide 
Published: September 2020

ABSTRACT

Background:
Clinical guidelines for the management of sepsis have accelerated the utilization of central venous catheterization (CVC). However, risks associated with CVC may be high in the initial phase of severe sepsis because of patient instability. The timing of CVC itself has not been fully evaluated. Therefore, we aimed to assess the association between CVC in the initial care of patients with severe sepsis and corresponding mortality rates.

Patients and Methods:
We conducted a nationwide retrospective analysis using the Japanese Diagnosis Procedure Combination database from April 1, 2014 to March 31, 2016. We identified patients who received CVC within 30 days from hospital admission. We compared the 30-day mortality between two groups: patients who received CVC within 2 days (early) after admission and those who received CVC 3 or more days (delayed) after admission, using marginal structural models with inverse probability treatment weighting.

Results:
We identified 6,028 eligible patients from 911 hospitals among 27,497 patients with severe sepsis for this study; 4,544 (75.4%) received early CVC. Patients with early CVC had poor prognostic baselines and received more intense treatment than patients with delayed CVC. After adjusting for baseline and time-dependent treatment variables, we found that there were no significant differences between patients who received CVC within 2 days after admission and those who received CVC 3 or more days after admission (hazard ratio 0.83, 95% confidence interval 0.62–1.10).

Conclusions:
Among patients with severe sepsis, early CVC was not associated with improved in-hospital mortality rates.
SARS-CoV-2 Uses CD4 to Infect T Helper Lymphocytes
Authors: Brunetti Natália S. , Davanzo Gustavo G. , de Moraes Diogo , Ferrari Allan J. R. , de Souza Gabriela F. , Muraro Stefanie P. , Knittel Thiago L. , Boldrini Vinícius O. , Monteiro Lauar B. , Virgilio-da-Silva João Victor , Profeta Gerson S. , Wassano Natália S. , Santos Luana N. , Carregari Victor C. , Dias Artur H. S. , Veras Flavio P. , Tavares Lucas A. , Forato Julia , Castro Ícaro , Silva-Costa Lícia C. , Palma Andre , Mansour Eli , Ulaf Raisa G. , Bernardes Ana F. , Nunes Thyago A. , Ribeiro Luciana C. , Agrela Marcus V. , Moretti Maria Luiza , Buscaratti Lucas I. , Crunfli Fernanda , Ludwig Raissa G. , Gerhardt Jaqueline A. , Munhoz-Alves Natália , Marques Ana M. , Sesti-Costa Renata , Amorim Mariene R. , Texeira Daniel A. T. , Parise Pierina L. , Martini Matheus C. , Bispo-dos-Santos Karina , Simeoni Camila L. , Granja Fabiana , Silvestrini Virginia C. , de Oliveira Eduardo B. , Faça Vitor M. , Carvalho Murilo , Castelucci Bianca G. , Pereira Alexandre B. , Coimbra Laís D. , Dias Marieli M. G. , Rodrigues Patricia B. , S. P. Gomes Arilson Bernardo , Pereira Fabricio B. , Santos Leonilda M. B. , Bloyet Louis-Marie , Stumpf Spencer , Pontelli Marjorie C. , Whelan Sean P. J. , Sposito Andrei C. , Carvalho Robson F. , Vieira Andre S. , Vinolo Marco A. R. , Damasio André , Velloso Licio A. , M. Figueira Ana Carolina , da Silva Luis L. P. , Cunha Thiago M. , Nakaya Helder I. , Marques-Souza Henrique , Marques Rafael E. , Martins-de-Souza Daniel , Skaf Munir S. , Proença-Modena José Luiz , Moraes-Vieira Pedro M. , Mori Marcelo A. , Farias Alessandro S. 
Published: September 2020

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as coronavirus disease-2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality1,2. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here we show that SARS-CoV-2 infects human CD4+T helper cells, but not CD8+T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS-CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.
Sleep apnoea is a risk factor for severe COVID-19
Authors: Strausz Satu , Kiiskinen Tuomo , Broberg Martin , Ruotsalainen Sanni E. , Koskela Jukka , Bachour Adel ,   FinnGen, Palotie Aarno , Palotie Tuula , Ripatti Samuli , Ollila Hanna M. 
Published: September 2020

AbstractObjectiveTo investigate if obstructive sleep apnoea (OSA) is an independent risk factor for severe COVID-19. To examine whether the risk for contracting COVID-19 is elevated among OSA patients.Design and settingRegistry based retrospective case-control study using Finnish nationwide health registries and the FinnGen Study cohort.ParticipantsInformation regarding OSA diagnosis and COVID-19 infection was extracted from the FinnGen study (N=260,405) with a total of 305 patients who had a recorded PCR-validated COVID-19 infection including 26 (8.5%) individuals who were also OSA patients. Severe COVID-19 (N=83; 27.2%) was defined as an infection requiring hospitalization. Among the hospitalized individuals there were 16 (19.3%) with OSA diagnosis. In addition, we also included in our analysis previously reported risk factors for both severe COVID-19 or risk factors and comorbidities for OSA from FinnGen.Main outcome measuresOSA diagnosis, information concerning COVID-19 infection such as hospitalization, were derived from Finnish National Hospital Discharge Registry, Causes of Death Registry and the National Infectious Diseases Registry.ResultsWe show that OSA is a risk factor for COVID-19 hospitalization independent from age, sex, body mass index (BMI), hypertension, diabetes, coronary heart disease (CHD), asthma and chronic obstructive pulmonary disease (COPD), (p-unadjusted=1.04×10−4, OR-adjusted=5.24 [95%CI 1.33 to 23.43], p-adjusted=0.022). OSA was not associated with the risk of contracting COVID-19 (p=0.49).ConclusionWhile an OSA patient’s risk of contracting COVID-19 is the same as non-OSA individuals, the OSA patients have a five-fold risk to be hospitalized when affected by COVID-19 than non-OSA individuals. Our findings suggest that, in assessment of patients with suspected or confirmed COVID-19 infection, OSA needs to be recognized as one of the comorbidity risk factors for developing a severe form of the disease.