bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Geometrical Spinal Shape on Fresh Vertebral Fractures in Elderly Volunteers
Authors: Yamada Tomohiro , Yamato Yu , Sato Yoshihiro , Togawa Daisuke , Hasegawa Tomohiko , Yoshida Go , Yasuda Tatsuya , Arima Hideyuki , Banno Tomohiro , Oe Shin , Ushirozako Hiroki , Ide Koichiro , Watanabe Yuh , Matsuyama Yukihiro 
Published: April 2020

Study Design.
Four-year, longitudinal cohort study.

Objective.
The aim of this study was to investigate the effect of original spinal shape on incidental vertebral fractures (VFs) and to identify the influence of changes in pre- and post-fracture geometrical spinal shape.

Summary of Background Data.
Clinical evidence demonstrates that VFs cause spinal kyphosis, morbidities, and deteriorating quality of life in elderly people. However, knowledge of geometrical spinal shapes that affect incidental VFs is limited.

Methods.
Three hundred seventeen volunteers underwent whole spine radiography as part of a health screening in both 2012 and 2016. We extracted volunteers with incidental VF in 2016. Sex- and age-matched volunteers without VF were enrolled as controls. Baseline demographic variables, geometrical spinal shape, and spinopelvic parameters were compared between the two groups. In volunteers with incidental VF, we investigated the association between baseline spinal shape and post-fracture shape.

Results.
Twenty-seven volunteers (12 men; mean age 75.4 ± 5.4 and 15 women; mean age 71.6 ± 7.9) with VF were enrolled, and 175 volunteers (48 men, 127 women) without VF were selected as controls. In men with VF, the thoracic kyphosis apex was located significantly more posteriorly and caudally than in those without VF. In women with VF, the lordosis apex was located significantly more posteriorly and caudally than in those without VF. After fractures occurring above the inflexion vertebra, the low anterior apex spine (L5) changed its geometrical shape in that the posterior apex and the inflexion vertebra shifted significantly more posteriorly compared to the high anterior apex spine (L4/5).

Conclusion.
Original geometrical spinal shape affected the occurrence of VF, and post-fracture spinal shape depended on the positional relationship between the inflexion vertebra and fractured vertebra. Our study helps to understand the influence of geometrical spinal shape on the risks of VF.

Level of Evidence: 3
Patient-reported Quality of Life Following Posterior Lumbar Interbody Fusion or Indirect Decompression Using Lateral Lumbar Interbody Fusion
Authors: Nakashima Hiroaki , Kanemura Tokumi , Satake Kotaro , Ito Kenyu , Tanaka Satoshi , Ouchida Jun , Segi Naoki , Kobayashi Kazuyoshi , Ando Kei , Ishiguro Naoki , Imagama Shiro 
Published: April 2020

Study design.
A retrospective review of prospectively collected data.

Objective.
The aim of this study was to compare quality of life (QOL) outcomes of posterior lumbar interbody fusion (PLIF) with lateral lumbar interbody fusion (LLIF) using reports from patients obtained at the 2-year postoperative follow-up.

Summary of Background Data.
Indirect decompression with LLIF is used to treat degenerative lumbar diseases that require neural decompression. However, the difference in improvement in QOL following indirect decompression compared with direct neural decompression using PLIF is unclear.

Methods.
We enrolled 284 consecutive patients with degenerative lumbar spondylolisthesis in the present study, 203 who underwent PLIF and 81 who underwent LLIF. All patients completed a minimum of 2 years of follow-up. We evaluated the effectiveness of surgery in each category of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).

Results.
The results of preoperative JOABPEQ and the severity of thecal sac stenosis were not significantly different between PLIF and LLIF, neither was the rate of perioperative complications (14.8% and 15.4% for the PLIF and LLIF groups, respectively; P = 0.91). The effectiveness at 2 years postoperatively was almost the same for all five domains of the JOABPEQ: 62.6% and 68.9% for pain-related disorders (P = 0.34), 38.3% and 42.7% for lumbar spine dysfunction (P = 0.51), 65.8% and 67.5% for gait disturbance (P = 0.79), 53.5% and 48.8% for social life dysfunction (P = 0.47), and 29.1% and 33.3% for psychological disorders (P = 0.48) following PLIF and LLIF, respectively. Visual analogue scale results for back and lower-limb pain and numbness of the lower limbs were almost the same for both groups. No significant differences were observed in terms of perioperative complications and radiographical outcomes.

