bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic factors for pain chronicity in low back pain: a systematic review
Authors: Nieminen Linda Karoliina , Pyysalo Liisa Maria , Kankaanpää Markku Juhani 
Published: April 2021

Abstract
Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain.
Analysis of COVID-19 Patients With Acute Respiratory Distress Syndrome Managed With Extracorporeal Membrane Oxygenation at US Academic Centers
Authors: Nguyen Ninh T. , Sullivan Brittany , Sagebin Fabio , Hohmann Samuel F. , Amin Alpesh , Nahmias Jeffry 
Published: April 2021

Objective:
This study analyzed the outcomes of COVID-19 patients with ARDS who were managed with extracorporeal membrane oxygenation (ECMO) across 155 US academic centers.

Summary Background Data:
ECMO has been utilized in COVID-19 patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia. Early case series with the use of ECMO in these patients reported high mortality exceeding 90%.

Methods:
Using ICD-10 codes, data of patients with COVID-19 with ARDS, managed with ECMO between April and September 2020, were analyzed using the Vizient clinical database. Outcomes measured included in-hospital mortality, hospital and ICU length of stay, and direct cost. For comparative purposes, the outcome of a subset of COVID-19 patients aged between 18 and 64 years and managed with versus without ECMO were examined.

Results:
1,182 patients with COVID-19 and ARDS received ECMO. In-hospital mortality was 45.9%, mean length of stay was 36.8 ± 24.9 days, and mean ICU stay was 29.1 ± 17.3 days. In-hospital mortality according to age group was 25.2% for 1 to 30 years; 42.2% for 31 to 50 years; 53.2% for 51 to 64 years; and 73.7% for ≥65 years. A subset analysis of COVID-19 patients, aged 18 to 64 years with ARDS requiring mechanical ventilation and managed with (n = 1113) vs without (n = 16,343) ECMO, showed relatively high in-hospital mortality for both groups (44.6% with ECMO vs 37.9% without ECMO).

Conclusions:
In this large US study of patients with COVID-19 and ARDS managed with ECMO, the in-hospital mortality is high but much lower than initial reports. Future research is needed to evaluate which patients with COVID-19 and ARDS would benefit from ECMO.
Surgical Decision-Making in Pancreatic Ductal Adenocarcinoma
Authors: Habib Joseph R. , Kinny-Köster Benedict , Bou-Samra Patrick , Alsaad Ranim , Sereni Elisabetta , Javed Ammar A. , Ding Ding , Cameron John L. , Lafaro Kelly J. , Burns William R. , He Jin , Yu Jun , Wolfgang Christopher L. , Burkhart Richard A. 
Published: April 2021

Objective:
To develop a predictive model of oncologic outcomes for patients with pancreatic ductal adenocarcinoma (PDAC) undergoing resection after neoadjuvant or induction chemotherapy use.

Background:
Early recurrence following surgical resection for PDAC is common. The use of neoadjuvant chemotherapy prior to resection may increase the likelihood of long-term systemic disease control. Accurately characterizing an individual's likely oncologic outcome in the perioperative setting remains challenging.

Methods:
Data from patients with PDAC who received chemotherapy prior to pancreatectomy at a single high-volume institution between 2007 and 2018 were captured in a prospectively collected database. Core clinicopathologic data were reviewed for accuracy and survival data were abstracted from the electronic medical record and national databases. Cox-proportional regressions were used to model outcomes and develop an interactive prognostic tool for clinical decision-making.

Results:
A total of 581 patients were included with a median overall survival (OS) and recurrence-free survival (RFS) of 29.5 (26.5–32.5) and 16.6 (15.8–17.5) months, respectively. Multivariable analysis demonstrates OS and RFS were associated with type of chemotherapeutic used and
the number of chemotherapy cycles received preoperatively. Additional factors contributing to survival models included: tumor grade, histopathologic response to therapy, nodal status, and administration of adjuvant chemotherapy. The models were validated using an iterative bootstrap method and with randomized cohort splitting. The models were well calibrated with concordance indices of 0.68 and 0.65 for the final OS and RFS models, respectively.

Conclusion:
We developed an intuitive and dynamic decision-making tool that can be useful in estimating OS, RFS, and location-specific disease recurrence rates. This prognostic tool may add value to patient care in discussing the benefits associated with surgical resection for PDAC.
Extract, Transform, Load Framework for the Conversion of Health Databases to OMOP
Authors: Quiroz Juan C. , Chard Tim , Sa Zhisheng , Ritchie Angus , Jorm Louisa , Gallego Blanca 
Published: April 2021

ABSTRACTObjectiveDevelop an extract, transform, load (ETL) framework for the conversion of health databases to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) that supports transparency of the mapping process, readability, refactoring, and maintainability.Materials and MethodsWe propose an ETL framework that is metadata-driven and generic across source datasets. The ETL framework reads mapping logic for OMOP tables from YAML files, which organize SQL snippets in key-value pairs that define the extract and transform logic to populate OMOP columns.ResultsWe developed a data manipulation language (DML) for writing the mapping logic from health datasets to OMOP, which defines mapping operations on a column-by-column basis. A core ETL pipeline converts the DML in YAML files and generates an ETL script. We provide access to our ETL framework via a web application, allowing users to upload and edit YAML files and obtain an ETL SQL script that can be used in development environments.DiscussionThe structure of the DML and the mapping operations defined in column-by-column operations maximizes readability, refactoring, and maintainability, while minimizing technical debt, and standardizes the writing of ETL operations for mapping to OMOP. Our web application allows institutions and teams to reuse the ETL pipeline by writing their own rules using our DML.ConclusionThe research community needs tools that reduce the cost and time effort needed to map datasets to OMOP. These tools must support transparency of the mapping process for mapping efforts to be reused by different institutions.
Early and ongoing importations of SARS-CoV-2 in Canada
Authors: McLaughlin Angela , Montoya Vincent , Miller Rachel L. , Mordecai Gideon J. , Worobey Michael , Poon Art F. Y. , Joy Jeffrey B. 
Published: April 2021

AbstractTracking the emergence and spread of SARS-CoV-2 is critical to inform public health interventions. Phylodynamic analyses have quantified SARS-CoV-2 migration on global and local scales1–5, yet they have not been applied to determine transmission dynamics in Canada. We quantified SARS-CoV-2 migration into, within, and out of Canada in the context of COVID-19 travel restrictions. To minimize sampling bias, global sequences were subsampled with probabilities corrected for their countries’ monthly contribution to global new diagnoses. A time-scaled maximum likelihood tree was used to estimate most likely ancestral geographic locations (country or Canadian province), enabling identification of sublineages, defined as introduction events into Canada resulting in domestic transmission. Of 402 Canadian sublineages identified, the majority likely originated from the USA (54%), followed by Russia (7%), India (6%), Italy (6%), and the UK (5%). International introductions were mostly into Ontario (39%) and Quebec (38%). Among Pango lineages6, B.1 was imported at least 191 separate times from 11 different countries. Introduction rates peaked in late March then diminished but were not eliminated following national interventions including restrictions on non-essential travel. We further identified 1,380 singleton importations, international importations that did not result in further sampled transmission, whereby representation of lineages and location were comparable to sublineages. Although proportion of international transmission decreased over time, this coincided with exponential growth of within-province transmission – in fact, total number of sampled transmission events from international or interprovincial sources increased from winter 2020 into spring 2020 in many provinces. Ontario, Quebec, and British Columbia acted as sources of transmission more than recipients, within the caveat of higher sequence representation. We present strong evidence that international introductions and interprovincial transmission of SARS-CoV-2 contributed to the Canadian COVID-19 burden throughout 2020, despite initial reductions mediated by travel restrictions in 2020. More stringent border controls and quarantine measures may have curtailed introductions of SARS-CoV-2 into Canada and may still be warranted.Significance StatementBy analyzing SARS-CoV-2 genomes from Canada in the context of the global pandemic, we illuminate the extent to which the COVID-19 burden in Canada was perpetuated by ongoing international importations and interprovincial transmission throughout 2020. Although travel restrictions enacted in March 2020 reduced the importation rate and proportion of transmission from abroad across all Canadian provinces, SARS-CoV-2 introductions from the USA, India, Russia, and other nations were detectable through the summer and fall of 2020.
Lesion covariance networks reveal proposed origins and pathways of diffuse gliomas
Authors: Mandal Ayan S. , Romero-Garcia Rafael , Seidlitz Jakob , Hart Michael G. , Alexander-Bloch Aaron , Suckling John 
Published: April 2021

