bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Clinically Significant Chromosomal Microarray Analysis Findings in Fetuses With Nuchal Translucency From 3.0 mm Through 3.4 mm
Authors: Sagi-Dain Lena , Singer Amihood , Ben Shachar Shay , Josefsberg Ben Yehoshua Sagi , Feingold-Zadok Michal , Greenbaum Lior , Maya Idit 
Published: December 2020

OBJECTIVE:
To examine the risk of clinically significant chromosomal microarray analysis findings in fetuses with nuchal translucency from 3.0–3.4 mm. In addition, we aimed to define the yield of noninvasive prenatal testing (NIPT) in such pregnancies.

METHODS:
This retrospective cohort study included results of all chromosomal microarray analysis tests performed owing to a nuchal translucency measurement from 3.0–3.4 mm, without ultrasonographic anomalies, retrieved from the Israeli Ministry of Health computerized database. Rates of clinically significant (pathogenic and likely pathogenic) microarray findings were compared with a previously published local control population, encompassing 2,752 fetuses with normal ultrasound findings and nuchal translucency less than 3.0 mm.

RESULTS:
Overall, 619 chromosomal microarray analyses were performed owing to isolated nuchal translucency from 3.0–3.4 mm. Of these, 29 (4.7%) cases had clinically significant copy number variants, a significantly higher risk compared with control-group pregnancies (relative risk 3.3, 95% CI 2.6–7.2). Divided by tenths of millimeters, the risk for abnormal chromosomal microarray analysis findings remained significantly increased, except for the subgroup of 198 fetuses with nuchal translucency measurements of 3.0 mm. Noninvasive prenatal testing for the five common chromosome aneuploidies would have missed 41.4% of the abnormal copy number variants—1.9% of overall cases, or 1 in 52 fetuses with nuchal translucency from 3–3.4 mm. Genome-wide NIPT, as well as traditional karyotyping, could have missed an abnormal finding in 9 of 619 (1.5%), or 1 in 69 fetuses.

CONCLUSION:
Our outcomes show that the rate of abnormal chromosomal microarray analysis findings in fetuses with nuchal translucency from 3.1–3.4 mm is significantly higher compared with fetuses with normal ultrasound findings.
Placenta Accreta Spectrum Among Women With Twin Gestations
Authors: Miller Hayley E. , Leonard Stephanie A. , Fox Karin A. , Carusi Daniela A. , Lyell Deirdre J. 
Published: December 2020

OBJECTIVE:
To assess whether placenta accreta spectrum occurs more frequently among women with twin gestations compared with singleton gestations.

METHODS:
All live births in California from 2016 to 2017 were identified from previously linked records of birth certificates and birth hospitalization discharges. The primary outcome was placenta accreta spectrum (which includes placenta accreta, increta, and percreta), identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes (O43.2x) for placenta accreta, increta, and percreta. We analyzed the association between twin gestation and placenta accreta spectrum by using multivariable logistic regression and assessed whether our findings were replicated by using a previously validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)–based approach.

RESULTS:
Among 918,452 live births, 1,126 were diagnosed with placenta accreta spectrum. The prevalence of placenta accreta spectrum was 11.8 per 10,000 among singleton pregnancies and 41.6 per 10,000 among twin pregnancies. In the unadjusted regression analysis, twin pregnancy was associated with higher relative risk of placenta accreta spectrum (RR 3.41, 95% CI 2.57–4.52). After adjusting the regression model for maternal age, previous cesarean birth, and sociodemographic factors, the association held with higher relative risk of placenta accreta spectrum (aRR 2.96, 95% CI 2.23–3.93). Women with twin compared with singleton gestations with placenta accreta spectrum were less likely to have placenta previa. When assessed using ICD-9-CM codes, placenta accreta spectrum was similarly more prevalent among twins than singletons, with an increase in the relative risk of placenta accreta spectrum (aRR 2.45, 95% CI 2.33–3.25).

CONCLUSION:
Twin gestation conferred an increased risk for placenta accreta spectrum independent of measured risk factors, which may contribute to increased maternal morbidity in twin gestation compared with singleton gestation. Clinicians should be aware of the increased risk for placenta accreta spectrum in twin gestation and should consider it during ultrasonographic screening.
Transcutaneous Electrical Nerve Stimulation to Reduce Pain With Medication Abortion
Authors: Goldman Ariella R. , Porsch Lauren , Hintermeister Abigail , Dragoman Monica 
Published: December 2020

OBJECTIVE:
To evaluate whether high-frequency transcutaneous electrical nerve stimulation (hfTENS) reduces pain during medication abortion.