Conclusion.
Indirect decompression using LLIF improves QOL and radiographical outcomes to a comparable degree as direct decompression via PLIF.

Level of Evidence: 4
Readmission Rate After 2-level Lumbar Decompression
Authors: Elsharydah Ahmad , Duncan Katherine L. , Rosero Eric B. , Minhajuddin Abu , Somasundaram Alwin , Joshi Girish P. 
Published: April 2020

Study Design:
Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2012–2015.

Objective:
Compare the 30-day readmission and postoperative major complications rates of 2-level lumbar decompression performed in the ambulatory and the inpatient settings.

Summary of Background Data:
In recent years, there is an increasing trend toward ambulatory spine surgery. However, there remains a concern regarding risks of readmission and postoperative morbidity after discharge.

Methods:
The ACS-NSQIP database from 2012 to 2015 was queried for adult patients who underwent elective 2-level lumbar decompression (CPT code 63047 accompanied with code 63048). A cohort of ambulatory lumbar decompression cases was matched 1:1 with an inpatient cohort after controlling for patient demographics, comorbidities, and complexity of the procedure. The primary outcome was the 30-day readmission rate. Secondary outcomes included a composite of 30-day postoperative major complications and hospital length of stay for hospitalized patients.

Results:
A total of 7505 patients met our study criteria. The ambulatory 2-level lumbar decompression surgery rate increased significantly over the study period from 28% in 2012 to 49% in 2015 (P<0.001). In the matched sample, there was no statistically significant difference in the 30-day readmission rate (odds ratio, 0.82; 95% confidence interval, 0.64–1.04; P=0.097) between the two cohorts; however, the ambulatory cohort had a lower 30-day postoperative major complication rate (odds ratio, 0.55; 95% confidence interval, 0.38–0.79; P=0.002).

Conclusions:
After 2-level lumbar decompression performed on inpatient versus outpatient basis, the 30-day readmission rate is similar. However, the 30-day postoperative complication rate is significantly lower in the ambulatory setting. The reasons for these differences need further exploration.

Level of Evidence:
Level III.
Peking University Third Hospital score: a comprehensive system to predict intra-operative blood loss in radical nephrectomy and thrombectomy
Authors: Liu Zhuo , Zhao Xun , Zhang Hong-Xian , Ma Run-Zhuo , Li Li-Wei , Tang Shi-Ying , Wang Guo-Liang , Zhang Shu-Dong , Wang Shu-Min , Tian Xiao-Jun , Ma Lu-Lin 
Published: April 2020

Abstract

Background
Radical nephrectomy and thrombectomy is the standard surgical procedure for the treatment of renal cell carcinoma (RCC) with tumor thrombus (TT). But the estimation of intra-operative blood loss is only based on the surgeon's experience. Therefore, our study aimed to develop Peking University Third Hospital score (PKUTH score) for the prediction of intra-operative blood loss volume in radical nephrectomy and thrombectomy.

Methods
The clinical data of 153 cases of renal mass with renal vein (RV) or inferior vena cava tumor thrombus admitted to Department of Urology, Peking University Third Hospital from January 2015 to May 2018 were retrospectively analyzed. The total amount of blood loss during operation is equal to the amount of blood sucked out by the aspirator plus the amount of blood in the blood-soaked gauze. Univariate linear analysis was used to analyze risk factors for intra-operative blood loss, then significant factors were included in subsequent multivariable linear regression analysis.

Results
The final multivariable model included the following three factors: open operative approach (P < 0.001), Neves classification IV (P < 0.001), inferior vena cava resection (P = 0.001). The PKUTH score (0–3) was calculated according to the number of aforementioned risk factors. A significant increase of blood loss was noticed along with higher risk score. The estimated median blood loss from PKUTH score 0 to 3 was 280 mL (interquartile range [IQR] 100–600 mL), 1250 mL (IQR 575–2700 mL), 2000 mL (IQR 1250–2900 mL), and 5000 mL (IQR 4250–8000 mL), respectively. Meanwhile, the higher PKUTH score was, the more chance of post-operative complications (P = 0.004) occurred. A tendency but not significant overall survival difference was found between PKUTH risk score 0 vs. 1 to 3 (P = 0.098).

