bluuebunny/crossref_metadata_2025_split huggingface dataset:
EYE LENS DOSE OPTIMIZATION THROUGH GANTRY TILTING IN BRAIN CT SCAN: THE POTENTIAL EFFECT OF THE RADIOLOGICAL TECHNOLOGISTS’ TRAINING
Authors: Ebrahiminia Ali , Asadinezhad Mohsen , Mohammadi Fereshteh , Khoshgard Karim 
Published: April 2020

Abstract
This study was designed to evaluate the effect of the radiological technologists’ training on optimising the eye lens dose in brain computed tomography (CT) examinations. The lens dose of 50 adult patients was measured using thermoluminescent dosimeters before and after technologists’ training. Dose values of lenses, dose length product (DLP), volumetric CT dose index (CTDIvol) as well as image quality in terms of quantitative (contrast to noise ratio and signal to noise ratio) and subjective (artefact) parameters were compared before and after training. Lens dose values were 31.57 ± 9.84 mGy and 5.36 ± 1.53 mGy before and after training, respectively, which was reduced by ~83% (p &lt; 0.05). The values of DLP, CTDIvol and image quality parameters were not significantly different (p &gt; 0.05) and all images were diagnostically acceptable. Excluding the orbits from the scanning range is an efficient approach to optimize the lens dose; the training of the technologists has also a pivotal role in dose reducing.
Left behind, not alone: feeling, function and neurophysiological markers of self-expansion among left-behind children and not left-behind peers
Authors: Bi Chongzeng , Oyserman Daphna , Lin Ying , Zhang Jiyuan , Chu Binghua , Yang Hongsheng 
Published: April 2020

Abstract
Four in 10 young rural Chinese children are ‘left behind’ by parents migrating for economic opportunities. Left-behind children do as well academically and imagine as many possible futures for themselves as their peers, implying that they must compensate in some ways for loss of everyday contact with their parents. Three studies test and find support for the prediction that compensation entails self-expansion to include a caregiving grandmother rather than one’s mother in self-concept, as is typical in Chinese culture. We measured self-expansion with feeling, function and neurophysiological variables. Twelve-year-old middle school left-behind children (Study 1, N = 66) and 20-year-old formerly left-behind children (now in college, Studies 2 and 3, N = 162) felt closer to their grandmothers and not as close to their mothers as their peers. Self-expansion had functional consequence (spontaneous depth-of-processing) and left a neurophysiological trace (event-related potential, Study 3). Left-behind participants had enhanced recall for information incidentally connected to grandmothers (Studies 1 and 3, not Study 2). Our results provide important insights into how left-behind children cope with the loss of parental presence: they include their grandmother in their sense of self. Future studies are needed to test downstream consequences for emotional and motivational resilience.
Aryl Hydrocarbon Receptor Mediates Larval Zebrafish Fin Duplication Following Exposure to Benzofluoranthenes
Authors: Garland Michael A , Geier Mitra C , Bugel Sean M , Shankar Prarthana , Dunham Cheryl L , Brown Joseph M , Tilton Susan C , Tanguay Robyn L 
Published: April 2020

AbstractThe aryl hydrocarbon receptor (AHR) mediates developmental toxicity of several xenobiotic classes including polycyclic aromatic hydrocarbons. Using embryonic zebrafish, we previously identified 4 polycyclic aromatic hydrocarbons that caused a novel phenotype among AHR ligands—growth of a lateral, duplicate caudal fin fold. The window of sensitivity to the most potent inducer of this phenotype, benzo[k]fluoranthene (BkF), was prior to 36 h postfertilization (hpf), although the phenotype was not manifest until 60 hpf. AHR dependency via Ahr2 was demonstrated using morpholino knockdown. Hepatocyte ablation demonstrated that hepatic metabolism of BkF was not required for the phenotype, nor was it responsible for the window of sensitivity. RNA sequencing performed on caudal trunk tissue from BkF-exposed animals collected at 48, 60, 72, and 96 hpf showed upregulation of genes associated with AHR activation, appendage development, and tissue patterning. Genes encoding fibroblast growth factor and bone morphogenic protein ligands, along with retinaldehyde dehydrogenase, were prominently upregulated. Gene Ontology term analysis revealed that upregulated genes were enriched for mesoderm development and fin regeneration, whereas downregulated genes were enriched for Wnt signaling and neuronal development. MetaCore (Clarivate Analytics) systems analysis of orthologous human genes predicted that R-SMADs, AP-1, and LEF1 regulated the expression of an enriched number of gene targets across all time points. Our results demonstrate a novel aspect of AHR activity with implications for developmental processes conserved across vertebrate species.
Unisexual flower initiation in the monoecious Quercus suber L.: a molecular approach
Authors: Sobral Rómulo , Silva Helena Gomes , Laranjeira Sara , Magalhães Joana , Andrade Luís , Alhinho Ana Teresa , Costa Maria Manuela Ribeiro 
Published: April 2020

