bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laminectomy Adjacent to Instrumented Fusion Increases Adjacent Segment Disease
Authors: Simonetta Brandon , Adeniyi Biodun , Corbett Andrew , Crandall Dennis , Chang Michael 
Published: April 2024

Study Design.
Retrospective cohort.

Objective.
To determine if performing a simultaneous laminectomy at an unfused level adjacent to an instrumented fusion increases the risk of adjacent segment disease (ASD).

Summary of Background Data.
Laminectomy adjacent to instrumented fusion has uncertain outcomes. The increased mechanical forces at the unfused laminectomy may lead to more ASD. Few studies have examined the development of ASD with regard to laminectomy performed adjacent to instrumented fusions.

Materials and Methods.
Seven hundred eighty-nine patients underwent instrumented lumbar fusion and laminectomy at the same level(s) (n=676) or with an additional adjacent level laminectomy (n=113) with a minimum of 2-year follow-up. Diagnoses were degenerative spondylosis (n=241), degenerative spondylolisthesis (n=485), and isthmic spondylolisthesis (n=63) in addition to central stenosis. Primary outcome measures included development of ASD, time to development of ASD, revision surgery, and time to revision surgery.

Results.
The adjacent laminectomy group developed ASD at a significantly greater rate of 57.5% (n=65), compared with 35.2% (n=238) of the nonadjacent laminectomy group (P<0.001). The revision surgery rate was also greater in the adjacent laminectomy group (22.1% vs. 13.5%, P<0.001). There was no difference in time to revision surgery (31.1 vs. 32.6 mo, P=0.71) or time to ASD development (31.2 vs. 32.3 mo, P=0.72). ODI and VAS scores did not differ, nor did patient baseline demographics including sex, BMI, Charleston Comorbidity Index, and tobacco use. The exception was the average age of the adjacent laminectomy group was 67.6 years while the average age of the nonadjacent laminectomy group was 62.3 years (P<0.001). However, age was not found to be an independent predictor of ASD development (P=0.44).

Conclusion.
Surgeons should be cautious when performing a laminectomy adjacent to an instrumented fusion, as this increases the rate of ASD as well as revision surgery.

Level of Evidence.
Therapeutic Level—II
Ransomware Cyberattack Associated With Cardiac Arrest Incidence and Outcomes at Untargeted, Adjacent Hospitals
Authors: Pham Thaidan T. , Loo Theoren M. , Malhotra Atul , Longhurst Christopher A. , Hylton Diana , Dameff Christian , Tully Jeffrey , Wardi Gabriel , Sell Rebecca E. , Pearce Alex K. 
Published: April 2024

OBJECTIVES:
Healthcare ransomware cyberattacks have been associated with major regional hospital disruptions, but data reporting patient-oriented outcomes in critical conditions such as cardiac arrest (CA) are limited. This study examined the CA incidence and outcomes of untargeted hospitals adjacent to a ransomware-infected healthcare delivery organization (HDO).

DESIGN, SETTING, AND PATIENTS:
This cohort study compared the CA incidence and outcomes of two untargeted academic hospitals adjacent to an HDO under a ransomware cyberattack during the pre-attack (April 3–30, 2021), attack (May 1–28, 2021), and post-attack (May 29, 2021–June 25, 2021) phases.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Emergency department and hospital mean daily census, number of CAs, mean daily CA incidence per 1,000 admissions, return of spontaneous circulation, survival to discharge, and survival with favorable neurologic outcome were measured. The study evaluated 78 total CAs: 44 out-of-hospital CAs (OHCAs) and 34 in-hospital CAs. The number of total CAs increased from the pre-attack to attack phase (21 vs. 38; p = 0.03), followed by a decrease in the post-attack phase (38 vs. 19; p = 0.01). The number of total CAs exceeded the cyberattack month forecast (May 2021: 41 observed vs. 27 forecasted cases; 95% CI, 17.0–37.4). OHCA cases also exceeded the forecast (May 2021: 24 observed vs. 12 forecasted cases; 95% CI, 6.0–18.8). Survival with favorable neurologic outcome rates for all CAs decreased, driven by increases in OHCA mortality: survival with favorable neurologic rates for OHCAs decreased from the pre-attack phase to attack phase (40.0% vs. 4.5%; p = 0.02) followed by an increase in the post-attack phase (4.5% vs. 41.2%; p = 0.01).

CONCLUSIONS:
Untargeted hospitals adjacent to ransomware-infected HDOs may see worse outcomes for patients suffering from OHCA. These findings highlight the critical need for cybersecurity disaster planning and resiliency.
The correlation between the intraoperative employment of indocyanine green videoangiography and incidences of residual aneurysm and parent vessel trauma: A retrospective analysis from a single center
Authors: Lin Kai-Chun , Hsieh Cheng-Ta , Chen Shiu-Jau , Tsai Cheng-Chia , Cheng Sheng-Yu , Lin Jui-Feng , Yang Chih-Chuan , Hu Chao-Kai , Chan Yun-Kai , Lin Hsin-Yao 
Published: April 2024

Abstract

Background
Mitigating residual cerebral aneurysm and parent artery trauma during the microsurgical treatment of aneurysms, specifically clipping, is of paramount importance to enhance patient outcomes. This study examines the effectiveness of intraoperative indocyanine green videoangiography (ICG-VA) as a strategic tool to attenuate these surgical complications.

Materials and Methods
We conducted a retrospective analysis of patient medical records who underwent cerebral aneurysm surgery in our institution from January 2012 to July 2018. The characteristic variables were juxtaposed between cohorts who had undergone intraoperative ICG-VA and those who had not, employing the independent-samples Student t test and χ
2 test for statistical comparison. The Sindou grading system was utilized to categorize aneurysm remnants, whereas injury to the parent artery was determined jointly by a neurosurgeon and a neuroradiologist. Logistic regression models were utilized to investigate the correlation between intraoperative ICG-VA usage and the presence of aneurysm remnants and parent artery injury.

Results
A total of 127 patients, harboring 131 aneurysms, underwent surgical treatment. Among these patients, 55 had intraoperative ICG-VA utilized. The occurrence rates of residual aneurysm and parent artery injury were documented at 30.5% and 6.9%, respectively. With regard to the Sindou grades I–III aneurysm remnants, interpreted as favorable outcomes, such results were observed in 14 (82.4%) patients in the non–ICG-VA group and 21 (91.3%) patients in the ICG-VA group, with no significant difference discerned between the two groups (P = 0.406; odds ratio [OR], 2.250; 95% confidence interval [CI], 0.332–15.236). Without parent artery injury, there were 64 (88.9%) patients in the non–ICG-VA group and 58 (98.3%) patients in the ICG-VA group, presenting a significant difference (P = 0.038; OR, 10.793; 95% CI, 1.134–102.691).

Conclusions
The utilization of intraoperative ICG-VA during microsurgical aneurysm-clipping could notably decrease the incidence of parent artery injury. Nonetheless, when considering the presence of aneurysm remnants, the expertise of the neurosurgeon may play a more influential role compared with the use of ICG-VA.
Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN)
Authors: Reeves Alexis N. , Lewis Tené T. , Hood Michelle M. , Thurston Rebecca C. , Avis Nancy E. , