bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Radiographic Analysis of Lumbar Fusion Status and Instrumentation Failure After Complex Adult Spinal Deformity Surgery With Spinopelvic Fixation
Authors: Shimizu Takayoshi , Lenke Lawrence G. , Cerpa Meghan , Beauchamp Eduardo C. , Carreon Leah Y. , Shaffrey Christopher I. , Cheung Kenneth M.C. , Fehlings Michael G. 
Published: July 2020

Study Design:
A retrospective review of prospectively collected data.

Objective:
The objective of this study was to investigate the fusion status of the lumbar spine and lumbosacral junction at 2 years postoperatively after complex adult spinal deformity (ASD) surgery.

Summary of Background Data:
Achieving fusion is crucial for maintaining optimal alignment in ASD surgery. However, prospective data assessing fusion status using large patient populations are lacking in this patient population.

Materials and Methods:
Postoperative radiographs of 162 patients from the Scoli-Risk-1 database, who underwent complex ASD surgery with fusion to the sacrum, were evaluated by 3 independent spine surgeons at 6-week, 6-month, and 2-year follow-up. The fusion rate of the lumbar spine segments at a 2-year follow-up was determined by using previously published radiographic grading criteria. We also assessed the prevalence of instrumentation failures.

Results:
The interrater reliabilities for grading the fusion status were overall fair at each level evaluated (Fleiss κ, 0.337–0.439). Overall, 70.3% (114/162) demonstrated the solid fusion of the entire lumbar spine at a 2-year follow-up. The fusion rates of each segment were L1/L2: 87.0%, L2/L3: 82.0%, L3/L4: 83.9%, L4/L5: 89.5%, and L5/S1: 89.5%. Pedicle screw loosening was the most frequent implant failure throughout the observation period (9.2%, 11.6%, and 11.0% at 6-wk, 6-mo, and 2-y follow-up, respectively). No rod breakage was observed at 6 weeks, increasing to 9.8% at 2-year follow-up. The prevalence of postoperative proximal junctional kyphosis was 5.5% at 6 weeks, showing no difference at 2 years postoperative.

Conclusions:
In this series of complex ASD surgeries often requiring 3-column osteotomies, 70.3% showed solid fusion of the entire lumbar spine, including the lumbosacral junction. The lumbosacral segments showed a relatively high fusion rate at a 2-year follow-up likely due to the frequent use of anterior column support and graft. The prevalence of rod breakage increased as follow-up proceeded to 9.8%, which was most commonly observed at the lumbosacral junction.

Level of Evidence:
Level IV.
Three-dimensional Printed Drill Guides Versus Fluoroscopic-guided Freehand Technique for Pedicle Screw Placement
Authors: Wallace Nicholas , Butt Bilal B. , Aleem Ilyas , Patel Rakesh 
Published: July 2020

Study Design:
A systematic review and meta-analysis.

Objective:
The objective of this study was to compare surgical, clinical, and radiographic outcomes of 3-dimensional printed (3DP) drill guides to the fluoroscopic-guided, freehand placement of pedicle screws in the spine.

Summary of Background Data:
3DP is a budding technology in spine surgery and has recently been applied to patient-specific drill guides for pedicle screw placement. Several authors have reported the benefits of these drill guides, but no clear consensus exists on their utility.

Materials and Methods:
A comprehensive search of the literature was conducted and independent reviewers assessed eligibility for included studies. Outcomes analyzed included: total operation time, estimated blood loss, screw accuracy, pain score, Japanese Orthopedic Association score, and postoperative complications. Weighted mean differences (WMD) and weighted risk differences were calculated using a random-effects model.

Results:
Six studies with a total of 205 patients were included. There were significantly lower operation times [WMD=−32.32 min, 95% confidence interval (CI)=−53.19 to −11.45] and estimated blood loss (WMD=−51.42 mL, 95% CI=−81.12 to −21.72) in procedures performed with 3DP drill guides as compared with freehand technique. The probability of “excellent” screw placement was significantly higher in 3DP guides versus freehand (weighted risk difference=−0.12, 95% CI=−0.17 to 0.07); however, no differences were observed in “poor” or “good” screw placement. There were no significant differences between groups in pain scores or Japanese Orthopedic Association scores. No difference in the rate of surgical complications was noted between the groups.

