bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Risk-Benefit Analysis of Increasing Surgical Invasiveness Relative to Frailty Status in Adult Spinal Deformity Surgery
Authors: Passias Peter G. , Brown Avery E. , Bortz Cole , Pierce Katherine , Alas Haddy , Ahmad Waleed , Passfall Lara , Kummer Nicholas , Krol Oscar , Lafage Renaud , Lafage Virginie , Burton Douglas , Hart Robert , Anand Neel , Mundis Gregory , Neuman Brian , Line Breton , Shaffrey Christopher , Klineberg Eric , Smith Justin , Ames Christopher , Schwab Frank J. , Bess Shay 
Published: February 2021

Study Design.
Retrospective review of a prospectively enrolled multicenter Adult Spinal Deformity (ASD) database.

Objective.
Investigate invasiveness and outcomes of ASD surgery by frailty state.

Summary of Background Data.
The ASD Invasiveness Index incorporates deformity-specific components to assess correction magnitude. Intersections of invasiveness, surgical outcomes, and frailty state are understudied.

Methods.
ASD patients with baseline and 3-year (3Y) data were included. Logistic regression analyzed the relationship between increasing invasiveness and major complications or reoperations and meeting minimal clinically important differences (MCID) for health-related quality-of-life measures at 3Y. Decision tree analysis assessed invasiveness risk-benefit cutoff points, above which experiencing complications or reoperations and not reaching MCID were higher. Significance was set to P < 0.05.

Results.
Overall, 195 of 322 patients were included. Baseline demographics: age 59.9 ± 14.4, 75% female, BMI 27.8 ± 6.2, mean Charlson Comorbidity Index: 1.7 ± 1.7. Surgical information: 61% osteotomy, 52% decompression, 11.0 ± 4.1 levels fused. There were 98 not frail (NF), 65 frail (F), and 30 severely frail (SF) patients. Relationships were found between increasing invasiveness and experiencing a major complication or reoperation for the entire cohort and by frailty group (all P < 0.05). Defining a favorable outcome as no major complications or reoperation and meeting MCID in any health-related quality of life at 3Y established an invasiveness cutoff of 63.9. Patients below this threshold were 1.8[1.38–2.35] (P < 0.001) times more likely to achieve favorable outcome. For NF patients, the cutoff was 79.3 (2.11[1.39–3.20] (P < 0.001), 111 for F (2.62 [1.70–4.06] (P < 0.001), and 53.3 for SF (2.35[0.78–7.13] (P = 0.13).

Conclusion.
Increasing invasiveness is associated with increased odds of major complications and reoperations. Risk-benefit cutoffs for successful outcomes were 79.3 for NF, 111 for F, and 53.3 for SF patients. Above these, increasing invasiveness has increasing risk of major complications or reoperations and not meeting MCID at 3Y.

Level of Evidence: 3
Subaxial Spine Fractures
Authors: Fröjd Révész David , Norell Andrea , Charalampidis Anastasios , Endler Peter , Gerdhem Paul 
Published: February 2021

Study Design.
Observational study on prospectively collected data.

Objectives.
The aim of this study was to compare long-term patient-reported outcomes and complications after anterior or posterior cervical spine surgery for subaxial fractures.

Summary of Background Data.
There is no consensus in the literature regarding the optimal surgical approach when treating spine fractures in the subaxial region.

Methods.
A total of 200 individuals who had been treated with either anterior or posterior surgery due to a subaxial single segment, or single vertebra, injury between 2006 and 2016 and had at least 1 year follow-up were identified in the Swedish Spine register. Cases were matched 1:1 for age (±5 years). Outcomes were Neck Disability Index (NDI) and EQ-5D-3L, and reoperations, mortality, and surgeon- and patient-reported wound complications within 90 days. t Tests and χ
2 tests were used statistical comparisons.

Results.
At follow-up, NDI was 23 (21) in the anterior group and 29 (21) in the posterior group (P = 0.07). EQ-5D-3L index was 0.62 (0.37) in the anterior group and 0.54 (0.39) in the posterior group (P = 0.13). Patient satisfaction was higher in the anterior group (89% vs. 73%, P = 0.03). No deaths occurred within the first 90 days after surgery, six individuals in the anterior group and three individuals in the posterior group were reoperated (P = 0.31), and five individuals in the anterior group and 24 in the posterior group suffered a wound infection (P < 0.001).