Conclusion
We present a structured and quantitative scoring system, PKUTH score, to predict intra-operative blood loss volume in radical nephrectomy and thrombectomy.
Detection and Analysis of Uncharged Particles Using Consumer-grade CCDs
Authors: Cummings John A. , Deaton James W. , Hess Charles T. , Hess Samuel T. 
Published: April 2020

Abstract
In the current climate of increased global terrorism, the threat of a radiological incident is becoming more realistic than ever, and as such, the necessity of early-warning detection is paramount to national security. To assist with this need, we have investigated the detection of uncharged particle emissions from radiological sources using charged-coupled devices (CCDs), which are contained within a variety of products, including consumer cellphones and traffic cameras. Because the CCD is intrinsically sensitive to charge accumulation as a result of linear energy transfer by the incident particles, each event can be counted and quantified using video-image processing and an estimated energy band assessed by the properties of the pixels. In an effort to make this process applicable to the widest possible range of CCDs available, this experiment was conducted using low-quality CCDs contained within consumer-grade, budget web cameras. Within a 239Pu-Be neutron howitzer, particles were detected using several camera models: Gigaware X76, Z76 and Logitech C170, C270. Particle detection events were counted by post-processing with Matlab, and an efficiency for each CCD was determined relative to both a theoretical flux model and a calibrated 3He tube detector. The relative detection efficiencies for the cameras tested fell within the range 14–18% and showed a linear correlation between incident energy and pixel response.
Post-LASIK Ectasia Versus Keratoconus: An In Vivo Confocal Microscopy Study
Authors: Alvani Azam , Hashemi Hassan , Pakravan Mohammad , Mahbod Mirgholamreza , Seyedian Mohammad Amin , Amanzadeh Kazem , Khabazkhoob Mehdi , Jafarzadehpur Ebrahim , Fotouhi Akbar 
Published: April 2020

Purpose:
To examine and compare corneal cellular and subbasal nerve (SBN) characteristics in post–laser-assisted in situ keratomileusis ectasia (PLE) corneas, normal post–laser-assisted in situ keratomileusis corneas (PLC), keratoconus (KC) corneas, and normal virgin corneas (NC).

Methods:
In this cross-sectional comparative study, 18 PLE eyes of 11 patients, 18 PLC of 15 cases, 32 KC eyes of 32 patients, and 29 NC of 29 subjects were assessed using in vivo confocal microscopy. The density of the basal epithelial cell (BEC), anterior keratocyte, posterior keratocyte, and endothelial cell layers, as well as the characteristics of SBN fibers, was compared between the 4 groups.

Results:
The density of the BEC and anterior and posterior keratocyte layers was significantly lower in KC compared with NC (−650 ± 190, P = 0.013; −181 ± 39, P < 0.001; and −36 ± 11, P = 0.021, respectively). However, there was no significant difference between PLE and PLC regarding these parameters (all Ps ≥ 0.6). Mean SBN parameters, including central corneal nerve branch density, nerve fiber length, total branch density, and nerve fiber area, were significantly lower in KC compared with NC and in PLE compared with PLC (all Ps ≤ 0.021).

Conclusions:
The pathophysiology of PLE seems to differ from KC. Apparent changes in the BEC and anterior and posterior keratocytes associated with KC were not observed in PLE. However, SBNs seem to be involved in both conditions.
Results 5 to 10 years after cataract surgery with primary IOL implantation in juvenile idiopathic arthritis–related uveitis
Authors: Leinonen Sanna , Kotaniemi Kaisu M. , Kivelä Tero T. , Krootila Kari 
Published: April 2020

Purpose:
To evaluate the results of cataract extraction with primary intraocular lens (IOL) implantation in patients with juvenile idiopathic arthritis (JIA) and uveitis-related cataract.

Setting:
Department of Ophthalmology, Helsinki University Hospital, Finland.

Design:
Retrospective case series.

Methods:
All consecutive patients younger than 20 years with JIA-uveitis–related cataract undergoing cataract extraction with primary IOL implantation in 1 or both eyes at the Department of Ophthalmology, Helsinki University Hospital, Finland, from February 2000 to April 2012 were included. Twenty eligible patients with 26 operated eyes were identified; 14 were girls and 6 were boys. All patients had a follow-up of 5 years and 13 patients (16 eyes [65%]) reached 10 years of follow-up.

