bluuebunny/crossref_metadata_2025_split huggingface dataset:
Herpes Simplex Virus Serotyping in Pregnant Women With a History of Genital Herpes and an Outbreak in the Third Trimester of Pregnancy
Authors: Chatroux Isabelle C. , Hersh Alyssa R. , Caughey Aaron B. 
Published: December 2020

OBJECTIVE:
To estimate whether serotyping women with a history of genital herpes simplex virus (HSV) and an outbreak during the third trimester of pregnancy is cost effective compared with no serotyping.

METHODS:
We designed a decision-analytic model using TreeAge Pro software to assess an approach of routine HSV serotyping in a theoretical cohort of 63,582 women (an estimate of the number of women in the United States with a history of genital HSV and an outbreak during the third trimester of pregnancy). Outcomes included mild, moderate, and severe neonatal HSV, neonatal death, costs, and quality-adjusted life-years (QALYs) for both the woman and neonate. Probabilities, utilities, and costs were derived from the literature, and we used a willingness-to-pay threshold of $100,000 per QALY. Sensitivity analyses were performed to assess the robustness of the results.

RESULTS:
In our theoretical cohort, HSV serology screening resulted in 519, 8, and 15 cases of mild, moderate, and severe neonatal HSV, whereas no serology screening resulted in 745, 65, and 85 cases, respectively. Thus, HSV serology screening led to 226, 57, and 70 fewer cases of mild, moderate, and severe neonatal HSV, respectively, as well as 91 fewer neonatal deaths. Additionally, serology screening saved $61 million and gained 7,900 QALYs, making it a dominant strategy. Univariate sensitivity analysis demonstrated that serology screening was cost effective until the chance of progression from neonatal HSV infection to disease despite empiric antiviral treatment was greater than 23%.

CONCLUSION:
Serology screening in pregnant women with an outbreak in the third trimester of pregnancy and a history of genital HSV resulted in improved outcomes and decreased costs.
Foley Bulb Insertion by Blind Placement Compared With Direct Visualization
Authors: Kuhlmann Maggie J. , Spencer Nicholas , Garcia-Jasso Carlos , Singh Prapti , Abdelwahab Mahmoud , Vaughn Micah , Marshall Karis , Prasad Nikita , Soulsby-Monroy Ruth , Saade George R. , Saad Antonio F. 
Published: December 2020

OBJECTIVE:
To test the hypothesis that digital placement of a balloon catheter is not inferior to the speculum method in terms of rate of maternal infection.

METHODS:
In an open-label noninferiority randomized trial, pregnant women who were undergoing induction of labor with unfavorable cervix (less than 3 cm dilated and less than 60% effaced) were randomly assigned to balloon catheter that was placed either digitally or using a sterile speculum. The primary outcome was a composite of maternal infection, defined by occurrence of fever (temperature 38°C or higher), chorioamnionitis, or endometritis (diagnoses were made by the managing obstetric physician or midwife). Prespecified secondary outcomes included outcomes in the primary composite, cesarean delivery rates, and maternal and neonatal outcomes. A patient satisfaction survey was also obtained. On the basis of a noninferiority margin of 10% and an expected primary outcome frequency of 10%, a sample size of 372 women was needed (90% power to confirm noninferiority with 90% protocol adherence).

RESULTS:
From February 2018 through February 2019, 372 women were randomized (185 digital placement, 187 sterile speculum). Baseline characteristics were similar between groups. The composite maternal infection rate was not different between groups (digital placement arm: 15.7% vs speculum arm: 12.8%), with an absolute difference with respect to the sterile speculum arm of 2.8% (95% CI −4.3 to 9.9%), indicating noninferiority for the prespecified margin. Secondary outcomes were not different between groups, except for a higher need for a second balloon catheter in the sterile speculum arm. Maternal and neonatal adverse events were not different between groups. Irrespective of method of placement, women were equally satisfied with the explanation of the method before placement, anxiety regarding the procedure, and pain during placement. More women in the sterile speculum group would choose the digital placement method for the subsequent pregnancy (37.6% vs 25.7%; P=.02.)