Conclusion.
Anterior surgery and posterior surgery were associated with similar neck disability and general quality of life at follow-up, whereas anterior surgery was associated with higher patient satisfaction and lower infection rates.

Level of Evidence: 3
Determining Average Linear Dimension and Volume of Korean Lungs for Lung Phantom Construction
Authors: Yang Sook , Kim Jeongin , Choi Seung Jin , Lee Kyung Won 
Published: February 2021

Abstract
The purpose of this study was to determine the average size and volume of lungs and to simulate the morphology of internal organs for the development of a Korean adult lung phantom. The body-size data of 2,195 males and 2,293 females aged between 20 and 60 y were included to calculate the average physical dimensions. Two hundred datasets of computed tomography corresponding to the average physique range were collected to measure the average linear dimensions (the length of x, y, and z-axis) of lungs. One set of lung CT images was finally obtained and converted to three-dimensional (3D) format. To confirm the validity of the new lung model, physical lung phantoms were constructed using International Commission on Radiation Units and Measurements (ICRU) density and similar density to what was obtained from the human CT image and then compared with the Lawrence Livermore National Laboratory (LLNL) phantom. The mean size of the chest width and thickness was 31.8 ± 2.8 and 21.4 ± 1.9 cm for males and 28.0 ± 1.6 cm and 19.4 ± 2.0 cm for females, respectively. The standard deviation of the lung dimension in this group was ± 3.0 cm in length, ± 0.8 cm in width, and ± 2.27 cm in depth. The two modified lung phantoms showed highly accurate geometry and linear attenuation coefficient vs. those of the LLNL phantom. The difference in CT number was ± 2% HU for the LLNL phantom and ± 4% HU for the human CT image based on a CT examination conducted using the chest CT protocol. Moreover, both lungs weighed 734 g to 1,246 g, within the range of the reference value of the ICRU report. These results demonstrate that a new lung model based on average linear dimension measurement in a group with average physique simulated the features and physical properties of real human lungs and facilitated further studies for phantom construction.
Efficacy and Safety of Ultrasound Cycloplasty for Refractory Glaucoma: A 3-Year Study
Authors: Rouland Jean-François , Aptel Florent 
Published: February 2021

Precis:
Ultrasound cycloplasty (UCP) treatment using high-intensity focused ultrasound is an effective and safe therapy to reduce intraocular pressure (IOP) in patients with refractory glaucoma over a 3-year period.

Purpose:
The purpose of this study was to evaluate the 3-year efficacy and safety of UCP in patients with refractory glaucoma.

Patients and Methods:
In all, 104 patients with refractory glaucoma recruited from 2 university hospitals underwent UCP. Examinations were performed 7 days, 1 week, 1, 3, 6, 12, 24, and 36 months after the UCP procedure. Primary outcomes were therapeutic success at 3 years (IOP reduction from baseline ≥20% and IOP >5 mm Hg without other surgical procedures) and vision-threatening complications. Secondary outcomes included mean IOP change from baseline at each follow-up visit, medication use, complications, and subsequent UCP and/or other postsurgical interventions.

Results:
At 3 years post-UCP, the therapeutic success rate was 55%. For 75% of the patients, results were obtained with only one procedure. For the overall study population, IOP was reduced significantly (P<0.005) from 27.6±8.9 mm Hg (n=3.0 topical hypotensive medication) to 17.0±6.8 mm Hg at 36 months (n=2.8 topical hypotensive medication) (33% reduction). For the success patients, the IOP was initially 29.3±8.8 mm Hg (n=3.0 topical hypotensive medication) and 15.6±4.3 mm Hg at 36 months (n=2.8 topical hypotensive medication) (43% reduction). The rate of complications was low and there were no cases of phthisis.

Conclusion:
The UCP procedure was efficacious with few complications and should be considered as an alternative to other IOP-lowering therapies including laser cyclocoagulation in patients with refractory glaucoma.
Efficacy and Safety of the Susanna Glaucoma Drainage Device After 1 Year of Follow-up
Authors: Susanna Fernanda N. , Susanna Bianca N. , Susanna Carolina N. , Nicolela Marcelo T. , Susanna Remo 
Published: February 2021

Precis:
This study found a rate of failure of 13.6% of the new Susanna Glaucoma Drainage Device (SGDD) after 1 year of follow-up. Severe complications occurred in 1 patient (4.5%).

Purpose:
The purpose of this study was to determine the success and complications rates of the SGDD implant in refractory glaucoma.