Abstract
Several plant species display a temporal separation of the male and female flower organ development to enhance outbreeding; however, little is known regarding the genetic mechanisms controlling this temporal separation. Quercus suber is a monoecious oak tree with accentuated protandry: in late winter, unisexual male flowers emerge adjacent to the swollen buds, whereas unisexual female flowers emerge in the axils of newly formed leaves formed during spring (4–8 weeks after male flowering). Here, a phylogenetic profiling has led to the identification of cork oak homologs of key floral regulatory genes. The role of these cork oak homologs during flower development was identified with functional studies in Arabidopsis thaliana. The expression profile throughout the year of flower regulators (inducers and repressors), in leaves and buds, suggests that the development of male and female flowers may be preceded by separated induction events. Female flowers are most likely induced during the vegetative flush occurring in spring, whereas male flowers may be induced in early summer. Male flowers stay enclosed within the pre-dormant buds, but complete their development before the vegetative flush of the following year, displaying a long period of anthesis that spans the dormant period. Our results portray a genetic mechanism that may explain similar reproductive habits in other monoecious tree species.
A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti
Authors: Deshommes Theony , Nagel Christian , Tucker Richard , Dorcélus Lindsay , Gautier Jacqueline , Koster Michael P , Lechner Beatrice E 
Published: April 2020

Abstract

Introduction
Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children’s hospital neonatal intensive care unit (NICU) in Haiti.

Methods
A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization ‘5 Moments for HH’. Data were analyzed using standard statistical analysis.

Results
HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water.

Conclusion
This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.
The Top 100 Spine Surgery Articles on Social Media
Authors: Parrish James M. , Jenkins Nathaniel W. , Brundage Thomas S. , Hrynewycz Nadia M. , Singh Kern 
Published: April 2020

Study Design.
Literature review.

Objective.
To discern which social media outlets contribute most to spine surgery literature dissemination and to investigate how popular articles compare to articles with most citations.

Summary of Background Data.
Scientific literature is increasingly disseminated through social media. The Altmetric Attention Score (AAS) is defined as an automated, weighted score calculation from counts of all online attention received by various research outputs. Increasing AAS values indicate more online attention. For example, the overall top 100 Altmetric spine surgery peer-reviewed articles since 2010 had an AAS range from 78 to 1537. Among all spine surgery literature reviewed since 2010, the mean AAS was 5.3 with a median of 1.0.

Methods.
We performed an Altmetric database search of nine spine surgery journals from January 2010 to October 2019. Mean AAS was summarized alongside metrics including citation count and impact factor. We assessed correlations between AAS and online sources, readers, and citations. Journals were grouped by impact factor, and analysis-of-variance compared mean AAS. The 100 highest AAS articles were compared to the most cited.

Results.
13,601 articles were included. The mean AAS was 5.3, with Twitter contributing the most. The three highest associations were news (P < 0.001), Twitter (P < 0.001), and Facebook (P < 0.001). There was no significant association between impact factor and AAS. Compared with the most cited articles, the top 100 AAS articles had significantly more article types, more prospective studies, fewer retrospective studies, fewer reviews, and fewer systematic reviews (P < 0.001 for all). Spine contributed the most articles in both top 100 sets.

Conclusion.
Our evaluation revealed Twitter, newsfeeds, and Facebook were the most significant social media outlets. Compared to articles with the most citations, the most popular articles are prospective and encompass broader study designs. Social media plays an integral role in dissemination, both within spine literature and the public sphere.