CONCLUSION:
Digital placement of a balloon catheter for preinduction cervical ripening is noninferior to the sterile speculum method, in terms of maternal infection. Women in the sterile speculum group more frequently required a second round of the mechanical dilator. The blind digital approach is a reasonable option for balloon placement for cervical ripening.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03450408.
Chromopertubation of an Ectopic Pregnancy
Authors: Sunkara Sowmya , Bardawil Elise , Nijjar J. Biba 
Published: December 2020

BACKGROUND:
An ectopic pregnancy is a nonviable pregnancy located outside of the endometrial cavity of the uterus, which can be managed medically or surgically.

CASE:
A 35-year-old woman with a prior ectopic pregnancy, who reported tubal surgery of unknown location and extent, presented with a recurrent ectopic pregnancy. Ultrasound imaging showed a complex cystic lesion adjacent to the ovary, moderate complex free fluid, and no intrauterine pregnancy. She underwent an urgent diagnostic laparoscopy. Chromopertubation was performed to demonstrate absence of the left fallopian tube. The ectopic pregnancy was incidentally noted to be mobile and was expelled from the right fallopian tube.

CONCLUSION:
Chromopertubation offers a minimally invasive technique for management of ectopic pregnancy that may reduce injury as a result of less surgical manipulation of the fallopian tube.
Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss
Authors: Shorter Jade M. , Koelper Nathanael , Sonalkar Sarita , Oquendo Maria A. , Sammel Mary D. , Schreiber Courtney A. 
Published: December 2020

OBJECTIVE:
To explore the relationship between race and depression symptoms among participants in an early pregnancy loss clinical trial.

METHODS:
We performed a planned secondary analysis of a randomized trial by comparing treatments for medical management of early pregnancy loss. We hypothesized that Black participants would have higher odds of risk for major depression (measured with the CES-D [Center for Epidemiological Studies-Depression] scale) 30 days after early pregnancy loss treatment when compared with non-Black participants. We analyzed the data as a cohort, with the primary exposure being race and secondary exposure being high adverse childhood experience scores (measured with the Adverse Childhood Experience scale). Our primary outcome was risk for major depression (score of 21 or higher on the CES-D scale) 30 days after early pregnancy loss treatment.

RESULTS:
Three hundred participants diagnosed with a nonviable intrauterine pregnancy from 5 to 12 weeks of gestation were randomized as part of the original trial from May 2014 to April 2017. Of 275 respondents included in this analysis, 120 [44%] self-identified as Black and 155 [56%] self-identified as non-Black. After early pregnancy loss treatment, 65 [24%] participants were at risk for major depression. Black participants had an increased risk for major depression (57%) after early pregnancy loss treatment compared with non-Black participants (43%; odds ratio [OR] 2.02; 95% CI 1.15–3.55). After adjustment for risk for baseline depression, adverse childhood experience score, and parity, the odds of risk for major depression 30 days after pregnancy loss treatment remained higher for Black participants when compared with non-Black participants (OR 2.02; 95% CI 1.15–3.55; adjusted OR 2.48; 95% CI 1.28–4.81).

CONCLUSION:
Overall, approximately one quarter of women who experience an early pregnancy loss are at an increased risk for major depression 30 days after treatment. This risk is about twice as high for Black women compared with non-Black women. There is a need for appropriate mental health resources for women undergoing early pregnancy loss care.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, NCT02012491.
Use of Intraoperative CT Improves Accuracy of Spinal Navigation During Screw Fixation in Cervico-thoracic Region
Authors: Habib Nermine , Filardo Giuseppe , Distefano Daniela , Candrian Christian , Reinert Michael , Scarone Pietro 
Published: December 2020

Study Design.
A retrospective analysis of a single-center consecutive series of patients.

Objective.
To test the hypothesis that using a mobile intraoperative computed tomography in combination with spinal navigation would result in better accuracy of lateral mass and pedicle screws between C3 and T5 levels, compared to cone-beam computed tomography and traditional 2D fluoroscopy.

Summary of Background Data.
Use of spinal navigation associated with 3D imaging has been shown to improve accuracy of screw positioning in the cervico-thoracic region. However, use of iCT imaging compared to a cone-beam CT has not been fully investigated in these types of surgical interventions.