Patients and Methods:
This is a retrospective study. Medical records from all consecutive refractory glaucoma patients (failed trabeculectomies with the use of adjunctive mitomycin) followed in a private clinical practice were included in the study. All patients had undergone SGDD implant surgery from September 2016 to July 2019 were included. All surgeries were done by the same surgeon (R.S.). Primary outcome was surgical failure, defined as intraocular pressure (IOP) >18 mm Hg and/or <20% IOP reduction from baseline, IOP<5 mm Hg, reoperation for glaucoma, need of implant removal or loss of light perception vision. Secondary outcomes included mean IOP, use of supplemental medical therapy, and complications.

Results:
In all, 22 eyes were analyzed. Mean patient age was 63±15 years (range: 27 to 87 y). Mean IOP decreased from 23±7 to 11±8 mm Hg (P<0.001, paired t test) at an average of 18±9 months after the tube implant. The mean SD number of glaucoma medications was reduced from 3.3±1 to 1.5±1.2 at the last postoperative visit (P<0.01, paired t test). No early postoperative complications occurred. There was 1 case of late persistent hypotony in a patient with previous endocyclophotocoagulation that was solved with tube ligature with silk 8-0. Failure because of high IOP occurred in 2 cases. There was no extrusion or erosion of the tube and the plate.

Conclusion:
The SGDD presented a 13.6% failure rate (86.4% success rate) with very few complications, being an efficient and safe alternative for refractory glaucoma.
Weekly Email Reminders Increase Nursing Students' Use of Empathic Communication
Authors: Varagona Lynn , Myers Rachel , Wilson Astrid 
Published: February 2021

Background
Empathic communication has numerous patient benefits, yet many nurses do not possess or utilize empathic communication skills.

Purpose
This study compared the efficacy of 2 low-cost, low-resource-intensive interventions to increase nursing students' use of empathic communication.

Methods
The study was a randomized controlled trial with a pretest, posttest, and 3-month follow-up test. Participants were assigned to 1 of 4 groups: weekly empathic communication email reminders, an empathic communication quick reference guide, both, or neither.

Results
All groups showed a significant increase in empathic communication between the pretest and posttest. The group that received emails only showed a significant increase above and beyond the control group. None of the groups significantly increased or decreased their empathic communication between the posttest and 3-month follow-up test.

Conclusions
Weekly empathic communication email reminders can increase nursing students' use of empathic communication above and beyond traditional lectures and class activities.
Comparing Interprofessional Socialization in Mixed-Discipline and Nursing Student–Only Cohorts
Authors: Groom Kara K. , Frenn Marilyn , Breakwell Susan , Melchert Timothy , Garnier-Villarreal Mauricio 
Published: February 2021

Background
A challenge to substantiating the value of interprofessional education (IPE) has been the limited number of studies that assess the effectiveness of IPE interventions compared with education interventions in which professions were learning separately from one another.

Purpose
The purpose was to compare interprofessional socialization (IS) in mixed-discipline and single-discipline–only student cohorts to determine if mixed-discipline cohorts demonstrate greater improvement in IS compared with single-discipline cohorts.

Methods
Interprofessional socialization was measured using the Interprofessional Socialization and Valuing Scale in 166 university students who completed a semester-long online palliative care course.

Results
Statistically significant increases in IS were seen with all participants, both those in discipline-specific as well as mixed-discipline cohorts and in all IS subscales. No difference was observed between a cohort of nursing student–only learners versus a cohort of mixed-discipline students.

Conclusion
The study demonstrates that IS can be significantly increased whether students participate with single discipline peers or in mixed-discipline settings.
The Calcium Versus Hemorrhage Trial
Authors: Schellingerhout Dawid , Jacobsen Megan , Le Roux Lucia , Johnson Jason , Baladandayuthapani Veera , Hwang Ken-Ping , Hazle John , Schomer Donald , Cody Dianna 
Published: February 2021

Purpose
Chronic susceptibility lesions in the brain can be either hemorrhagic (potentially dangerous) or calcific (usually not dangerous) but are difficult to discriminate on routine imaging. We proposed to develop quantitative diagnostic criteria for single-energy computed tomography (SECT), dual-energy computed tomography (DECT), and quantitative susceptibility mapping (QSM) to distinguish hemorrhage from calcium.

