bluuebunny/crossref_metadata_2025_split huggingface dataset:
Black Race as a Social Determinant of Health and Outcomes After Lumbar Spinal Fusion Surgery
Authors: Aladdin Dima El Halawani , Tangel Virginia , Lui Briana , Pryor Kane O. , Witkin Lisa R. , White Robert S. 
Published: January 2020

Study Design.
A retrospective analysis of patient hospitalization and discharge records.

Objective.
To examine the association between race and inpatient postoperative complications following lumbar spinal fusion surgery.

Summary of Background Data.
Racial disparities in healthcare have been demonstrated across a range of surgical procedures. Previous research has identified race as a social determinant of health that impacts outcomes after lumbar spinal fusion surgery. However, these studies are limited in that they are outdated, contain data from a single institution, analyze small limited samples, and report limited outcomes. Our study aims to expand and update the literature examining the association between race and inpatient postoperative complications following lumbar spine surgery.

Methods.
We analyzed 267,976 patient discharge records for inpatient lumbar spine surgery using data from the Healthcare Cost and Utilization Project's State Inpatient Databases for California, Florida, New York, Maryland, and Kentucky from 2007 through 2014. We used unadjusted bivariate analysis, adjusted multivariable, and stratified analysis to compare patient demographics, present-on-admission comorbidities, hospital characteristics, and complications by categories of race/ethnicity.

Results.
Black patients were 8% and 14% more likely than white patients to experience spine surgery specific complications (adjusted odds ratios [aOR]: 1.08, 95% confidence interval [CI]: 1.03–1.13) and general postoperative complications (aOR: 1.14, 95% CI: 1.07–1.20), respectively. Black patients, compared with white patients, also had increased adjusted odds of 30-day readmissions (aOR: 1.13, 95% CI: 1.07–1.20), 90-day readmissions (aOR: 1.07, 95% CI: 1.02–1.13), longer length of stay (LOS) (adjusted Incidence Rate Ratio: 1.15, 95% CI: 1.14–1.16), and higher total charges (adjusted Incidence Rate Ratio: 1.08, 95% CI: 1.07–1.09).

Conclusion.
Our findings demonstrate that black patients, as compared with white patients, are more likely to have postoperative complications, longer postoperative lengths of stay, higher total hospital charges, and increased odds of 30- and 90-day readmissions following lumbar spinal fusion surgery.

Level of Evidence: 4
Double-Masked and Unmasked Prospective Study of Terpinen-4-ol Lid Scrubs With Microblepharoexfoliation for the Treatment of Demodex Blepharitis
Authors: Epstein Ilan J. , Rosenberg Eric , Stuber Ross , Choi Michael B. , Donnenfeld Eric D. , Perry Henry D. 
Published: January 2020

Purpose:
To evaluate terpinen-4-ol lid scrubs (Cliradex) with Microblepharoexfoliation (MBE) (BlephEx) in the treatment of Demodex blepharitis.

Methods:
An Institutional Review Board (IRB) approved the randomized prospective double-masked trial of 50 patients with Demodex positive blepharitis. All subjects were given an in-office MBE treatment and randomized to masked lid scrubs (terpinen-4-ol or sham) twice daily for 1 month. All subjects then returned for an additional MBE treatment and received open-label terpinen-4-ol scrubs twice daily for 1 month.

Outcomes:

Demodex levels, Ocular Surface Disease Index, tear osmolarity, MMP-9, Schirmer 1 and grading of the lid margin appearance, meibomian gland dropout, and meibomian gland secretions.

Results:
Forty-six subjects (23 per group) were included for the analysis; 4 lost to follow up. Total Demodex folliculorum levels in the Cliradex group improved: 4.7 to 3.6 (first month interval P = 0.266) to 2.6 (second month interval P = 0.279), overall P < 0.05 over 2 months. Total levels in the sham group improved: 5.1 to 3.0 (first month interval P < 0.05) to 2.5 (second month interval P = 0.496), overall P < 0.05 over 2 months. No clear statistically meaningful improvements in other dry eye and blepharitis data metrics were observed.