Methods.
We retrospectively analyzed a series of patients who underwent posterior cervico-thoracic fixations using different intraoperative imaging systems in a single hospital. We identified three different groups of patients: Group A, operated under 2D-fluoroscopic guidance without navigation; Group B: O-arm guidance with navigation; Group C: iCT AIRO guidance with navigation. Primary outcome was the rate of accurately placed screws, measured on intra or postoperative CT scan with Neo et al. classification for cervical pedicles screws and Gertzbein et al. for thoracic pedicle screws. Screws in cervical lateral masses were evaluated according to a new classification created by the authors.

Results.
Data on 67 patients and 495 screws were available. Overall screw accuracy was 92.8% (95.6% for lateral mass screws, 81.6% for cervical pedicle screws, and 90% for thoracic pedicle screws). Patients operated with iCT AIRO navigation had significantly fewer misplaced screws (2.4%) compared to 2D-fluoroscopic guidance (9.1%) and O-arm navigation (9.7%) (P = 0.0152). Accuracy rate of iCT navigation versus O-arm navigation was significantly higher (P = 0.0042), and there was no statistically significant difference in surgical time between the three Groups (P = 0.5390).

Conclusion.
Use of high-quality CT associated with spinal navigation significantly improved accuracy of screw positioning in the cervico-thoracic region.

Level of Evidence: 3.
Deep Learning Automates Measurement of Spinopelvic Parameters on Lateral Lumbar Radiographs
Authors: Schwartz John T. , Cho Brian H. , Tang Peter , Schefflein Javin , Arvind Varun , Kim Jun S. , Doshi Amish H. , Cho Samuel K. 
Published: December 2020

Study Design.
Cross-sectional database study.

Objective.
The objective of this study was to develop an algorithm for the automated measurement of spinopelvic parameters on lateral lumbar radiographs with comparable accuracy to surgeons.

Summary of Background Data.
Sagittal alignment measurements are important for the evaluation of spinal disorders. Manual measurement methods are time-consuming and subject to rater-dependent error. Thus, a need exists to develop automated methods for obtaining sagittal measurements. Previous studies of automated measurement have been limited in accuracy, inapplicable to common plain films, or unable to measure pelvic parameters.

Methods.
Images from 816 patients receiving lateral lumbar radiographs were collected sequentially and used to develop a convolutional neural network (CNN) segmentation algorithm. A total of 653 (80%) of these radiographs were used to train and validate the CNN. This CNN was combined with a computer vision algorithm to create a pipeline for the fully automated measurement of spinopelvic parameters from lateral lumbar radiographs. The remaining 163 (20%) of radiographs were used to test this pipeline. Forty radiographs were selected from the test set and manually measured by three surgeons for comparison.

Results.
The CNN achieved an area under the receiver-operating curve of 0.956. Algorithm measurements of L1-S1 cobb angle, pelvic incidence, pelvic tilt, and sacral slope were not significantly different from surgeon measurement. In comparison to criterion standard measurement, the algorithm performed with a similar mean absolute difference to spine surgeons for L1-S1 Cobb angle (4.30° ± 4.14° vs. 4.99° ± 5.34°), pelvic tilt (2.14° ± 6.29° vs. 1.58° ± 5.97°), pelvic incidence (4.56° ± 5.40° vs. 3.74° ± 2.89°), and sacral slope (4.76° ± 6.93° vs. 4.75° ± 5.71°).

Conclusion.
This algorithm measures spinopelvic parameters on lateral lumbar radiographs with comparable accuracy to surgeons. The algorithm could be used to streamline clinical workflow or perform large scale studies of spinopelvic parameters.

Level of Evidence: 3
Extensive Periprosthetic Metallosis Associated to Osteolysis and Spinal Instrumentation Failure
Authors: Rasmussen Jorge , Estefan Valentin , Estefan Martín , Estefan Guillermo 
Published: December 2020

Study Design.
Case-report and literature review.

Objective.
To depict main features of a potentially deleterious postoperative spinal fixation complication.

Summary of Background Data.
Tisular deposit of metal particles from prosthetic systems—metallosis—is an uncommon complication of spinal fixation surgery. Manifestations as chronic postoperative pain, instrumentation failure, infection, or neurological impairment can be developed, but metallosis often appears as an unexpected intraoperative finding.