Materials and Methods
Patients with positive susceptibility lesions on routine T2*-weighted magnetic resonance of the brain were recruited into this prospective imaging clinical trial, under institutional review board approval and with informed consent. The SECT, DECT, and QSM images were obtained, the lesions were identified, and the regions of interest were defined, with the mean values recorded. Criteria for quantitative interpretation were developed on the first 50 patients, and then applied to the next 45 patients. Contingency tables, scatter plots, and McNemar test were applied to compare classifiers.

Results
There were 95 evaluable patients, divided into a training set of 50 patients (328 lesions) and a validation set of 45 patients (281 lesions). We found the following classifiers to best differentiate hemorrhagic from calcific lesions: less than 68 Hounsfield units for SECT, calcium level of less than 15 mg/mL (material decomposition value) for DECT, and greater than 38 ppb for QSM. There was general mutual agreement among the proposed criteria. The proposed criteria outperformed the current published criteria.

Conclusions
We provide the updated criteria for the classification of chronic positive susceptibility brain lesions as hemorrhagic versus calcific for each major clinically available imaging modality. These proposed criteria have greater internal consistency than the current criteria and should likely replace it as gold standard.
Infectious Complications in Tocilizumab-treated Kidney Transplant Recipients
Authors: Sethi Supreet , Peng Alice , Najjar Reiad , Vo Ashley , Jordan Stanley C. , Huang Edmund 
Published: February 2021

Background.
Tocilizumab is an interleukin-6 receptor antagonist recently described as a promising treatment for antibody-mediated rejection. We compared infectious complications among tocilizumab-treated kidney transplant patients with those receiving intravenous immunoglobulin (IVIG)/rituximab.

Methods.
Infections occurring among 148 kidney recipients treated with tocilizumab 8 mg/kg IV monthly (n = 83) or IVIG/rituximab (n = 65) for donor-specific antibodies and antibody-mediated rejection through 1 year after treatment cessation were reviewed. Incidence rates of infections were compared using Poisson regression.

Results.
There were 106 infections observed over 190.1 person-years, yielding an incidence rate of 558 infections/1000 patient-years. A lower incidence rate of infections was observed among tocilizumab-treated compared with IVIG/rituximab-treated patients (463 infections/1000 patient-years versus 730 infections/1000 patient-years; P = 0.02). Twenty-five of 49 infections (51%) in the IVIG/rituximab group required hospitalization compared with 31 of 57 (54%; P = 0.85) in the tocilizumab group. There were no infection-related deaths in either group. Urinary tract infections and pneumonia were the most common types of infections, whereas gastrointestinal, blood, skin/soft tissue, viral, and fungal infections were less common. On multivariable Poisson regression, there was a lower incidence rate of infections associated with tocilizumab compared with IVIG/rituximab (incidence rate ratio, 0.63; 95% confidence interval, 0.43-0.93).

Conclusions.
Among kidney transplant patients treated with tocilizumab, there was no excess risk of infections compared with standard therapy with IVIG/rituximab.
Association Between Treatment of Secondary Hyperparathyroidism and Posttransplant Outcomes
Authors: Mathur Aarti , Sutton Whitney , Ahn JiYoon B. , Prescott Jason D. , Zeiger Martha A. , Segev Dorry L. , McAdams-DeMarco Mara 
Published: February 2021

Background.
Secondary hyperparathyroidism (SHPT) affects nearly all patients on maintenance dialysis therapy. SHPT treatment options have considerably evolved over the past 2 decades but vary in degree of improvement in SHPT. Therefore, we hypothesize that the risks of adverse outcomes after kidney transplantation (KT) may differ by SHPT treatment.

Methods.
Using the Scientific Registry of Transplant Recipients and Medicare claims data, we identified 5094 adults (age ≥18 y) treated with cinacalcet or parathyroidectomy for SHPT before receiving KT between 2007 and 2016. We quantified the association between SHPT treatment and delayed graft function and acute rejection using adjusted logistic models and tertiary hyperparathyroidism (THPT), graft failure, and death using adjusted Cox proportional hazards; we tested whether these associations differed by patient characteristics.