AbstractDiffuse gliomas have been hypothesized to originate from neural stem cells in the subventricular zone. Here, we evaluated this hypothesis by mapping independent sources of glioma localization and determining their relationships with neurogenic niches, genetic markers, and large-scale connectivity networks. Using lesion data from a total of 410 patients with glioma, we identified -- and replicated in an independent sample -- three lesion covariance networks (LCNs), which reflect clusters of frequent glioma co-localization. Each LCN overlapped with a distinct horn of the lateral ventricles. The first LCN, which overlapped with the anterior horn, was associated with low-grade, IDH-mutated/1p19q-codeleted tumors, as well as a neural transcriptomic signature and improved overall survival. Each LCN significantly corresponded with multiple brain networks, with LCN1 bearing an especially strong relationship with structural and functional connectivity, consistent with its neural transcriptomic profile. Finally, we identified subcortical, periventricular structures with functional connectivity patterns to the cortex that significantly matched each LCN. Cumulatively, our findings support a model wherein periventricular brain connectivity guides tumor development.
Effectiveness of An Impedance Cardiography Guided Treatment Strategy to Improve Blood Pressure Control in A Real-World Setting: Results from A Pilot Pragmatic Clinical Trial
Authors: Wang Luyan , Lu Yuan , Wang Hongyi , Gu Jianlei , Ma Zheng J. , Lian Zheng , Zhang Zhiying , Krumholz Harlan M. , Sun Ningling 
Published: April 2021