Results:
Twenty-six eyes of 20 patients were studied. Preoperative median corrected distance visual acuity (CDVA) was 0.05 in decimal notation. Median CDVA was 1.0 at 5 years and 0.9 at 10 years of follow-up. Two eyes did not reach CDVA 0.5 with the operation, and in 2 eyes, CDVA decreased below 0.5 over the period of 3 to 5 years after the operation. Active uveitis during 3 and 12 months preoperatively was a risk indicator for postoperative CDVA <0.5 at 5 years (P = .005 and P = .007, respectively).

Conclusions:
Cataract extraction with primary IOL implantation provides long-standing good visual acuity for young patients with well-controlled JIA-related uveitis.
Role of real-time shear-wave elastogarphy in differentiating hepatocellular carcinoma from other hepatic focal lesions
Authors: Gad Magdy A. Mawgood , Eraky Tamer E. , Omar Hazem M. , Abosheaishaa Hazem Maarouf 
Published: April 2020

Background:
Hepatocellular carcinoma (HCC) has an increasing incidence worldwide, and is considered the second cause of cancer-related death.

Aim:
The aim of the study is to assess the usefulness of real-time shear-wave elastography in differentiating HCC from other hepatic focal lesions.

Patients and methods:
The current study was conducted on 110 patients in addition to 10 healthy subjects, divided into four groups as follows: liver cirrhosis, HCC, hepatic focal lesions other than HCC, and control. Demographic, laboratory and imaging data were collected and then elastographic assessment of the hepatic focal lesions and the surrounding liver parenchyma using elastograph point quantification (ElastPQ) (iU22x MATRIX, Philips) was done.

Results:
ElastPQ (iU22x MATRIX, Philips) has shown its ability to differentiate between HCC and cystic focal lesions, HCC and cholangiocarcinoma, and HCC and focal nodular hyperplasia (FNH). Cystic lesions demonstrated lower stiffness in comparison to HCC; however, cholangiocarcinoma and FNH demonstrated higher stiffness in comparison to HCC. ElastPQ was unable to differentiate between stiffness in both ‘HCC and hemangioma’ and ‘HCC and metastatic focal lesions’. ElastPQ showed that HCC, cystic focal lesions, and cholangiocarcinoma had lower stiffness in comparison to their surrounding liver parenchyma, whereas FNH had higher stiffness in comparison to the surrounding liver parenchyma. ElastPQ showed that the surrounding liver parenchyma of the HCC group has the highest stiffness amongst all studied hepatic focal lesions surrounding liver parenchyma.

Conclusion:
‘Point’ shear-waves elastography (ElastPQ; Philips iU22x MATRIX, Philips) is a noninvasive, quantitative and nonradiating method for evaluation of tissue elasticity, and is helpful in differentiating HCC from other hepatic focal lesions.
Changing paradigms in the treatment of residual/recurrent head and neck cancer: implications for dysphagia management
Authors: Brady Grainne C. , Hardman John C. , Paleri Vinidh , Harrington Kevin J. , Roe Justin W.G. 
Published: April 2020

Purpose of review
Despite advances in head and neck cancer treatment provision, recurrence rates remain high with the added risk of successfully treated patients developing a second primary. We report on the management of dysphagia in the context of residual/recurrent or new disease in a preirradiated field and make suggestions for future research.

Recent findings
There have been numerous developments in treatment options for people with residual/recurrent head and neck cancer. This is because of improved surgical interventions including microvascular reconstruction techniques and transoral robotic surgery. In the era of highly conformal radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT), there may be opportunities for re-irradiation. These advancements are now increasingly employed in the context of locoregionally recurrent disease. With results being reported from an increasing number of clinical trials, systemic therapies, including treatment with immunotherapy, offer the potential for increased survival with less treatment-related toxicity.

Summary
Dysphagia is recognized as a significant toxicity following radical surgical and radiation-based approaches, particularly when multimodal treatment is required. Increasingly, late radiation-associated dysphagia is gaining greater attention in the literature. Many patients presenting with residual and recurrent disease do so against a background of comorbidities as well as persistent and late treatment-related toxicity.
Preresection Radiologic Assessment and Imaging Features of 156 Pathologically Proven Adrenal Adenomas
Authors: Elsherif Sherif B. , Javadi Sanaz , Blair Katherine J. , Morshid Ali I. , Hui Ling , Khalaf Ahmed M. , Elbanan Mohamed G. , Zhang Miao , Habra Mouhammed A. , Elsayes Khaled M. 
Published: April 2020

Purpose
The aims of the study were to assess the typical and atypical radiologic features of pathologically proven adrenal adenomas and to determine the relationship between the radiologic and histopathologic classification.