Conclusions:
In-office MBE treatments combined with either Cliradex terpinen-4-ol medicated lid scrubs or sham scrubs showed a statistically significant reduction in D. folliculorum infestation levels; however, conclusions on clinical significance could not be made. In-office MBE with terpinen-4-ol lid scrubs showed no significant improvement over sham scrubs.
Evaluation of Meibomian Glands in Obstructive Sleep Apnea-Hypopnea Syndrome
Authors: Muhafiz Ersin , Ölçen Merhamet , Erten Remzi , Bozkurt Erdinç 
Published: January 2020

Purpose:
To evaluate the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on the meibomian glands, ocular surface, and tear parameters.

Methods:
The study included 59 individuals (32 subjects with OSAHS, 27 control subjects) who underwent polysomnography in the Chest Diseases Clinic. The right eyes of all individuals were evaluated in the Ophthalmology Clinic. The first noninvasive tear break-up time (f-NTBUT) and the average noninvasive tear break-up time were measured, and Schirmer test was applied. Meibography was taken (Sirius; CSO, Florence, Italy), and meiboscore was used for indexing meibography. Finally, a sample was taken for conjunctival impression cytology.

Results:
In the study and control groups, the median of f-NTBUT was 2.1 seconds [interquartile range (IQR); 1.5–5.0] and 5.7 seconds (IQR; 2.9–8.8) and the median of average noninvasive tear break-up time was 5.6 seconds (IQR; 3.6–9.5) and 7.2 seconds (IQR; 4.2–10.7), respectively (P = 0.007 and P = 0.487, respectively). The mean Schirmer value was 16.3 ± 5.9 mm (range; 5–25) and 17.3 ± 6.6 mm (range; 5–30) in the study and control groups (P = 0.604). In upper eyelid meibography, the median of loss in the meibomian glands was 20.10% (IQR; 11.60%–40.80%) in the study group and 14.70% (IQR; 10.40%–21.30%) in the control group (P = 0.043). In lower eyelid meibography, the median of loss in the meibomian glands was 19.00% (IQR; 13.60%–35.30%) in the study group and 12.40% (IQR; 9.10%–16.40%) in the control group (P = 0.002). The median of the Nelson grade in conjunctival impression cytology was 1 (IQR; 0–1) in the study group and 1 (IQR; 0–1) in the control group (P = 0.445).

Conclusions:
The loss in the meibomian glands together with the shortened f-NTBUT shows that there could be a predisposition in OSAHS for evaporative dry eye originating from meibomian gland damage.
Intergroup anxiety in pain care: impact on treatment recommendations made by white providers for black patients
Authors: Grant Alexis D. , Miller Megan M. , Hollingshead Nicole A. , Anastas Tracy M. , Hirsh Adam T. 
Published: January 2020

Abstract
Race disparities in pain care are well-documented. Given that most black patients are treated by white providers, patient–provider racial discordance is one hypothesized contributor to these disparities. Research and theory suggest that providers' trait-level intergroup anxiety impacts their state-level comfort while treating patients, which, in turn, impacts their pain treatment decisions. To test these hypothesized relationships, we conducted a planned secondary analysis of data from a randomized controlled trial of a perspective-taking intervention to reduce pain treatment disparities. Mediation analyses were conducted on treatment decision data from white providers for black virtual patients with chronic pain. Results indicated that white providers with higher trait-level intergroup anxiety reported lower state-level comfort treating black patients and were thereby more likely to recommend opioid (indirect effect = 0.76, 95% confidence interval [CI]: 0.21-1.51) and pain specialty (indirect effect = 0.91, 95% CI: 0.26-1.78) treatments and less likely to recommend nonopioid analgesics (indirect effect = −0.45, 95% CI: −0.94 to −0.12). Neither trait-level intergroup anxiety nor state-level comfort significantly influenced provider decisions for physical therapy. This study provides important new information about intrapersonal and interpersonal contributors to race disparities in chronic pain care. These findings suggest that intergroup anxiety and the resulting situational discomfort encroach on the clinical decision-making process by influencing white providers' decisions about which pain treatments to recommend to black patients. Should these findings be replicated in future studies, they would support interventions to help providers become more aware of their trait-level intergroup anxiety and manage their state-level reactions to patients who are racially/ethnically different from themselves.
Robotic-assisted computed tomography-guided 18F-FDG PET/computed tomography-directed biopsy for diagnosis of intra thoracic lesions: An experience from a tertiary care centre in North India.
Authors: Nath Alok , Prashanth Arun , Lal Hira , Kumar Sheo , Barai Sukanta , Gambhir Sanjay 
Published: January 2020