ABSTRACTBackgroundHypertension is a hemodynamic-related disorder characterized by abnormalities of the cardiac output (CO) and/or systemic vascular resistance (SVR). We hypothesized that selecting antihypertensive therapy based on patients’ hemodynamic profile could improve blood pressure (BP) control more effectively than standard care in hypertensive patients in real-world clinical practice.MethodsWe conducted a pilot single-center, pragmatic randomized trial involving adults with uncontrolled hypertension who sought outpatient care at a hypertension clinic of the Peking University People’s Hospital, the largest teaching hospital of Peking University, in Beijing China, between December 2018 and December 2019. Participants were randomly assigned to the standard care group or the hemodynamic group in a 1:1 ratio. Impedance cardiography (ICG) was performed with all participants to measure hemodynamic parameters. Only physicians in the hemodynamic group were provided with patients’ ICG findings and a computerized clinical decision support of recommended treatment choices based on patients’ hemodynamic profiles. The primary outcomes were the changes in systolic BP (SBP) and diastolic BP (DBP) levels at the follow-up visit 4-12 weeks after baseline. Secondary outcomes included achievement of BP goal of <140/ 90 mmHg and the changes in BP by baseline BP, age, sex, and BMI.ResultsA total 102 adults (mean age was 54±14 years; 41% were women) completed the study. The mean baseline SBP was 150.9 (±11.5) mmHg and mean baseline DBP was 91.1 (±11.3) mmHg. At the follow-up visit, the mean SBP and DBP decreased by 19.9 and 11.3 mmHg in the hemodynamic group, as compared with 12.0 and 4.9 mmHg in the standard care group (P value for difference between groups <0.001 for both SBP and DBP). The proportion of patients achieving BP goal of <140/ 90 mmHg in the hemodynamic group was 67%, as compared with 41% in the standard care group (P=0.017). The hemodynamic group had a larger effect on BP reduction consistently across subgroups by age, sex, BMI, and baseline BP.ConclusionsAn ICG-guided treatment strategy led to greater reductions in BP levels than were observed with standard care in a real-world population of outpatients with hypertension. There is a need for further validation of this strategy for improving blood pressure treatment selection. (Funded by internal research grant from the Peking University People’s Hospital; ClinicalTrials.gov number: NCT04715698.)
GRAd-COV2, a gorilla adenovirus based candidate vaccine against COVID-19, is safe and immunogenic in young and older adults
Authors: Lanini Simone , Capone Stefania , Antinori Andrea , Milleri Stefano , Nicastri Emanuele , Camerini Roberto , Agrati Chiara , Castilletti Concetta , Mori Federica , Sacchi Alessandra , Matusali Giulia , Gagliardini Roberta , Ammendola Virginia , Cimini Eleonora , Grazioli Fabiana , Scorzolini Laura , Napolitano Federico , Piazzi Maria Maddalena , Soriani Marco , De Luca Aldo , Battella Simone , Sommella Andrea , Contino Alessandra M. , Barra Federica , Gentile Michela , Raggioli Angelo , Shi Yufang , Girardi Enrico , Maeurer Markus , Capobianchi Maria R. , Vaia Francesco , Piacentini Mauro , Kroemer Guido , Vitelli Alessandra , Colloca Stefano , Folgori Antonella , Ippolito Giuseppe 
Published: April 2021

AbstractSafe and effective vaccines against coronavirus disease 2019 (COVID-19) are urgently needed to control the ongoing pandemic. Although impressive progress has been made with several COVID-19 vaccines already approved, it is clear that those developed so far cannot meet the global vaccine demand. We have developed a COVID-19 vaccine based on a replication-defective gorilla adenovirus expressing the stabilized pre-fusion SARS-CoV-2 Spike protein, named GRAd-COV2. We aimed to assess the safety and immunogenicity of a single-dose regimen of this vaccine in healthy younger and older adults to select the appropriate dose for each age group. To this purpose, a phase 1, dose-escalation, open-label trial was conducted including 90 healthy subjects, (45 aged 18-55 years and 45 aged 65-85 years), who received a single intramuscular administration of GRAd-CoV2 at three escalating doses. Local and systemic adverse reactions were mostly mild or moderate and of short duration, and no serious AE was reported. Four weeks after vaccination, seroconversion to Spike/RBD was achieved in 43/44 young volunteers and in 45/45 older subjects. Consistently, neutralizing antibodies were detected in 42/44 younger age and 45/45 older age volunteers. In addition, GRAd-COV2 induced a robust and Th1-skewed T cell response against the S antigen in 89/90 subjects from both age groups. Overall, the safety and immunogenicity data from the phase 1 trial support further development of this vaccine.One Sentence SummaryGRAd-COV2, a candidate vaccine for COVID-19 based on a novel gorilla adenovirus, is safe and immunogenic in younger and older adults
Increased serum thromboxane A2 and prostacyclin but lower complement C3 and C4 levels in COVID-19: associations with chest CT-scan anomalies and lowered peripheral oxygen saturation
Authors: Al-Hakeim Hussein Kadhem , Al-Hamami Shaymaa Ali , Maes Michael 
Published: April 2021