METHODS:
We conducted a randomized, placebo-controlled trial. Participants who were undergoing medication abortion with mifepristone and misoprostol through 70 days of gestation either received active 80 Hz hfTENS or sham to use for a minimum of 60 minutes within 8 hours of misoprostol. Maximum pain on an 11-point numerical rating scale at 8 hours after misoprostol was the primary outcome. We estimated 20 per group for 80% power to detect a 2-point difference and up to 10% attrition. Secondary outcomes included a maximum pain score at 24 hours, additional analgesia use, the difference in score before and after treatment, the experience of side effects, abortion outcomes, and acceptability. We collected data at baseline, time of misoprostol (0-hour), 8-hour and 24 hours using real-time electronic surveys, and at follow-up.

RESULTS:
Between June 2019 and March 2020, we screened 251 patients and randomized 40—20 each to hfTENS or sham—with one postrandomization exclusion and two patients lost to follow-up. Baseline characteristics were similar. Median maximum pain scores at 8 hours were 7.0 (interquartile range 3.0) and 10.0 (interquartile range 3.0) for hfTENS and sham, respectively. The distribution of these scores was lower among hfTENS users compared with sham (mean rank 15.17 vs 22.63, P=.036). High-frequency TENS users also experienced a significant reduction in posttreatment pain score (−2.0 [interquartile range 2.5] vs 0 [interquartile range 1.5], P=.008). We found no statistically significant differences in use of additional analgesia, distribution of maximum pain scores at 24 hours, side effects, or measures of acceptability.

CONCLUSION:
High-frequency TENS reduced maximum pain scores within 8 hours of misoprostol and reduced pain scores immediately after treatment compared with placebo. High-frequency TENS offers an effective nonpharmacologic option for pain management during medication abortion.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03925129.
Thoracolumbar Burst Fracture: McCormack Load-sharing Classification
Authors: Filgueira Ériko Gonçalves , Imoto Aline Mizusaki , da Silva Helbert Eustáquio Cardoso , Meves Robert 
Published: December 2020

Study Design.
A systematic review and single-arm meta-analysis of randomized clinical trials.

Objective.
The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF).

Summary of Background Data.
There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures.

Methods.
On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I
2 and τ2 statistics.

Results.
The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I
2 = 77%, τ2 < 0.0015, P < 0.01).

Conclusion.
Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.

Level of Evidence: 1
Vertebral Artery Variation in Patients With Congenital Cervical Scoliosis
Authors: Xia Tian , Sun Yu , Wang Shaobo , Zhang Fengshan , Zhang Li , Pan Shengfa , Diao Yinze , Chen Xin , Zhou Feifei , Zhao Yanbin 
Published: December 2020

Study Design.
Observational, anatomical, radiological study.

Objective.
The aim of this study was to explore the incidence and type of vertebral artery (VA) variation in patients with congenital cervical scoliosis and approach their clinical importance during surgery.

Summary of Background Data.
Congenital scoliosis of the cervical spine is usually sporadic and caused by a variety of bone structural anomalies. Most of the cases remain asymptomatic. Surgical intervention is the main management for patients with neurological compromise or with cosmetic demands. The operation involved more screw insertion and osteotomy than the regular degenerative cases. The incidence and pattern of VA variants in these patients have not been reported.

Methods.
Patients with congenital cervical scoliosis treated in our department were reviewed. We measured Cobb angle of cervical spine. We observed bilateral VAs and recorded variants. We measured their diameter in each segment through CT angiography. The bilateral diameter in each patient was then compared respectively.

Result.
There is a total of 44 patients enrolled. The incidence of VA variation was 41% (18/44). Fifty percent (22/44) of patients had the dominant VA with no difference between concave side and convex side. Patients with a dominant VA had a larger Cobb angle than those who had not (30.25° vs. 23.24°, P < 0.05). The courses of VA were abnormal in 18 patients. Two patients had unilateral variant in V1 segment. Twelve patients had variants in V2 segment. Eight patients had variants in V3 segment. Three patients had VA variants in multiple sites.

Conclusion.
In patients with congenital cervical scoliosis, the dominance of VA is not related to the convex side or concave side, but patients with a dominance of VA have a larger Cobb angle. The incidence of variant in V2 and V3 segment is higher. A thorough evaluation of bilateral VAs is required before surgery. Extra cautions must be taken during surgery.

Level of Evidence: 5
Predictive Value of the Spinal Instability Neoplastic Score for Survival and Ambulatory Function After Surgery for Metastatic Spinal Cord Compression in 110 Patients with Prostate Cancer
Authors: Wänman Johan , Jernberg Johannes , Gustafsson Patrik , Abul-Kasim Kasim , Grabowski Pawel , Bobinski Lukas , Crnalic Sead 
Published: December 2020

Study Design..
We retrospectively analyzed Spinal Instability Neoplastic Score (SINS) in 110 patients with prostate cancer operated for metastatic spinal cord compression (MSCC).

Objective..
We aimed to investigate the association between SINS and clinical outcomes after surgery for MSCC in patients with prostate cancer.