Conclusions:
Pedicle screws placed with 3DP drill guides may result in shorter operative time, less blood loss, and a greater probability of excellent screw placement as compared with those placed with freehand techniques. We conclude that 3DP guides may potentially develop into an efficient and accurate option for pedicle screw placement. However, more prospective, randomized controlled trials are needed to strengthen the confidence of these conclusions.

Level of Evidence:
Level III.
Pelvic Incidence Affects Age-adjusted Alignment Outcomes in a Population of Adult Spinal Deformity
Authors: Passias Peter G. , Bortz Cole A. , Segreto Frank A. , Horn Samantha R. , Pierce Katherine E. , Manning Jordan , Vasquez-Montes Dennis , Diebo Bassel , Lafage Renaud , Lafage Virginie 
Published: July 2020

Study Design:
A single-center retrospective cohort study.

Objective:
The objective of this study was to assess the effects of patient height and pelvic incidence (PI) on age-adjusted alignment outcomes of surgical adult spinal deformity (ASD) patients.

Summary of Background Data:
Patient height and PI have yet to be evaluated for their individual effects on achieving age-adjusted alignment targets.

Methods:
Surgical ASD patients were grouped by percentile (low: <25th; normative: 25th–75th; high: >75th) for height and PI. Correction groups were generated at postoperative follow-up for actual alignment compared with age-adjusted ideal values for pelvic tilt (PT), pelvic incidence minus lumbar lordosis mismatch (PI−LL), and sagittal vertical axis, and PI-adjusted ideal alignment values for sacral slope (SS), as derived from clinically relevant formulas. Means comparison tests assessed differences in rates of matching ideal alignment (±10 y threshold for age-adjusted targets; −7 to 5 degrees measured minus ideal for SS) across height and PI groups.

Results:
Breakdown of all included 198 patients by PI group: low (25%, 38±11 degrees), normative (50%, 57±5 degrees), high (25%, 75±7 degrees). Breakdown of patient height groups: low (25%, 1.52±0.04 m), normative (50% 1.64±0.05 m), and high (25%, 1.79±0.06 m). Overall, 29% of patients met postoperative age-adjusted alignment targets for PT, 23% for PI−LL, and 25% for sagittal vertical axis. Overall, 26% of patients met PI-adjusted SS alignment. There were no differences across patient height groups in rates of achieving adjusted alignment target (all P>0.05). Patients with high PI reached age-adjusted ideal alignment for PT at a lower rate (16%) than patients with normative (33%) or low PI (33%, P=0.056). Of patients that matched at least 1 ideal alignment target, those with high PI showed inferior preoperative to postoperative changes in EuroQol 5-dimension questionnaire as compared with normative and low PI patients (P=0.015).

Conclusions:
Patients with high PI reached ideal postoperative age-adjusted PT alignment at a lower rate than patients with normative and low PI. Height had no impact on postoperative age-adjusted alignment outcomes. Current postoperative ideal alignment targets may warrant an adjustment to account for PI.
Patient Risk Factors Associated With 30- and 90-Day Readmission After Cervical Discectomy
Authors: Elsamadicy Aladine A. , Koo Andrew B. , Lee Megan , Freedman Isaac G. , David Wyatt B. , Kundishora Adam J. , Gorrepati Ramana , Kuzmik Gregory A. , Camara-Quintana Joaquin , Qureshi Tariq , Kolb Luis , Laurans Maxwell , Abbed Khalid 
Published: July 2020

Study Design:
This is a retrospective cohort study.

Objective:
The aim of this study was to assess the patient-level risk factors associated with 30- and 90-day unplanned readmissions following elective anterior cervical decompression and fusion (ACDF) or cervical disk arthroplasty (CDA).

Summary of Background Data:
For cervical disk pathology, both ACDF and CDA are increasingly performed nationwide. However, relatively little is known about the adverse complications and rates of readmission for ACDF and CDA.

Methods:
A retrospective cohort study was performed using the Nationwide Readmission Database from the years 2013 to 2015. All patients undergoing either CDA or ACDF were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Unique patient linkage numbers were used to follow patients and to identify 30- and 31–90-day readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 days (30-R), and readmission within 31–90 days (90-R).