Level of Evidence: 3
Does Augmented Reality Navigation Increase Pedicle Screw Density Compared to Free-Hand Technique in Deformity Surgery? Single Surgeon Case Series of 44 Patients
Authors: Edström Erik , Burström Gustav , Persson Oscar , Charalampidis Anastasios , Nachabe Rami , Gerdhem Paul , Elmi-Terander Adrian 
Published: April 2020

Study Design.
Retrospective comparison between an interventional and a control cohort.

Objective.
The aim of this study was to investigate whether the use of an augmented reality surgical navigation (ARSN) system for pedicle screw (PS) placement in deformity cases could alter the total implant density and PS to hook ratio compared to free-hand (FH) technique.

Summary of Background Data.
Surgical navigation in deformity surgery provides the possibility to place PS in small and deformed pedicles were hooks would otherwise have been placed, and thereby achieve a higher screw density in the constructs that may result in better long-term patient outcomes.

Methods.
Fifteen deformity cases treated with ARSN were compared to 29 cases treated by FH. All surgeries were performed by the same orthopedic spine surgeon. PS, hook, and combined implant density were primary outcomes. Procedure time, deformity correction, length of hospital stay, and blood loss were secondary outcomes. The surgeries in the ARSN group were performed in a hybrid operating room (OR) with a ceiling-mounted robotic C-arm with integrated video cameras for AR navigation. The FH group was operated with or without fluoroscopy as deemed necessary by the surgeon.

Results.
Both groups had an overall high-density construct (>80% total implant density). The ARSN group, had a significantly higher PS density, 86.3% ± 14.6% versus 74.7% ± 13.9% in the FH group (P < 0.05), whereas the hook density was 2.2% ± 3.0% versus 9.7% ± 9.6% (P < 0.001). Neither the total procedure time (min) 431 ± 98 versus 417 ± 145 nor the deformity correction 59.3% ± 16.6% versus 60.1% ± 17.8% between the groups were significantly affected.

Conclusion.
This study indicates that ARSN enables the surgeon to increase the PS density and thereby minimize the use of hooks in deformity surgery without prolonging the OR time. This may result in better constructs with possible long-term advantage and less need for revision surgery.

Level of Evidence: 3
The Rate of Heterotopic Ossification Following Cervical Disc Arthroplasty
Authors: Dowdell James E. , Kim Jun S. , Mikhail Christopher , Overley Samuel C. , Levin Jay Michel , McAnany Steven J. , Mroz Thomas E. , Hecht Andrew C. 
Published: April 2020

Study Design.
Systematic review.

Objectives.
The purpose of the current study is to determine the overall incidence of Heterotopic Ossification (HO) following cervical disc arthroplasty (CDA) as well as per annum rates.

Summary of Background Data.
CDA is a well-established surgical modality for treatment of one- and two-level degenerative disc disease that has failed conservative treatment. Despite its proven mid-term clinical success, the potential for accelerated HO following CDA remains an area of clinical concern.

Methods.
A MEDLINE literature search was performed using PubMed, the Cochrane Database of Systematic Reviews, and Embase from January 1980 to February 2018. We included studies involving adult patients, who underwent CDA, documentation of HO, with >12 month follow-up. The pooled results were obtained by calculating the effect size based on the logit event rate. Per annum rates were determined based on weighted averages according to average follow-up period.

Results.
The initial database review resulted in 230 articles, with 19 articles that met inclusion and exclusion criteria. These pooled results included 2151-disc levels and 1732 patients (50% men and 50% women) who underwent CDA and were evaluated for postoperative HO. The mean age was 45 years with a mean follow-up of 60 months. Sixteen studies reported the occurrence of severe HO resulting in 22.8% of disc levels developing severe HO. When stratifying these studies based on funding type, severe HO was reported at a rate of 21.6% by IDE studies and 27.9% by independent studies.

Conclusion.
The findings of the pooled data show the incidence of severe HO following CDA to be 22.8%. However, there is a significant difference in reported rates of mild and severe HO between IDE and independent data. This alludes to possible underreporting of HO and severity of HO in the industry sponsored IDE studies when compared with independent studies.