ObjectiveThe aim of this study was to assess the diagnostic yield of robotic-assisted computed tomography (CT)-guided18F-FDG PET/CT-directed biopsy for the evaluation of intrathoracic space occupying lesions.MethodsTwenty-four patients being evaluated for intrathoracic masses were included in the study. The indications were patients with unknown/likely primary detected from PET-CT, suspicious lesions identified from PET-CT in a known primary disease and fine needle aspiration cytology/CT-guided biopsy negative lesions with a high index of suspicion for malignancy. Biopsies were carried out with the help of automated radiology arm (ROBIO-EX) which is essentially a needle positioning and holding device. A two-day protocol was followed in which PET-CT scan was done on the first day, biopsy procedure was done on the next scheduled day. PET images were refused with the CT images done on the second day in the console by using manual alignment and then a biopsy was carried out with the help of a robotic arm. Primary outcome was histopathological yield from the obtained specimens.ResultsTissue yield was 100% (n = 24) and histopathological diagnosis rate was 96% (n = 23). Out of the 24 lesions biopsied 30% (n = 8) were benign and 70% (n = 16) turned out to be malignant. The complication rates were pneumothorax 4% (n = 1) and haemothorax 4% (n = 1).ConclusionRobotic-assisted CT-guided18F-FDG PET/CT-directed biopsy is a useful and accurate technique for diagnostic evaluation of intrathoracic neoplasms with minimal complications rates as compared with conventional imaging techniques.
Direct comparisons of left ventricular volume and function by simultaneous cardiac magnetic resonance imaging and gated 13N-ammonia positron emission tomography
Authors: Kiko Takatoyo , Yoshihisa Akiomi , Yokokawa Tetsuro , Misaka Tomofumi , Yamada Shinya , Kaneshiro Takashi , Nakazato Kazuhiko , Takeishi Yasuchika 
Published: January 2020

Objectives
Hybrid PET/MRI is useful for the simultaneous evaluation of both 13 N-ammonia PET and MRI data. The aim of the current study was to compare the accuracy of gated 13 N-ammonia PET with MRI for the measurement of left ventricular volumes and function in patients with coronary artery disease (CAD), using simultaneous acquisitions on a hybrid PET/MRI system.

Methods
Fifty-one consecutive patients with suspected CAD who underwent 13 N-ammonia PET/MRI were enrolled in this study. End-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) were simultaneously evaluated using both gated 13 N-ammonia PET and cine MRI. Regional wall motion was visually scored on a 4-point scale using a 17-segment model for both methods.

Results
The correlations between each EDV (R = 0.99, P < 0.001), ESV (R = 0.98, P < 0.001), and LVEF (R = 0.99, P = 0.001) measured by gated 13 N-ammmonia and MRI were very high. These high correlations were also observed in postmyocardial infarction patients. Furthermore, the regional wall motion scores determined on gated 13 N-ammonia PET and MRI showed an agreement of 89.0% with a kappa value of 0.82 ± 0.02.