Methods.
A 70-year-old female underwent several spinal fixation procedures due to progressive degenerative adult scoliosis, who developed instrumentation failure. Unexpected metallosis was evidenced extensively surrounding the dislodged construct due to vertebral osteolysis. Instrumentation replacement and debridement of metallotic tissue was performed. We also conduct a literature review for the terms “spinal metallosis” and “spinal corrosion” on the PubMed/MEDLINE database. Previous publications depicting black/dark staining, discoloration and/or fibrotic tissue, as well as histopathological metal particle deposits, or merely metallosis, were reviewed. Articles reporting individual cases or case-series/cohorts with patient-discriminated findings were included.

Results.
The histopathological analysis of our patient revealed dense fibroconnective tissue with black metallic pigment associated. She evolved with great pain relief in the immediately postoperative period. The patient achieved pain-free standing with significant pharmacotherapy reduction and independent ambulation. The literature search retrieved 26 articles for “spinal metallosis” and 116 for “spinal corrosion”; 16 articles met selection criteria. Approximately 60% of the reported cases accounted for patients younger than 30 years old, mainly related to expandable fixation system (65%) for idiopathic scoliosis. Usually, the symptoms were correlated with abnormal radiological findings: instrumentation breakage, dislodgement, loosening, expandable systems fracture. All the reviewed patients evolved free of pain and neurologically recovered.

Conclusion.
Instrumentation removal and metallosis debridement seems to be useful for symptomatic patients, but remains controversial on fixed asymptomatic patients. If solid fusion has not been achieved, extension, and reinforcement of the failed fixation could be required.

Level of Evidence: 4
Tcf12 balances the reconstitution and differentiation capacity of hematopoietic stem cell
Authors: Liao Min , Wang Jianwei 
Published: December 2020

Abstract
Tcf12 has been identified as one of the main helix-loop-helix transcription factors that regulates T cell development from double negative to double positive stage transition. While, the function of Tcf12 in hematopoietic stem cells remains not investigated. In this study, we observed that Tcf12 is expressed in HSCs and targeted deletion of Tcf12 in hematopoietic cells results in increased frequency and absolute number of HSCs, but compromises the reconstitution capacity of HSCs. Further analysis reveals that Tcf12 is dispensable for the self-renewal of HSCs. The declined reconstituted capacity of Tcf12−/− HSCs stems from the decrease in the ability to differentiate into lymphoid-primed multipotent progenitors, and furthermore B and T lineages.
Single Antegrade Intramedullary Kirschner Wire Fixation For Transverse Metacarpal Shaft Fractures: A Retrospective Review
Authors: Collins Devin W. , Rehak Christopher , Rehak David 
Published: December 2020

Introduction:
Fractures of the metacarpals are frequently encountered. Transverse metacarpal shaft fractures are inherently unstable and amenable to surgical intervention. Few studies have evaluated outcomes of patients with a singular transverse metacarpal shaft fracture surgically corrected with an antegrade intramedullary Kirschner (K) wire. We present our series of patients and their outcomes performed by a single surgeon.

Materials and Methods:
A retrospective chart review of cases at our institution was performed on transverse metacarpal fracture treated with an intramedullary K-wire. Fifteen patients met the inclusion criteria. Data extracted included metacarpal involved, laterality, sex, age, if removal of hardware was performed, time from initial injury to surgery, tourniquet time, complications, range of motion, clinical outcome, among others.

Results:
All fractures occurred about the right hand with 7 involving the small finger metacarpal, 4 involving the index, 3 involving the ring, and 1 involving the middle. The average patient age was 25 years (range: 18 to 58 y). The average tourniquet time was 16 minutes (range: 10 to 20 min). There were no intraoperative complications and 1 patient had hardware removed at 8 weeks due to proximal pin site pain. All patients achieved clinical union with a return of full function.

Discussion:
Single antegrade intramedullary K-wire fixation is a simple, reliable, and potentially cost-effective treatment option for transverse metacarpal shaft fractures. Further research is needed to determine long-term outcomes and formal cost analysis. Our series indicate this technique can be safely utilized, with a low risk of complications and good clinical outcomes.