Results:
There were a total of 13,093 index admissions with 856 (6.5%) readmissions [30-R: n=532 (4.0%); 90-R: n=324 (2.5%)]. Both overall length of stay and total cost were greater in the 30-R cohort compared with 90-R and Non-R cohorts. The most prevalent 30- and 90-day complications seen among the readmitted cohorts were infection, genitourinary complication, and device complication. On multivariate regression analysis, age, Medicaid status, medium and large hospital bed size, deficiency anemia, and any complication during index admission were independently associated with increased 30-day readmission. Whereas age, large hospital bed size, coagulopathy, and any complication during the initial hospitalization were independently associated with increased 90-day readmission.

Conclusion:
Our nationwide study identifies the 30- and 90-day readmission rates and several patient-related risk factors associated with unplanned readmission after common anterior cervical spine procedures.

Level of Evidence:
Level III.
Is the Cranial Sagittal Vertical Axis (Cr-SVA) a Better Midterm Predictor of Clinical Results Than C7-SVA in Adult Patients Operated on Spinal Deformity After a Minimum 2-Year Follow-Up?
Authors: Gomez-Rice Alejandro , Madrid Cristina , Izquierdo Enrique , Marco-Martínez Fernando , Tresguerres Jesús A.F. , Sanchez-Mariscal Felisa 
Published: July 2020

Study Design:
This is nonconcurrent prospective study approved by the Institutional Research Ethics Committee

Objective:
The purpose of this study is to determine if the cranial sagittal vertical axis (Cr-SVA) measured in full spine standing radiographs is a better predictor of clinical results than the C7 sagittal vertical axis (C7-SVA) in adult patients operated on spinal deformity with a minimum 2-year follow-up after surgery.

Summary of Background Data:
The Cr-SVA has recently been described as a better predictor of health-related quality of life outcomes than the C7-SVA for patients with adult spinal deformity (ASD) before undergoing surgery. This has not been confirmed in patients after ASD surgery.

Methods:
Inclusion criteria were age at surgery more than 25 years and a minimum 2-year follow-up after a ≥5 level fusion for ASD. Full-length standing lateral radiographs (including nasion-inion line, spine, and femoral heads) and Scoliosis Research Society 22 Questionnaire and SF36 questionnaires were available for every patient at the final follow-up. The distance from the Cr-SVA to the posterior corner of S1 (Cr-SVA-S) and to the centers of the hip (Cr-SVA-H) was measured and also the C7-SVA, lumbar lordosis, pelvic incidence, pelvic tilt, and PI-LL.

Results:
Sixty-five patients (58 female individuals) operated on ASD in a single institution were included. Age at surgery was 61 years (26–67). The mean follow-up was 53 months (24–120). Spearman rank-order test showed several significant correlations. After multivariable analysis, only Cr-SVA-S and age persisted as predictors for Scoliosis Research Society (SRS) image scores, Cr-SVA-H for SRS satisfaction, Cr-SVA-H and age for SRS total scores, Cr-SVA-H and age for SF36 Physical Function, Cr-SVA-S for SF36 Role Physical, Cr-SVA-H for SF36 Bodily Pain, and Cr-SVA-H for SF36 Role Emotional.

Conclusions:
The Cr-SVA measured in full spine standing radiographs seems to be a better predictor of health-related quality of life outcomes than the C7-SVA for adults operated on spinal deformity >2 years after surgery.
Long-term results in the patients with traumatic hip fracture-dislocation: Important prognostic factors
Authors: Ma Hsuan-Hsiao , Huang Chung-Chin , Pai Fu-Yuan , Chang Ming-Chau , Chen Wei-Ming , Huang Tung-Fu 
Published: July 2020

Background:
Traumatic hip dislocation with or without acetabular fractures can lead to various outcomes of the hip. Long-term follow-up studies on traumatic hip dislocation are few. We conducted a retrospective study of the treatment and long-term outcomes in patients with hip dislocation to determine prognostic factors.

Methods:
From 2001 to 2016, we enrolled 38 patients in our study. All the patients had been diagnosed through radiography or computed tomography. Emergent closed reduction was performed initially. We hypothesized that poor outcomes, including osteonecrosis and traumatic osteoarthritis, are related to specific factors.

Results:
All the patients had posterior dislocation initially. Closed reduction or open reduction due to irreducible after closed reduction was performed within 6 hours of dislocation in most patients. In total, nine patients had poor outcomes of the hip, including osteonecrosis and traumatic osteoarthritis and total hip arthroplasty. Specific factors that lead to poor outcomes were patient age and timing of reduction.