Conclusion
EDV, ESV, LVEF, and regional wall motion measured by gated 13 N-ammonia PET were highly correlated with those measured by MRI.
Complementary role of 18F-FDG PET/CT for sentinel lymph node algorithm in endometrial cancer with high-risk factors for lymphatic metastasis
Authors: Taşkin Salih , Varli Bulut , Ersöz Cevriye Cansiz , Altin Duygu , Soydal Çiğdem , Ortaç Firat 
Published: January 2020

Objective
National Comprehensive Cancer Network (NCCN) sentinel lymph node (SLN) algorithm includes ‘mandatory steps’ for evaluating pelvic lymph nodes, but assessment of paraaortic area is left to surgeon’s discretion. In this study, we aimed to investigate the complementary role of preoperative 18F-FDG PET/computed tomography (CT) scan in detecting pelvic and especially paraaortic lymphatic metastasis in endometrial cancer patients with high-risk factor(s) according to Mayo Clinic Criteria and underwent SLN algorithm.

Methods
Patients who underwent preoperative 18F-FDG PET/CT scan, intraoperative SLN algorithm followed by systematic lymphadenectomy (LND) and had at least one high-risk criterion for lymphatic metastasis were included in this study. 18F-FDG PET/CT and SLN algorithm were compared with final histopathological results of systematic LND.

Results
Thirty-eight patients were eligible for the study. Lymphatic metastasis was seen in 10 patients (26.3%). Four cases had paraaortic lymphatic metastases which were together with pelvic (n:2) or isolated (n:2) metastases. SLN algorithm was able to detect all pelvic lymph node metastases. However, isolated paraaortic metastases were diagnosed only by 18F-FDG PET/CT. In 76 hemipelvises, sensitivity and negative predictive value of SLN algorithm for diagnosis of pelvic nodal metastasis were 100%, while sensitivity, specificity, positive predictive value and negative predictive value of 18F-FDG PET/CT were 45.4, 95.3, 62.5 and 91.1%, respectively.

Conclusions
Although SLN algorithm has an excellent diagnostic value for pelvic nodal metastasis, paraaortic metastasis might be underdiagnosed. 18F-FDG PET/CT may be a feasible tool to exclude paraaortic lymphatic metastasis in high-risk patients for lymphatic metastasis who will undergo SLN algorithm.
Gram‐negative Microbiota Blooms in Premature Twins Discordant for Parenteral Nutrition‐associated Cholestasis
Authors: Hourigan Suchitra K. , Moutinho Thomas J. , Berenz Andrew , Papin Jason , Guha Pallabi , Bangiolo Lois , Oliphant Sandra , Provenzano Marina , Baveja Raj , Baker Robin , Vilboux Thierry , Levy Shira , Deopujari Varsha , Nataro James P. , Niederhuber John E. , Moore Sean R. 
Published: January 2020

ABSTRACTParenteral nutrition‐associated cholestasis (PNAC) causes serious morbidity in the neonatal intensive care unit. Infection with gut‐associated bacteria is associated with cholestasis, but the role of intestinal microbiota in PNAC is poorly understood. We examined the composition of stool microbiota from premature twins discordant for PNAC as a strategy to reduce confounding from variables associated with both microbiota and cholestasis. Eighty‐four serial stool samples were included from 4 twin sets discordant for PNAC. Random Forests was utilized to determine genera most discriminatory in classifying samples from infants with and without PNAC. In infants with PNAC, we detected a significant increase in the relative abundance of Klebsiella, Veillonella, Enterobacter, and Enterococcus (P < 0.05). Bray‐Curtis dissimilarities in infants with PNAC were significantly different (P < 0.05) from infants without PNAC. Our findings warrant further exploration in larger cohorts and experimental models of PNAC to determine if a microbiota signature predicts PNAC, as a basis for future interventions to mitigate liver injury.
Using a Quality Improvement Approach in the Prevention of Mother-to-Child HIV Transmission Program in Uganda Improves Key Outcomes and Is Sustainable in Demonstration Facilities: Partnership for HIV-Free Survival
Authors: Flax Valerie L. , Kasasa Simon , Ssendagire Steven , Lane Charlotte , Atuyambe Lynn , Lance Peter M. , Ssengooba Freddie , Draru Joyce , Bobrow Emily A. 
Published: January 2020