Results.
Of 5094 KT recipients who were treated for SHPT while on dialysis, 228 (4.5%) underwent parathyroidectomy, and 4866 (95.5%) received cinacalcet. There was no association between treatment of SHPT and posttransplant delayed graft function, graft failure, or death. However, compared with patients treated with cinacalcet, those treated with parathyroidectomy had a lower risk of developing THPT (adjusted hazard ratio, 0.56; 95% confidence interval, 0.35-0.89) post-KT. Furthermore, this risk differed by dialysis vintage (P
interaction = 0.039). Among patients on maintenance dialysis therapy for ≥3 y before KT (n = 3477, 68.3%), the risk of developing THPT was lower when treated with parathyroidectomy (adjusted hazard ratio, 0.43; 95% confidence interval, 0.24-0.79).

Conclusions.
Parathyroidectomy should be considered as treatment for SHPT, especially in KT candidates on maintenance dialysis for ≥3 y. Additionally, patients treated with cinacalcet for SHPT should undergo close surveillance for development of tertiary hyperparathyroidism post-KT.
Emergence of SARS-CoV-2 stains harbouring the signature mutations of both A2a and A3 clade
Authors: Sarkar Rakesh , Banerjee Anindita , Dutta Shanta , Chawla-Sarkar Mamta 
Published: February 2021

AbstractSARS-CoV-2 strains with both high transmissibility and potential to cause asymptomatic infection is expected to gain selective advantage over other circulating strains having either high transmissibility or ability to trigger asymptomatic infection. The D614G mutation in spike glycoprotein, the characteristic mutation A2a clade, has been associated with high transmissibility, whereas the A3 clade specific mutation L37F in NSP6 protein has been linked with asymptomatic infection. In this study, we performed a comprehensive mutational analysis of 3,77,129 SARS-CoV-2 genomes collected during January, 2020 to December, 2020 from all across the world for the presence of D614G and L37F mutations. Out of 3,77,129 SARS-CoV-2 strains analysed, 14, 598 (3.87%) were found to harbour both the D614G and L37F mutations. Majority of these double mutant SARS-CoV-2 strains were identified in Europe (11097) followed by North America (1915), Asia (980), Oceania (242), Africa (219), and South America (145). Geographical root surveillance revealed their first emergence during February-March in all the six continents. Temporal prevalence analysis from February, 2020 to December, 2020 showed a gradual upsurge in their frequencies worldwide, which strongly demonstrated the adaptive selection of these double mutants. Evolutionary analysis depicted that these double mutants emerged as a new clade in the dendrogram (named as A2a/3), and were sub-divided into four distinct clusters (Cluster I, II, III and IV) according to different sets of coexisting mutations. The frequency distribution pattern showed the global predominance of cluster III (41.42%), followed by cluster IV (23.31%), cluster II (21.02%) and cluster I (14.25%). Overall, our study highlighted the emergence of a unique phylogenetic clade encompassing the double-mutant SARS-CoV-2 strains which may provide a fitness advantage during course of virus evolution.
A Cross-Sectional Study Evaluating Tick-borne Encephalitis Vaccine Uptake and Timeliness Among Adults in Switzerland
Authors: Zens Kyra D. , Baroutsou Vasiliki , Sinniger Philipp , Lang Phung 
Published: February 2021

AbstractObjectivesThe goal of this study was to evaluate timeliness of Tick-borne Encephalitis vaccination uptake among adults in Switzerland.MethodsIn this cross-sectional survey, we collected vaccination records from randomly selected adults 18-79 throughout Switzerland. Of 4,626 participants, data from individuals receiving at least 1 TBE vaccination (n=1875) were evaluated. We determined year and age of first vaccination and vaccine compliance, evaluating dose timeliness. Participants were considered “on time” if they received doses according to the recommended schedule ± a 15% tolerance period.Results45% of participants received their first TBE vaccination between 2006 and 2009. 25% were first vaccinated aged 50+ (mean age 37). More than 95% of individuals receiving the first dose also received the second; ∼85% of those receiving the second dose received the third. For individuals completing the primary series, 30% received 3 doses of Encepur, 58% received 3 doses of FSME-Immun, and 12% received a combination. According to conventional schedules, 88% and 79% of individuals received their second and third doses “on time”, respectively. 20% of individuals receiving Encepur received their third dose “too early”. Of individuals completing primary vaccination, 19% were overdue for a booster. Among the 31% of subjects receiving a booster, mean time to first booster was 7.1 years.ConclusionsWe estimate that a quarter of adults in Switzerland were first vaccinated for TBE aged 50+. Approximately 80% of participants receiving at least one vaccine dose completed the primary series. We further estimate that 66% of individuals completing the primary series adhered to an “ideal” TBE vaccination schedule.