bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severity of Myelopathy is Closely Associated With Advanced Age and Signal Intensity Change in Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Hirai Takashi , Yoshii Toshitaka , Egawa Satoru , Sakai Kenichiro , Kusano Kazuo , Nakagawa Yukihiro , Wada Kanichiro , Katsumi Keiichi , Fujii Kengo , Kimura Atsushi , Furuya Takeo , Nagoshi Narihito , Kanchiku Tsukasa , Nagamoto Yukitaka , Oshima Yasushi , Ando Kei , Takahata Masahiko , Mori Kanji , Nakajima Hideaki , Murata Kazuma , Matsunaga Shunji , Kaito Takashi , Yamada Kei , Kobayashi Sho , Kato Satoshi , Ohba Tetsuro , Inami Satoshi , Fujibayashi Shunsuke , Katoh Hiroyuki , Kanno Haruo , Imagama Shiro , Koda Masao , Kawaguchi Yoshiharu , Takeshita Katsushi , Matsumoto Morio , Yamazaki Masashi , Okawa Atsushi 
Published: March 2021

Study Design:
Prospective, nationwide case series.

Objective:
To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data:
Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL.

Materials and Methods:
Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2–7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2–7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned.

Results:
Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2–7 according to the type of OPLL, significant differences were observed in a range of motion at C2–7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging.

Conclusions:
This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery.

Level of Evidence:
Level II.
Association Between C5 Palsy and the Anterior Decompression Procedures, Corpectomy and Discectomy
Authors: Odate Seiichi , Shikata Jitsuhiko , Yamamura Satoru , Okahata Akinori , Kawaguchi Shinji 
Published: March 2021

Study Design:
This is a retrospective study.

Objective:
The aim was to evaluate the influence of various decompression procedures on the incidence of C5 palsy (C5P).

Summary of Background Data:
C5P is a well-known but unsolved complication of cervical spine surgery. Among anterior cervical decompressive procedures, both corpectomy and discectomy are important surgical methods, whose effects on the incidence of C5P are unknown.

Methods:
We retrospectively analyzed 818 patients (529 men; mean age: 59.2±11.6 y) who underwent anterior cervical decompression and fusion. The surgical choice to use corpectomy, discectomy, or hybrid decompression was based on standard treatment strategies depending on local compressive pathology and presenting clinical symptoms. We introduced an original “decompression combination score” as a means of quantifying the effects of the procedures on the development of C5P. The scores were based on the relative severity of various risk factors associated with the eventual development of C5P and were assigned as follows: C4 corpectomy, 1 point; C5 corpectomy, 1 point; C3 corpectomy successive to C4 corpectomy, 0.5 point; C6 or C7 corpectomy successive to C5 corpectomy, 0.5 point; C4/5 discectomy, 0.5 point; discectomy at another segment, 0 point. Each patient’s decompression combination score was then comprised of the sum of these points.

Results:
C5P occurred in 55 (47 men, mean age: 65.7±8.7 y) of the 818 (6.7%) patients. A larger number of operated disc segments was significantly associated with C5P. Higher decompression combination score was significantly associated with C5P. Multivariate analysis revealed that male sex, higher decompression combination score, and older age were significant risk factors.

Conclusions:
Corpectomy increased the incidence of C5P, while discectomy decreased the risk. The lower incidence of postoperative C5P after discectomy may be because of minimizing tethering effect to the C5 nerve root. As a preventive measure against C5P, corpectomy should be avoided, while discectomy is recommended as much as possible.

Level of Evidence:
Levels of Evidence: Step IV—Oxford Center for Evidence-Based Medicine 2011.
Comparison of Immunohistochemical Expression of Cytokeratin 19, c-KIT, BerEP4, GATA3, and NUTM1 Between Porocarcinoma and Squamous Cell Carcinoma
Authors: Goto Keisuke , Ishikawa Misawo , Hamada Kengo , Muramatsu Koji , Naka Miho , Honma Keiichiro , Sugino Takashi 
Published: March 2021

Abstract:
Distinguishing porocarcinoma from squamous cell carcinoma (SCC) is clinically significant; however, differential diagnosis can often be challenging. This study sought to confirm the diagnostic utility of cytokeratin 19, c-KIT, BerEP4, GATA3, and NUTM1 immunohistochemistry in distinguishing porocarcinoma from SCC. Immunohistochemical analysis of cytokeratin 19, c-KIT, BerEP4, GATA3, and NUTM1 in 14 porocarcinomas and 22 SCCs was performed; the extents and intensities of expression of these markers were recorded. The statistical associations of the immunoexpression between porocarcinoma and SCC were analyzed using the Pearson χ2 test. Cytokeratin 19 was positive in 13 (92.9%) of 14 porocarcinomas, and for all the positive cases, staining was strong and evident in >20% of the tumor cells. By contrast, 9 (40.9%) of 22 SCCs expressed cytokeratin 19 (P = 0.0018), of which 6 showed extremely focal (≤10% of the tumor cells) expression. Of the 14 porocarcinomas, 11 (78.6%) cases showed c-KIT positivity, whereas only 3 of 22 SCCs (13.6%) expressed c-KIT focally (P = 0.0001). In addition, BerEP4 immunostaining differed between porocarcinomas and SCCs (57.1% vs. 9.1%, respectively; P = 0.0017). However, no significant difference between the groups was reported in terms of GATA3 expression (57.1% vs. 72.7%, respectively; P = 0.3336). NUTM1 was expressed in 4/14 (28.6%) porocarcinomas but not in the SCCs. Immunohistochemistry for cytokeratin 19, c-KIT, and BerEP4 could be helpful in distinguishing porocarcinomas from SCCs. In addition, NUTM1 immunoexpression is highly specific, although not sensitive, to porocarcinomas. GATA3 immunohistochemistry has no meaningful implications in the differential diagnosis of porocarcinoma and SCC.
Accounting for Repeat Pregnancies in Risk Prediction Models
Authors: Grandi Sonia M. , Filion Kristian B. , Hutcheon Jennifer A. , Rosella Laura C. , Platt Robert W. 
Published: March 2021

Background:
In perinatal epidemiology, the development of risk prediction models is complicated by parity; how repeat pregnancies influence the predictive accuracy of models that include obstetrical history is unclear.

Methods:
To assess the influence of repeat pregnancies on the association between predictors and the outcomes, as well as the influence of ignoring the nonindependence between pregnancies, we created four analytical cohorts using the Clinical Practice Research Datalink. The cohorts included (1) first deliveries, (2) a random sample of one delivery per woman, (3) all eligible deliveries per woman, and (4) all eligible deliveries and censoring of follow-up at subsequent pregnancies. Using Plasmode simulations, we varied the predictor–outcome association across cohorts.

Results:
We found minimal differences in the relative contribution of predictors to the overall predictions and the discriminative accuracy of models in the cohort of randomly sampled deliveries versus the all deliveries cohort (C-statistic: 0.62 vs. 0.63; Nagelkerke’s R2: 0.03 for both). Accounting for clustering and censoring upon subsequent pregnancies also had negligible influence on model performance. We found important differences in model performance between the models developed in the cohort of first deliveries and the random sample of deliveries.

Conclusions:
In our study, a model including first deliveries had the best predictive accuracy but was not generalizable to women of varying parities. Moreover, including repeat pregnancies did not improve the predictive accuracy of the models. Multiple models may be needed to improve the transportability and accuracy of prediction models when the outcome of interest is influenced by parity.
Dengue, Severity Paradox, and Socioeconomic Distribution Among Afro-Colombians
Authors: Carabali Mabel , Maheu-Giroux Mathieu , Kaufman Jay S. 
Published: March 2021

Background:
The clinical presentation of dengue ranges from self-limited mild illness to severe forms, including death. African ancestry is often described as protective against dengue severity. However, in the Latin American context, African ancestry has been associated with increased mortality. This “severity paradox” has been hypothesized as resulting from confounding or heterogeneity by socioeconomic status (SES). However, few systematic analyses have been conducted to investigate the presence and nature of the disparity paradox.

Methods:
We fit Bayesian hierarchical spatiotemporal models using individual-level surveillance data from Cali, Colombia (2012–2017), to assess the overall morbidity and severity burden of notified dengue. We fitted overall and ethnic-specific models to assess the presence of heterogeneity by SES across and within ethnic groups (Afro-Colombian vs. non-Afro-Colombians), conducting sensitivity analyses to account for potential underreporting.

Results:
Our study included 65,402 dengue cases and 13,732 (21%) hospitalizations. Overall notified dengue incidence rates did not vary across ethnic groups. Severity risk was higher among Afro-Colombians (risk ratio [RR] = 1.16; 95% Credible Interval [95% CrI] = 1.08, 1.24) but after accounting for underreporting by ethnicity this association was nearly null (RR = 1.02; 95% CrI = 0.97, 1.07). Subsidized health insurance and low-SES were associated with increased overall dengue rates and severity.

Conclusion:
The paradoxically increased severity among Afro-Colombians can be attributed to differential health-seeking behaviors and reporting among Afro-Colombians. Such differential reporting can be understood as a type of intersectionality between SES, insurance scheme, and ethnicity that requires a quantitative assessment in future studies.
Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature
Authors: Berrocal María H. , Acaba-Berrocal Luis 
Published: March 2021

Purpose of review
Diabetic retinopathy (DR) is one of the leading causes of preventable vision loss in the world and its prevalence continues to increase worldwide. One of the ultimate and visually impairing complications of DR is proliferative diabetic retinopathy (PDR) and subsequent tractional retinal detachment. Treatment modalities, surgical techniques, and a better understanding of the pathophysiology of DR and PDR continue to change the way we approach the disease. The goal of this review is to provide an update on recent treatment modalities and outcomes of proliferative diabetic retinopathy and its complications including tractional retinal detachment.

Recent findings
Panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF), and pars plana vitrectomy are the mainstay of PDR treatment. However, PRP and anti-VEGF are associated with significant treatment burden and multiple subsequent treatments. Early vitrectomy is associated with vision preservation, less treatment burden, and less subsequent treatments than therapy with PRP and anti-VEGF.

Summary
Concerning costs, high rates of noncompliance in the diabetic population and significant rates of subsequent treatments with initial PRP and anti-VEGF, early vitrectomy for diabetic retinopathy in patients at risk of PDR is a cost-effective long-term stabilizing treatment for diabetics with advanced disease.
“The lesser of two evils”: a framework analysis of consumers' perspectives on opioid deprescribing and the development of opioid deprescribing guidelines
Authors: Langford Aili V. , Gnjidic Danijela , Lin Chung-Wei Christine , Bero Lisa , Blyth Fiona , Penm Jonathan , Schneider Carl R. 
Published: March 2021

Abstract
Deprescribing opioids has been identified as an intervention to mitigate opioid harm; however, it is often challenging to implement interventions and communicate deprescribing decisions to consumers. The development of opioid deprescribing guidelines may provide guidance and support on when and how to reduce or cease opioids in routine care. This study aimed to explore the perspectives of opioid consumers on opioid deprescribing and determine factors to be considered in the development of opioid deprescribing guidelines. A purposive sample of 20 consumers using opioids for pain was recruited. Semistructured interviews were conducted, audio recorded, and transcribed verbatim. Inductive thematic analysis was undertaken, followed by a framework analysis informed by Bandura's Social Cognitive Theory. Behavioral, cognitive, and environmental factors influence consumers' attitudes and actions regarding opioid deprescribing. Significant barriers to opioid deprescribing were identified, including fears of pain and withdrawal effects, opioid-related stigma, and perceived inadequacies of the healthcare system. Improved communication between healthcare professionals and consumers regarding expectations of deprescribing and goals of care, as well as the provision of greater opportunities for consumer engagement in decision making were identified as avenues to improve the success of opioid deprescribing. For opioid deprescribing guidelines to be effective and achieve the intended goal of optimizing opioid use, consumers need to feel empowered to engage in opioid reduction or cessation. The findings of this study may facilitate a patient-centred approach for practitioners and guideline developers in creating recommendations and interventions to enable opioid deprescribing through targeting behavioral change.
Responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study
Authors: Kennedy Donna L. , Vollert Jan , Ridout Deborah , Alexander Caroline M. , Rice Andrew S.C. 
Published: March 2021

Abstract
The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism-associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy. With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated before and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change. Quantitative sensory testing results (n = 76) were compared with healthy controls (n = 54). At 6 months postsurgery, 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (P < 0.001). Change in QST parameters occurred for thermal detection, thermal pain, and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures was not statistically significant. Change occurred in sensory phenotype postsurgery (P < 0.001); sensory phenotype was associated with symptom subgroup (P = 0.03) and patient-rated surgical outcome (P = 0.02). Quantitative sensory testing-derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease-modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
Outcome comparison between vaginoscopy and standard hysteroscopy: A retrospective cohort study
Authors: Tien Chin-Tzu , Li Pei-Chen , Ding Dah-Ching 
Published: March 2021

Background:
Hysteroscopy is a traditional diagnostic method, whereas vaginoscopy is a more recent but proven approach. However, most physicians are unfamiliar with vaginoscopy. We aimed to compare the feasibility and tolerability between the two techniques to increase clinical awareness.

Methods:
We retrospectively reviewed the data of 100 patients who underwent office hysteroscopy with either the standard approach or the vaginoscopic approach between May and July 2019. While the standard hysteroscopy group underwent speculum insertion and the cervix was grasped with forceps, the vaginoscopy group did not. The primary outcome was a successfully completed examination. Related outcomes were the pain score, complications, and absence of signs of infection at 1 week after completing the examination.

Results:
The success rates of vaginoscopy and standard hysteroscopy were comparable (95.5% vs 96.3%). The median time to complete a vaginoscopy (135 seconds) was significantly shorter than to complete a standard hysteroscopy (190 seconds, p = 0.02). The median pain score was 3 for vaginoscopy, which was significantly lower than that for standard hysteroscopy (5; p = 0.01). There were no differences in the surgical complication rate between vaginoscopy (n = 4) and standard hysteroscopy (n = 3) (relative risk = 0.81, 95% confidence interval = 0.11-6.00).

Conclusion:
Vaginoscopy required a shorter time for the completion of the examination and involved lesser pain than the standard hysteroscopy. The success rates were comparable between the two techniques. Therefore, vaginoscopy is a good option for office hysteroscopic examinations.
Vaccine Hesitancy Against SARS-CoV-2 in Health Personnel of Northeastern Mexico and Its Determinants
Authors: Castañeda-Vasquez David Emmanuel , Ruiz-Padilla Juan Pablo , Botello-Hernandez Edgar 
Published: March 2021

With the emergence of effective vaccines against SARS-CoV-2, the need to find the determinants for its correct distribution is created, with health personnel being an essential group where coverage must be ensured.

Materials and Methods:
A cross-sectional study was conducted through an electronic survey that was distributed to health personnel in the state of Nuevo Leon, Mexico. Potential determinants for vaccine hesitancy were covered including their intention to be vaccinated against SARS-CoV-2.

Results:
A total of 543 responses were collected from health professionals, which 30 (5.5%) of the subjects stated that they would reject SARS-CoV-2 vaccination. How well informed the subjects were was the most determining factor, where misinformation related to vaccination and COVID-19 was the most important cause of vaccine rejection.

Conclusion:
The implementation of educational strategies for health personnel are required.
New insights into muscle function in chronic kidney disease and metabolic acidosis
Authors: Chalupsky Megan , Goodson David Alex , Gamboa Jorge L. , Roshanravan Baback 
Published: March 2021

Purpose of review
: Sarcopenia, defined as decreased muscle mass or function, is prevalent in chronic kidney disease (CKD) increasing the risk of mobility impairment and frailty. CKD leads to metabolic acidosis (MA) and retention of uremic toxins contributing to insulin resistance and impaired muscle mitochondrial energetics. Here we focus on the central role of muscle mitochondrial metabolism in muscle function.

Recent findings
: Mitochondrial dysfunction underlies muscle wasting and poor physical endurance in CKD. Uremic toxins accumulate in muscle disrupting mitochondrial respiration and enzymes. Changes in mitochondrial quantity, quality, and oxidative capacity contribute to mobility impairment in CKD. Major determinants of muscle mitochondrial function are kidney function, inflammation, and oxidative stress. In CKD, MA is the major determinant of muscle mitochondrial function. Metabolomics reveals defects in pathways linked to mitochondrial energy metabolism and acid-base homeostasis underlying insulin resistance in CKD.

Summary
: Decreased mitochondrial capacity and quality control can impair muscle function contributing to decreased physical endurance. MA augments insulin resistance perpetuating the catabolic state underlying muscle wasting in CKD. Further studies are needed to investigate if targeting of MA improves muscle mitochondrial function and insulin resistance translating into meaningful improvements in physical endurance.
Transarterial Radioembolization Treatment as a Bridge to Surgical Resection in Pediatric Hepatocellular Carcinoma
Authors: Whitlock Richard S. , Loo Caitlyn , Patel Kalyani , Bista Ranjan , Goss John A. , Heczey Andras , Khan Osman , Lopez-Terrada Dolores , Masand Prakash , Nguyen HaiThuy , Mahvash Armeen , Vasudevan Sanjeev A. , Kukreja Kamlesh 
Published: March 2021

Background:
Children with unresectable hepatocellular carcinoma (HCC) have a poor prognosis and limited treatment options. Transarterial radioembolization (TARE) using Yttrium-90 (Y90) has emerged as a potential bridge therapy to hepatic resection or transplantation for HCC with very limited studies in children.

Observations:
Here we present the clinical course of 2 children successfully treated with TARE Y90 for initially unresectable fibrolamellar HCC (FL-HCC) and bridged to partial hemihepatectomy with >1-year overall survival post-TARE.

Conclusion:
Although there have been prior published reports of pediatric patients with HCC being treated with TARE Y90 and some being able to undergo subsequent orthotopic liver transplantation, this is the first report of pediatric HCC patients treated with TARE Y90 as a bridge to nontransplant resections and going on to have >1-year overall survival.