AbstractBackgroundCOVID-19 patients suffer from hypercoagulation and activated immune-inflammatory pathways. This study was performed to assay serum complement C3 and C4, and thromboxane A2 (TxA2) and prostacyclin (PGI2) in association with chest CT scan anomalies (CCTAs) and peripheral oxygen saturation (SpO2)MethodsSerum levels of C3, C4, TxA2, and PGI2 were measured by ELISA and albumin, calcium, and magnesium by spectrophotometric method in 60 COVID-19 patients and 30 controls.ResultsC3 and C4 are significantly decreased and TxA2 and PGI2 significantly increased in COVID-19 patients as compared with controls. Neural networks showed that a combination of C3, albumin, and TxA2 yielded a predictive accuracy of 100% in detecting COVID-19 patients. SpO2 was significantly decreased in COVID-19 patients and was inversely associated with TxA2 and PGI2, and positively with C3, C4, albumin, and calcium. CCTAs were accompanied by lower SpO2 and albumin, and increased PGI2 levels. Patients with positive IgG results show significantly higher SpO2, TxA2, PGI2, and C4 levels than IgG negative patients.ConclusionHypoalbuminemia, which is strongly associated with lung lesions and lowered peripheral oxygen saturation, is characterized by increased TxA2, suggesting that interactions between immune-inflammatory pathways and platelet hyperactivity participate in the pathophysiology of COVID-19 and consequently may play a role in enhanced risk of hypercoagulability and venous thromboembolism. These mechanisms are aggravated by lowered calcium and magnesium levels.
Cascade screening following a polygenic risk score test: what is the risk of a relative conditional on a high score of a proband?
Authors: Carmi Shai 
Published: April 2021

AbstractPolygenic risk scores (PRSs) for predicting disease risk have become increasingly accurate, leading to rising popularity of PRS tests. Consider an individual whose PRS test has placed him/her at the top q-quantile of genetic risk. Recently, Reid et al. (Circ Genom Precis Med. 2021;14:e003262) have investigated whether such a finding should motivate cascade screening in the proband’s siblings. Specifically, using data from the UK biobank, Reid et al. computed the empirical probability of a sibling of the proband to also have a PRS at the top q-quantile. In this short note, I use the liability threshold model to compute this probability analytically (for either a sibling of the proband or for a more distant relative), showing excellent agreement with the empirical results of Reid et al., including that this probability is disease-independent. Further, I compute the probability of the relative of the proband to be affected, as a function of the quantile threshold q, the proportion of variance explained by the score, and the disease prevalence.
Depression and anxiety among the University community during the Covid-19 pandemic: a study in Southern Brazil
Authors: Schuch Helena S. , Cademartori Mariana G. , Dias Valesca Doro , Levandowski Mateus L. , Munhoz Tiago N , Hallal Pedro R. C. , Demarco Flávio F. 
Published: April 2021

AbstractBackgroundThe COVID-19 pandemic has disrupted people’s routine in several ways, including the temporary cessation of face-to-face teaching activities, which may affect the mental health of the population. This study aimed to assess the mental health of the academic community of a University in South Brazil during the Covid-19 pandemic.MethodsCross-sectional web-based survey conducted between July-August 2020 through a self-administered online questionnaire. All University staff and students were eligible. Depression was assessed using the Patient Health Questionnaire-9 and anxiety by the Generalized Anxiety Disorder-7. All analyses were stratified by academic or administrative staff, undergraduate and graduate students.Results2,785 individuals participated in the study. Prevalence of depression and anxiety were 39.2% (95% Confidence Interval (CI) 37.3-41.1) and 52.5% (95% CI 50.6-54.4), respectively. On stratified analyses, undergraduate students showed a higher prevalence of the outcomes compared to other groups. In relation to social distancing, higher prevalence of mental illness was associated to strictly following the authority’s guidelines and with not leaving the house routinely, but these associations were restricted to some subgroups. Mental health care and previous diagnosis of mental illness were associated with higher rates of anxiety and depression.LimitationsThe main concerns were the representativeness of the sample and the response rate.ConclusionsAn alarming prevalence of mental illness was observed in this academic community. Despite the well-known benefits of social distancing and quarantine to public health, it requires a special surveillance on the mental health of the population, especially students and those with previous mental illness diagnosis.