Level of Evidence: 2
The Prevalence of Abnormalities in the Pediatric Spine on MRI
Authors: van den Heuvel Marleen M. , Oei Edwin H.G. , Bierma-Zeinstra Sita M.A. , van Middelkoop Marienke 
Published: April 2020

Study Design.
Systematic review and meta-analysis.

Objective.
The aim of this study was to provide an overview of the prevalence of reported musculoskeletal abnormalities on magnetic resonance imaging (MRI) of the pediatric spine.

Summary of Background Data.
Back pain is a common complaint and significant health issue, already in children. Several studies have investigated musculoskeletal abnormalities of the pediatric spine as possible cause of low back pain (LBP). However, it is not clear which abnormalities are the most prevalent among children.

Methods.
A systematic literature search on the prevalence of musculoskeletal spinal abnormalities on MRI in children was conducted in the Embase, Medline Ovid, and Cochrane CENTRAL databases. Risk of bias (RoB) was assessed using a checklist based on the Downs and Black checklist. General information on study and patient characteristics and the prevalence of spinal abnormalities were extracted from the studies. Prevalence data were presented in three subgroups: nonathletes without LBP, participants with LBP, and athletes. Prevalence data of the most reported abnormalities were pooled using random-effects proportion meta-analysis. The study protocol was prospectively registered in PROSPERO (CRD42017080543).

Results.
The search resulted in 16,783 articles, of which 31 articles (2373 participants) were included in this systematic review. Two-thirds of the studies had a low RoB. The pooled prevalence in nonathletes without LBP, participants with LBP, and athletes without LBP was respectively 22%, 44%, and 22% for disc degeneration, 1%, 38%, and 13% for herniated discs, 5%, 22%, and 11% for endplate changes, and 0%, 30%, and 6% for pars fractures.

Conclusion.
Disc degeneration, herniated discs, endplate changes, and spondylolysis are the most reported spinal abnormalities on MRI in children in literature. Spinal abnormalities seen in adults are already prevalent in children with LBP, with the highest prevalence for disc degeneration and herniated discs.

Level of Evidence: 2
Breast Implant Illness: A Biofilm Hypothesis
Authors: Lee Mark , Ponraja Ganesa , McLeod Kevin , Chong Smathi 
Published: April 2020

Background:
“Breast implant illness” (BII) is a poorly defined cluster of nonspecific symptoms, attributed by patients as being caused by their breast implants. These symptoms can include joint pain, skin and hair changes, concentration, and fatigue. Many patients complaining of BII symptoms are dismissed as psychosomatic. There are currently over 10,000 peer-reviewed articles on breast implants, but at the time of commencing this study, only 2 articles discussed this entity. At the same time, mainstream media and social media are exploding with nonscientific discussion about BII.

Methods:
We have prospectively followed 50 consecutive patients, self-referring for explantation due to BII. We analyzed their preoperative symptoms and followed up each patient with a Patient-Reported Outcome Questionnaire. All implants and capsules were, if possible, removed en bloc. Explanted implants were photographed. Implant shell and capsule sent for histology and microbiological culture.

Results:
BII symptoms were not shown to correlate with any particular implant type, surface, or fill. There was no significant finding as to duration of implant or location of original surgery. Chronic infection was found in 36% of cases with Propionibacterium acnes the most common finding. Histologically, synoviocyte metaplasia was found in a significantly greater incidence than a matched cohort that had no BII symptoms (P = 0.0164). Eighty-four percent of patients reported partial or complete resolution of BII symptoms on Patient-Reported Outcome Questionnaire. None of the 50 patients would consider having breast implants again.

Conclusion:
The authors believe BII to be a genuine entity worthy of further study. We have identified microbiological and histological abnormalities in a significant number of patients identifying as having BII. A large proportion of these patients have reported resolution or improvement of their symptoms in patient-reported outcomes. Improved microbiology culture techniques may identify a larger proportion of chronic infection, and further investigation of immune phenotypes and toxicology may also be warranted in this group.
Measurement of In Vivo Biomechanical Changes Attributable to Epithelial Removal in Keratoconus Using a Noncontact Tonometer
Authors: Ziaei Mohammed , Gokul Akilesh , Vellara Hans , Lu Lucy M. , Patel Dipika V. , McGhee Charles N. J. 
Published: April 2020

Purpose:
To compare the biomechanical properties of the cornea after epithelial removal in eyes with keratoconus undergoing corneal cross-linking.