Conclusion:
Although end results in severe traumatic hip dislocation are disappointing, conservatism in applying the secondary reconstructive procedure is desirable. In our series, crucial factors for long-term prognosis were patient age and timing of hip reduction.
Is Noninvasive Vagus Nerve Stimulation a Safe and Effective Alternative to Medication for Acute Migraine Control?
Authors: Blech Benzion , Starling Amaal J. , Marks Lisa A. , Wingerchuk Dean M. , O’Carroll Cumara B. 
Published: July 2020

Background:
Noninvasive neuromodulation devices have been used for a variety of headache disorders, including cluster and migraine, since recently being cleared by the Federal Drug Administration. Although these devices have been touted as low-risk options for improved headache control, the data behind actual efficacy endpoints remain unclear.

Objective:
To critically assess current evidence regarding the efficacy of the noninvasive vagus nerve stimulator (nVNS) device for acute migraine management.

Methods:
The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions.
Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and a content expert in the field of headache.

Results:
A randomized, double-blind, sham-controlled clinical trial was selected for critical appraisal. In this trial, the primary endpoint (pain freedom at 120 min after use of nVNS for first acute migraine attack) was not met when compared with sham device (30.4% for nVNS vs. 19.7% for sham; P=0.067). However, there were statistically significant differences found for various secondary endpoints favoring nVNS, such as pain freedom rates at 30 and 60 minutes, pain relief at 120 minutes, and mean percentage pain score reduction rates at 60 and 120 minutes.

Conclusions:
When comparing nVNS with sham, no statistically significant differences were found with regards to the primary endpoint of pain freedom at 120 minutes, although differences were found with various secondary endpoints and post hoc analysis. nVNS is likely a safe alternative to medications.
Strong Correlation Between Prevalence of Severe Vitamin D Deficiency and Population Mortality Rate from COVID-19 in Europe
Authors: Pugach Isaac Z. , Pugach Sofya 
Published: July 2020

AbstractBackgroundSARS-CoV-2 virus causes a very wide range of COVID-19 disease severity in humans: from completely asymptomatic to fatal, and the reasons behind it are often not understood. There is some data that Vitamin D may have protective effect, so authors decided to analyze European country-wide data to determine if Vitamin D levels are associated with COVID-19 population death rate.MethodsTo retrieve the Vitamin D levels data, authors analyzed the Vitamin D European population data compiled by 2019 ECTS Statement on Vitamin D Status published in the European Journal of Endocrinology. For the data set to used for analysis, only recently published data, that included general adult population of both genders ages 40-65 or wider, and must have included the prevalence of Vitamin D deficiency.ResultsThere were 10 countries data sets that fit the criteria and were analyzed. Severe Vitamin D deficiency was defined as 25(OH)D less than 25 nmol/L (10 ng/dL). Pearson correlation analysis between death rate per million from COVID-19 and prevalence of severe Vitamin D deficiency shows a strong correlation with r = 0.76, p = 0.01, indicating significant correlation. Correlation remained significant, even after adjusting for age structure of the population. Additionally, over time, correlation strengthened, and r coefficient asymptoticaly increased.ConclusionsAuthors recommend universal screening for Vitamin D deficiency, and further investigation of Vitamin D supplementation in randomized control studies, which may lead to possible treatment or prevention of COVID-19.
Perturbation robustness analyses reveal important parameters in variant interpretation pipelines
Authors: Wang Yaqiong , Adhikari Aashish N. , Sunderam Uma , Kvale Mark N. , Currier Robert J. , Gallagher Renata C. , Kwok Pui-Yan , Puck Jennifer M. , Srinivasan Rajgopal , Brenner Steven E. 
Published: July 2020