Summary of Background Data..
The SINS is a useful tool for assessing tumor-related spinal instability, but its prognostic value regarding survival and neurological outcome is still controversial.

Methods..
We analyzed 110 consecutive patients with prostate cancer who underwent surgery for MSCC. The patients were categorized according to their SINS. Patients with castration-resistant prostate cancer (CRPC, n = 84) and those with hormone-naïve disease (n = 26) were analyzed separately.

Results..
In total, 106 of 110 patients met the SINS criteria for potential instability or instability (scores 7–18). The median SINS was 10 (range 6–15) for patients with CRPC and 9 (7–16) for hormone-naïve patients. In the CRPC group, the SINS was classified as stable (score 0–6) in 4 patients, as potentially unstable (score 7–12) in 70 patients, and as unstable (score 13–18) in 10 patients. In the hormone-naïve group, 22 patients met the SINS criteria for potential instability and 4 patients for instability. There was no statistically significant difference in the overall risk for death between the SINS potentially unstable and unstable categories (adjusted hazard ratio 1.3, P = 0.4), or in the risk of loss of ambulation 1 month after surgery (adjusted odds ratio 1.4, P = 0.6).

Conclusion..
The SINS is helpful in assessing spinal instability when selecting patients for surgery, but it does not predict survival or neurological outcomes. Patients with a potential spinal instability benefit equally from surgery for MSCC as do patients with spinal instability.

Level of Evidence: 3
Cancer mortality and predictions for 2020 in selected Australasian countries, Russia and Ukraine
Authors: Pizzato Margherita , Carioli Greta , Bertuccio Paola , Malvezzi Matteo , Levi Fabio , Boffetta Paolo , Negri Eva , La Vecchia Carlo 
Published: December 2020

Objectives
Predicted cancer mortality figures are useful for public health planning. We predicted cancer mortality rates in Israel, Hong Kong, Japan, the Philippines, Korea, Australia, Russia and Ukraine for the year 2020 using the most recent available data. We focused on breast cancer.

Methods
We obtained cancer death certification and population data from the WHO and the United Nations Population Division databases. We derived figures for 10 major cancer sites and total cancers over 1970–2017. We predicted numbers of deaths and age-standardized mortality rates for 2020 through joinpoint regression models. We calculated the number of avoided deaths from 1994–2020.

Results
Overall, total cancer mortality is predicted to decline. Russia had the highest all cancers rates in 2020, 151.9/100 000 men and 79.6 women; the Philippines had the lowest rate in men, 78.0/100 000, Korea in women, 47.5. Stomach cancer rates declined over the whole period in all countries considered, colorectal cancer since the late 1990s. Trends for pancreas were inconsistent. Predicted rates for lung and breast cancer were favourable; women from Hong Kong, Korea and Australia had lung cancer death rates higher than breast ones. Predicted rates for uterine, ovarian, prostate and bladder cancers and leukaemias were downward for most countries. Between 1994 and 2020, over 3.3 million cancer deaths were avoided in the considered countries, except for the Philippines where no reduction was observed.

Conclusion
Predicted cancer rates were lower than in the European Union and the USA, even though falls started later and were less marked.
Generation of Filler Emboli as a Mechanism for Filler-Related Blindness
Authors: Ugradar Shoaib , Diniz Stefania , Hoenig Jonathan , Goldberg Robert A. 
Published: December 2020

BACKGROUND
Intra-arterial injection of fillers can lead to occlusion of the ophthalmic artery or its branches supplying the retina or the optic nerve. The mechanism through which this occurs is incompletely understood. We investigated the possibility of generating microparticles after injecting commercially available fillers into a flowing system in vitro.

METHODS
Three hyaluronic acid fillers and one calcium hydroxylapatite filler were injected into an artificial saline flow system mimicking arterial systolic blood pressure and corresponding to the diameter of the facial artery. All the saline at the end of the tube was collected, centrifuged, and inspected for filler particles.

RESULTS
After injection into the system, all fillers immediately disintegrated into small particles that were carried downstream with the flow of the saline. The saline at the end of the tube contained collections of filler.

CONCLUSION
Hyaluronic acid and hydroxylapatite fillers break up into small particles immediately after injection into a flowing system, generating emboli rather than a column of filler. The results of this study lead us to hypothesize another potential mechanism leading to filler-related blindness.
Home-Based Versus Outpatient-Based Cardiac Rehabilitation Post–Coronary Artery Bypass Graft Surgery
Authors: Takroni Mohammed A. , Thow Morag , Ellis Brian , Seenan Christopher 
Published: December 2020

Background
The prevalence of coronary heart disease continues to increase in the Kingdom of Saudi Arabia (KSA). Despite advances in cardiac surgery, there are no established outpatient cardiac rehabilitation programs in the KSA.