Background:
The Partnership for HIV-Free Survival (PHFS) in Uganda used a quality improvement (QI) approach to integrate the prevention of mother-to-child transmission (MTCT) of HIV, maternal and child health, and nutrition services, with the goal of increasing the retention of mother–baby pairs in care and decreasing vertical transmission of HIV.

Methods:
This evaluation of PHFS used a retrospective longitudinal design to assess the program's association with 4 outcomes. Data were extracted from patient records from 2011 (before the program) to 2018 (after the program) at 18 demonstration, 18 scale-up, and 24 comparison facilities. Difference-in-differences analyses were conducted with significance set at P < 0.15 during and P > 0.15 or a significant continued improvement after PHFS.

Results:
PHFS was associated with an increase in exclusive breastfeeding (EBF) (P = 0.08), 12-month retention in care (P < 0.001), and completeness of child 18-month HIV test results (P = 0.13) at demonstration facilities during program implementation. MTCT at 18 months decreased, but did not differ between groups. Increases in EBF (P = 0.67) and retention in care (P = 0.16) were sustained, and data completeness (P = 0.10) continued to increase at demonstration facilities after the program. PHFS was associated with an increase in EBF (P < 0.001) at scale-up facilities, but there was no difference between groups for retention in care, MTCT, or data completeness. Gains in EBF were lost (P = 0.08) and retention in care declined (P < 0.001) at scale-up facilities after the program.

Conclusion:
PHFS′ quality improvement approach increased EBF, retention in care, and data completeness in demonstration facilities during the program and these benefits were sustained.
Interobserver Agreement of Magnetic Resonance Imaging of Liver Imaging Reporting and Data System Version 2018
Authors: Abdel Razek Ahmed Abdel Khalek , El-Serougy Lamiaa Galal , Saleh Gehad Ahmad , Abd el-wahab Rihame , Shabana Walaa 
Published: January 2020

AimThis study aimed to assess the interobserver agreement of magnetic resonance (MR) imaging of Liver Imaging Reporting and Data System version 2018 (LI-RADS v2018).Subjects and MethodsRetrospective analysis was done for 119 consecutive patients (77 male and 42 female) at risk of hepatocellular carcinoma who underwent dynamic contrast MR imaging. Image analysis was done by 2 independent and blinded readers for arterial phase hyperenhancement, washout appearance, enhancing capsule appearance, and size. Hepatic lesions were classified into 7 groups according to LI-RADS v2018.ResultsThere was excellent interobserver agreement of both reviewers for LR version 4 (κ = 0.887,P= 0.001) with 90.76% agreement. There was excellent interobserver agreement for nonrim arterial phase hyperenhancement(κ = 0.948; 95% confidence interval [CI], 0.89–0.99;P= 0.001), washout appearance (κ = 0.949; 95% CI, 0.89–1.0;P= 0.001); and enhancing capsule (κ = 0.848; 95% CI, 0.73–0.97;P= 0.001) and excellent reliability of size (interclass correlation, 0.99;P= 0.001). There was excellent interobserver agreement for LR-1 (κ = 1.00,P= 0.001), LR-2 (κ = 0.94,P= 0.001), LR-5 (κ = 0.839,P= 0.001), LR-M (κ = 1.00,P= 0.001), and LR-TIV (κ = 1.00; 95% CI, 1.0–1.0;P= 0.001), and good agreement for LR-3 (κ = 0.61,P= 0.001) and LR-4 (κ = 0.61,P= 0.001).ConclusionMR imaging of LI-RADS v2018 is a reliable imaging modality and reporting system that may be used for standard interpretation of hepatic focal lesions.
The Specific Magnetic Resonance Imaging Indicators in Predicting Clear-Cell Renal Cell Carcinoma Metastatic to the Sinonasal Region
Authors: Yang Bentao , Wang Ziyi , Dong Jiyong 
Published: January 2020