Methods:
Prospective interventional case series at a university hospital tertiary referral center. Corneal biomechanical properties were measured in patients with keratoconus undergoing corneal cross-linking, immediately before and after epithelial debridement by using a dynamic ultrahigh-speed Scheimpflug camera equipped with a noncontact tonometer.

Results:
The study comprised 45 eyes of 45 patients with a mean age of 19.6 ± 4.9 years (range 14–34). The cornea was found to be 23.7 ± 15.7 μm thinner after epithelial removal (P < 0.01). Corneal stiffness was reduced after epithelial removal as demonstrated by a significant decrease of parameters such as stiffness parameter A1 (12.31, P < 0.01), stiffness parameter-highest concavity (2.25, P < 0.01), A1 length (0.13 mm, P = 0.04), highest concavity radius of curvature (0.26 mm, P = 0.01), highest concavity time (0.22 ms, P = 0.04) and an increase in A1 velocity (−0.01 m/s, P = 0.01), A1 deformation amplitude (−0.03 mm, P ≤ 0.01), A1 deflection length (−0.32 mm, P < 0.01), A2 deformation amplitude (−0.03 mm, P = 0.01), and A2 deflection length (−1.00 mm, P < 0.01). There were no significant differences in biomechanical intraocular pressure (0.15 mm Hg, P = 0.78), deformation amplitude (0.03, P = 0.54), maximum inverse radius (−0.01 mm, P = 0.57), and whole eye movement length (−0.02 mm, P = 0.12).

Conclusions:
Dynamic ultrahigh-speed Scheimpflug camera equipped with a noncontact tonometer offers an alternative method for in vivo measurements of the epithelial layer's contribution to corneal biomechanical properties. Our results suggest that corneal epithelium may play a more significant role in corneal biomechanical properties in patients with keratoconus than previously described.
Anterior Segment Findings in Patients With Osteogenesis Imperfecta: A Case-Control Study
Authors: Keleş Ali , Doğuizi Sibel , Şahin Nursel Muratoğlu , Koç Mustafa , Aycan Zehra 
Published: April 2020

Purpose:
To evaluate the anterior segment parameters in patients with osteogenesis imperfecta (OI) compared with healthy control subjects.

Methods:
Seventeen patients with OI and 19 age-matched healthy controls were included into this cross-sectional case-control study. Corneal topographic, topometric and Belin–Ambrósio Enhanced Ectasia Display III analysis, corneal densitometry (12-mm corneal diameter), and lens densitometry measurements were obtained by using the Pentacam HR-Scheimpflug imaging system (Oculus, Wetzlar, Germany). The corneal endothelial cell properties were determined by specular microscopy.

Results:
In comparison to the control group, patients with OI had significantly higher front astigmatism (0.8 ± 0.4 vs. 1.4 ± 1.1 mm, P = 0.026), thinner thinnest corneal thickness (556.4 ± 32.7 μm vs. 482.5 ± 66.9 μm, P = 0.002), smaller corneal volume (62.4 ± 3.5 mm3 vs. 53.7 ± 6.4 mm3, P < 0.001), lower anterior chamber depth (3.2 ± 0.3 mm vs. 3.0 ± 0.2 mm, P = 0.009), higher index of vertical asymmetry (0.1 ± 0.04 vs. 0.2 ± 0.11, P < 0.001), higher posterior elevation (6.0 ± 2.7 μm vs. 11.9 ± 7.8 μm, P = 0.002), lower maximum Ambrósio relational thickness indice (456.6 ± 67.5 vs. 365.6 ± 115.7, P = 0.009), and higher final “D” value (0.7 ± 0.4 vs. 2.0 ± 1.6, P = 0.002). The corneal and lens densitometry values were similar in all concentric zones and layers in both groups except that 6 to 10 mm in the center. Corneal densitometry was higher in eyes with OI than that in the control group (9.8 ± 1.7 and 8.8 ± 1.0, P = 0.010). There was no difference in endothelial cell morphology between the groups (P > 0.05).

Conclusions:
The morphologic parameters determined on the corneal analysis are in general agreement with the known pathophysiology of OI. Corneal analysis may prove useful in monitoring patients with OI in clinical practice.