Objective
The aim of this study was to investigate the effectiveness of home-based cardiac rehabilitation compared with outpatient-based cardiac rehabilitation and usual care for patients who are post–coronary artery bypass graft surgery.

Method
This 3-arm, single-blind, randomized controlled trial was carried out at the King Faisal Specialist Hospital, Riyadh, KSA. A total of 82 patients post–coronary artery bypass graft surgery were randomized and 73 patients completed the study. Recruited patients were distributed to home-based cardiac rehabilitation (n = 24), outpatient-based cardiac rehabilitation (n = 25), or usual care (control group) (n = 24). Participants in the intervention groups completed an individualized exercise program for 2 hours, 3 times a week for 8 weeks. The control group followed usual care (no intervention). The incremental shuttle walk test (ISWT), metabolic equivalence task, Short Form-36, and Hospital Anxiety and Depression Scale (HADS) were measured at baseline, postintervention, and after a 4-week follow-up period.

Results
Postintervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P < .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures.

Conclusion
Home-based cardiac rehabilitation is as effective as outpatient-based cardiac rehabilitation. Home-based cardiac rehabilitation appears to be more effective at maintaining improvements follow the end of the intervention.
Persistent Heart Failure Symptoms at Hospital Discharge Predicts 30-Day Clinical Events
Authors: Senecal Laura E. , Jurgens Corrine Y. 
Published: December 2020

Background
The relationship between heart failure (HF) symptoms at hospital discharge and 30-day clinical events is unknown. Variability in HF symptom assessment may affect ability to predict readmission risk.

Objective
The aim of this study was to describe HF symptom profiles and burden at hospital discharge. A secondary aim was to examine the relationship between symptom burden at discharge and 30-day clinical events.

Methods
An exploratory descriptive design was used. Patients with HF (n = 186) were enrolled 24 to 48 hours pre hospital discharge. The HF Somatic Perception Scale quantified 18 HF physical signs and symptoms. Scores were divided into tertiles (0–10, 11–19, and 20 and higher). The Patient Health Questionnaire-9 quantified depressive symptoms. Self-assessed health, comorbid illnesses, and 30-day clinical events were documented. Chi-square and logistic regression were used to examine clinical events.

Results
The sample (n = 186) was predominantly White (87.6%), male (59.1%), elderly (mean [SD], 74.2 [12.5]), and symptomatic (92.5%) at discharge. Heart Failure Somatic Perception Scale scores ranged from 0 to 53, with a mean (SD) of 13.7 (10.1). Symptoms reported most frequently were fatigue (67%), nocturia (62%), need to rest (53%), and inability to do usual activities due to shortness of breath (52%). Thirty-day event rate was 28%, with significant differences between Heart Failure Somatic Perception Scale tertiles (9.4% vs 37.7% in the second and third tertiles, respectively; χ2(N = 186) = 16.73, P < .001). Heart Failure Somatic Perception Scale tertile 2 or 3 (odds ratio [OR], 5.7; P = .003; and OR, 4.3; P = .021), self-assessed health (OR, 2.6; P = .029), and being in a relationship predicted clinical events.

Conclusions
Heart failure symptom burden at discharge predicted 30-day clinical events. Comprehensive symptom assessment is important when determining readmission risk.
Anxiety and Depression
Authors: di Giacomo Ester , Colmegna Fabrizia , Biagi Enrico , Zappa Luigi , Caslini Manuela , Dakanalis Antonios ,   UnimibPsychiatricResearch-Group (Martina Tremolada,‡ Giulia Gamba,‡ Francesca Pescatore,‡ Rodolfo Pessina,‡ Valeria Placenti,∗ Jacopo Santambrogio,‡ Francesca Costantini‡), Clerici Massimo 
Published: December 2020

Abstract
Anxiety and depressive disorders affect one fourth of the population. Personality disorders often present comorbid with anxiety and depressive disorders during the lifetime course of the illness. To fully explore the interplay between personality disorders and anxiety or depression, 179 patients, consecutively admitted to the Anxiety and Depression Outpatient Department, were clinically evaluated and tested with the Mini-International Neuropsychiatric Interview and the Iowa Personality Disorder Screening. Twenty-six percent of the total sample was affected only by personality disorders (PDs), and 21% had a comorbidity between a personality, anxiety, and/or depressive disorder (Comorbidity). Compared with PDs, Comorbidity used more antipsychotics and benzodiazepines (4.3% vs. 9.6%, χ
2 = 0.267; 43.4 vs. 72.6, p = 0.004), showing a worse clinical picture, and expressed more personality traits even without statistical significance (6.863 ± 2.328 vs. 7.609 ± 1.674, p = 0.105). The different impact of personality disorders compared with anxiety and/or depression has to be further analyzed in terms of economic load and resource allocation.