Level of Evidence:
Level IV—therapeutic.
Role of gut microbiota in metabolic syndrome: a review of recent evidence
Authors: Alveirinho Manuel , Freitas Paula , Faleiro Maria Leonor 
Published: December 2020

Abstract
The metabolic syndrome is a complex entity comprised of multiple cardiovascular risk factors grouped in a single individual, contributing to an increased rate of cardiovascular events which goes beyond what would be expected given the impact of each individual risk factor. It is a multifactorial condition whose complete pathogenesis is not yet fully understood. Several studies have shown that not only the intestinal microbiota and dysbiosis may play a role in its pathogenesis, but also that modulating said microbiota may play a role in treating or at least ameliorating the metabolic syndrome. The purpose of this article is to review some of the most recent evidence linking the gut microbiome and the metabolic syndrome to help further understand this relationship and try to identify further research directions.
Dietary Intake Among Members of a Volunteer Fire Department Compared With US Daily Dietary Recommendations
Authors: Kadiwar Payal , Shah Nimit , Black Taylor , Caban-Martinez Alberto J. , Steinberg Michael , Black Kathleen , Sackey Joachim , Graber Judith 
Published: December 2020

Objective:
To characterize the diet of volunteer firefighters compared with the United States recommended dietary intake.

Methods:
A survey was administered to members of volunteer fire department which collected information on demographics, behavioral risks, fire service history, and dietary intake using the Dietary Screener Questionnaire. Dietary intake was compared with US recommendations; associations between dietary intake and years of firefighting, were assessed using bi- and multivariate analysis.

Results:
The 122 male study participants were majority non-Hispanic white (96.4%), and over 90% were overweight or obese. Participants had lower mean intakes of fruit and vegetables, whole grains, and dietary fiber, and a higher mean intake of added sugars compared with the US recommended dietary intake.

Conclusion:
Volunteer firefighters in our study had suboptimal daily dietary intake of fruits and vegetables, dietary fiber, whole grains, and added sugars.
Spillover of Early Extubation Practices From the Pediatric Heart Network Collaborative Learning Study*
Authors: Witte Madolin K. , Mahle William T. , Pasquali Sara K. , Nicolson Susan C. , Shekerdemian Lara S. , Wolf Michael J. , Zhang Wenying , Donohue Janet E. , Gaies Michael 
Published: December 2020

Objectives:
The Pediatric Heart Network Collaborative Learning Study used collaborative learning strategies to implement a clinical practice guideline that increased rates of early extubation after infant repair of tetralogy of Fallot and coarctation of the aorta. We assessed early extubation rates for infants undergoing cardiac surgeries not targeted by the clinical practice guideline to determine whether changes in extubation practices spilled over to care of other infants.

Design:
Observational analyses of site’s local Society of Thoracic Surgeons Congenital Heart Surgery Database and Pediatric Cardiac Critical Care Consortium Registry.

Setting:
Four Pediatric Heart Network Collaborative Learning Study active-site hospitals.

Patients:
Infants undergoing ventricular septal defect repair, atrioventricular septal defect repair, or superior cavopulmonary anastomosis (lower complexity), and arterial switch operation or isolated aortopulmonary shunt (higher complexity).

Interventions:
None.

Measurements and Main Results:
Aggregate outcomes were compared between the 12 month pre-clinical practice guideline and 12 months after study completion (Follow Up). In infants undergoing lower complexity surgeries, early extubation increased during Follow Up compared with Pre-Clinical Practice Guideline (30.2% vs 18.8%, p = 0.006), and hours to initial postoperative extubation decreased. We observed variation in these outcomes by surgery type, with only ventricular septal defect repair associated with a significant increase in early extubation during Follow Up compared with Pre-Clinical Practice Guideline (47% vs 26%, p = 0.006). Variation by study site was also seen, with only one hospital showing an increase in early extubation. In patients undergoing higher complexity surgeries, there was no difference in early extubation or hours to initial extubation between the study eras.

Conclusions:
We observed spillover of extubation practices promoted by the Collaborative Learning Study clinical practice guideline to lower complexity operations not included in the original study that was sustainable 1 year after study completion, though this effect differed across sites and operation subtypes. No changes in postoperative extubation outcomes following higher complexity surgeries were seen. The significant variation in outcomes by site suggests that center-specific factors may have influenced spillover of clinical practice guideline practices.