AbstractMotivationGenome sequencing is being used routinely in clinical and research applications, but subsequent variant interpretation pipelines can vary widely. A systematic approach for exploring parameter choices and selection plays an important role in designing robust pipelines for specific clinical applications.ResultsWe present a framework to be applied in scenarios with limited data whereby expert knowledge informs pipeline refinement. Starting from initial reference variant interpretation pipelines with commonly used parameters, we derived pipelines by perturbing the parameters one by one to determine which parameters can yield meaningful changes in a pipeline’s performance. We updated the reference pipeline by fixing the value of parameters which have small impact on the pipeline’s performance. Then we conducted new rounds of perturbation as the process converged, yielding a stable pipeline which is robust. We applied the framework for genetic disease prediction in de-identified exomes from a cohort of 138 individuals with rare Mendelian inborn errors of metabolism (IEMs) and systematically explored how perturbing different parameters affected the pipeline’s sensitivity and specificity. For this application, we perturbed commonly used parameters in variant interpretation pipelines, including choices of genes, variant callers, transcript models, databases of allele frequencies, databases of curated disease variants, and tools for variant impact prediction. Our analyses showed that choice of variant callers, variant impact prediction tools, MAF threshold, and MAF databases can meaningfully alter results from a pipeline. This work informs the development of exome analysis pipelines designed for newborn metabolic disorder screening and suggests the general application of perturbation analysis in genome interpretation pipeline design.
Multi-Tissue Neocortical Transcriptome-Wide Association Study Implicates 8 Genes Across 6 Genomic Loci in Alzheimer’s Disease
Authors: Gockley Jake , Montgomery Kelsey S. , Poehlman William L. , Wiley Jesse C. , Liu Yue , Gerasimov Ekaterina , Greenwood Anna K , Sieberts Solveig K. , Wingo Aliza P. , Wingo Thomas S. , Mangravite Lara M. , Logsdon Benjamin A. 
Published: July 2020

AbstractBackgroundAlzheimer’s disease (AD), an incurable neurodegenerative disease, currently affecting 1.75% of the United States population, with projected growth to 3.46% by 2050. Identifying common genetic variants driving differences in transcript expression that confer AD-risk is necessary to elucidate AD mechanism and develop therapeutic interventions. We modify the FUSION Transcriptome Wide Association Study (TWAS) pipeline to ingest expression from multiple neocortical regions, provide a set of 6780 gene weights which are abstracatable across the neocortex, and leverage these to find 8 genes from six loci with associated AD risk validated through summary mendelian randomization (SMR) utilizing IGAP summary statistics.MethodA combined dataset of 2003 genotypes clustered to Central European (CEU) ancestry was used to construct a training set of 790 genotypes paired to 888 RNASeq profiles across 6 Neo-cortical tissues (TCX=248, FP=50, IFG=41, STG=34, PHG=34, DLPFC=461). Following within-tissue normalization and covariate adjustment, predictive weights to impute expression components based on a gene’s surroundingcis-variants were trained. The FUSION pipeline was modified to support input of pre-scaled expression values and provide support for cross validation with a repeated measure design arising from the presence of multiple transcriptome samples from the same individual across different tissues.ResultsCis-variant architecture alone was informative to train weights and impute expression for 6780 (49.67%) autosomal genes, the majority of which significantly correlated with gene expression; FDR < 5%: N=6775 (99.92%), Bonferroni: N=6716 (99.06%). Validation of weights in 515 matched genotype to RNASeq profiles from the CommonMind Consortium (CMC) was (72.14%) in DLPFC profiles. Association of imputed expression components from all 2003 genotype profiles yielded 8 genes significantly associated with AD (FDR < 0.05); APOC1, EED, CD2AP, CEACAM19, CLPTM1, MTCH2, TREM2, KNOP1.ConclusionWe provide evidence of cis-genetic variation conferring AD risk through 8 genes across six distinct genomic loci. Moreover, we provide expression weights for 6780 genes as a valuable resource to the community, which can be abstracted across the neocortex and a wide range of neuronal phenotypes.
Mapping extinction risk in the global functional spectra across the tree of life
Authors: Carmona Carlos P. , Tamme Riin , Pärtel Meelis , de Bello Francesco , Brosse Sébastien , Capdevila Pol , González-M. Roy , González-Suárez Manuela , Salguero-Gómez Roberto , Vásquez-Valderrama Maribel , Toussaint Aurèle 
Published: July 2020

AbstractAlthough one quarter of the species of plants and vertebrates are threatened with extinction, little is known about how the potential effect of extinctions on the global diversity of ecological strategies. Using trait and phylogenetic information for more than 75,000 species of plants, mammals, birds, reptiles, amphibians and freshwater fishes, we characterized the global functional spectra of each of these groups. Mapping of extinction risk within these spectra revealed that larger species with slower pace of life are universally threatened. Simulated potential extinctions revealed extensive internal reorganizations in the global functional spectra, which are particularly severe for mammals and amphibians. Considering the disproportionate importance of the largest species for ecological processes, our results emphasize the importance of actions to prevent the extinction of the megabiota.