PurposeThe aim of this study was to determine the valuable magnetic resonance imaging (MRI) features of sinonasal metastatic clear-cell renal cell carcinoma (cc-RCC), especially focusing on its dynamic-enhanced characteristics.MethodsThe conventional and dynamic-enhanced MRI findings of 8 patients with histopathologically confirmed sinonasal metastatic cc-RCC were reviewed by 2 radiologists. The control group of 8 patients with capillary hemangioma underwent the same MRI protocol.ResultsMetastatic cc-RCCs arose from the nasoethmoid region, maxillary sinus, posterior ethmoid and sphenoid sinus, and nasal cavity in 2 patients in each. These lesions were well circumscribed and the mean maximum dimension was 42 mm. The signal intensity of these lesions was isointense to brain stem on both MR T1- and T2-weighted images. All metastatic tumors showed vivid enhancement on enhanced T1-weighted image. Multiple flow voids within these metastatic lesions were identified in 6 patients. Peripheral cyst was detected around the metastatic tumor in 4 patients. Metastatic cc-RCCs exhibited a characteristic type 4 time intensity curve (TIC) similar to that of the internal carotid artery, whereas capillary hemangiomas showed a type 3 TIC on dynamic-enhanced MRI.ConclusionsA hypervascular mass with the characteristic type 4 TIC in the sinonasal region is highly suggestive of a metastatic cc-RCC.
Normal Pressure Hydrocephalus: Clinical Symptoms, Cerebrospinal Fluid Flow Metrics and White Matter Changes
Authors: Atasoy Bahar , Aralasmak Ayse , Cetinkaya Ezra , Toprak Huseyin , Toprak Ali , Tokdemir Sevil , Babacan Gulsen , Alkan Alpay 
Published: January 2020

Purpose
The aim of this study was to investigate correlations between clinical symptoms, cerebrospinal fluid flow metrics, hydrocephalus index, small-vessel disease, and white matter (WM) changes in normal pressure hydrocephalus (NPH).

Methods
Aquaductal stroke volumes (ASVs), Z Evans index, Fazekas grading (FG), and diffusion tensor imaging measurements from WM bundles of 37 patients with NPH were retrospectively evaluated. Mann-Whitney U test between clinical symptoms and other variables and Spearman ρ correlations for relationships between variables and Kruskal-Wallis to correlate FG with nonclinical variables were used.

Results
Patients with NPH had increased ASV (median 53 μL). No correlation was found between Z Evans index and ASV. Three groups of patients with dementia or ataxia or incontinence had increased ASV values than their counterparts without symptoms (55 vs 48.5 μL, 75 vs 47 μL, 64 vs 49.5 μL, respectively). Patients having 2 common symptoms of dementia and ataxia and patients having all 3 symptoms of dementia, ataxia, and incontinence were compared with ASV values of 63.5 versus 78 μL, respectively. Patients with FG 1 had median ASV values of 45 μL; FG 2, 82.5 μL; and FG 3, 59 μL. Patients with dementia had significantly higher apparent diffusion coefficient (ADC) values of corona radiata (CR) on both sides. There were no significant WM changes in patients with ataxia and incontinence. The Z Evans index was positively correlated with ADC values of CR on both sides and genu of corpus callosum. Fazekas grading was found positively correlated with ADC and negatively correlated with FA values of CR.

Conclusions
Patients with NPH, regardless of stages of the diseases, have increased ASV values and could benefit from shunting. Decreasing ASV values of patients with FG 3 comparing with those with FG 2 support the hypothesis of decreasing compliance of brain with aging and increasing severity of small-vessel disease.