Methods
We retrospectively studied 156 pathologically proven adrenal adenomas in 154 patients from our institutional databases who have computed tomography (CT) and/or magnetic resonance imaging (MRI) examinations before intervention. We determined the histopathologic diagnosis (typical or atypical) using Weiss scoring and classified the adenomas radiologically into typical, atypical, or indeterminate based on lesion size, precontrast CT attenuation, absolute percentage washout, calcification, and necrosis. The κ statistic was used to assess the agreement between radiologists. The Fisher exact test was used to compare the radiologic and pathological classifications.

Results
In consensus, there were 83 typical, 42 atypical, and 31 indeterminate adrenal lesions. Logistic regression model showed that radiologically atypical adenoma was significantly associated with larger size, lobulated shape, higher unenhanced CT attenuation, heterogeneous appearance, nonfunctioning status, absolute percentage washout of less than 60%, and a signal intensity index of less than 16.5%.
Pathologically, 147 adenomas were pathologically typical (Weiss 0), and 9 adenomas were pathologically atypical (Weiss 1–2). Radiologically, there was substantial agreement between both readers, with Cohen κ at 0.71. Approximately 98% of radiologically typical adenomas were pathologically typical. Only 17% of radiologically atypical adenomas were pathologically atypical. All radiologically indeterminate adenomas were pathologically typical. However, some of the radiologically indeterminate and typical adenomas still had an atypical component on pathologic analysis, such as necrosis, nuclear atypia, or oncocytic features.

Conclusions
Radiologically atypical lesion was significantly associated with larger size and higher unenhanced CT attenuation. Approximately 27% of the cases demonstrated atypical features on imaging. Most radiologically atypical adrenal adenomas are pathologically typical.
The Center for Trauma Survivorship: Addressing the great unmet need for posttrauma center care
Authors: Livingston David H. , La Bagnara Susan , Sieck Derrick , Yonclas Peter , Castellano Cherie , Cho Cathy , Walling Patricia A. , Mosenthal Anne C. 
Published: April 2020

BACKGROUND
Returning patients to preinjury status is the goal of a trauma system. Trauma centers (TCs) provide inpatient care, but postdischarge treatment is fragmented with clinic follow-up rates of <30%. Posttraumatic stress disorder (PTSD) and depression are common, but few patients ever obtain necessary behavioral health services. We postulated that a multidisciplinary Center for Trauma Survivorship (CTS) providing comprehensive care would meet patient's needs, improve postdischarge compliance, deliver behavioral health, and decrease unplanned emergency department (ED) visits and readmissions.

METHODS
Focus groups of trauma survivors were conducted to identify issues following TC discharge. Center for Trauma Survivorship eligible patients are aged 18 to 80 years and have intensive care unit stay of >2 days or have a New Injury Severity Score of ≥16. Center for Trauma Survivorship visits were scheduled by a dedicated navigator and included physical and behavioral health care. Patients were screened for PTSD and depression. Patients screening positive were referred for behavioral health services. Patients were provided 24/7 access to the CTS team. Outcomes include compliance with appointments, mental health visits, unplanned ED visits, and readmissions in the year following discharge from the TC.

RESULTS
Patients universally felt abandoned by the TC after discharge. Over 1 year, 107 patients had 386 CTS visits. Average time for each appointment was >1 hour. Center for Trauma Survivorship “no show” rate was 17%. Eighty-six percent screening positive for PTSD/depression successfully received behavioral health services. Postdischarge ED and hospital admissions were most often for infections or unrelated conditions. Emergency department utilization was significantly lower than a similarly injured group of patients 1 year before the inception of the CTS.

CONCLUSION
A CTS fills the vast gaps in care following TC discharge leading to improved compliance with appointments and delivery of physical and behavioral health services. Center for Trauma Survivorship also appears to decrease ED visits in the year following discharge. To achieve optimal long-term recovery from injury, trauma care must continue long after patients leave the TC.

LEVEL OF EVIDENCE
Therapeutic, Level III.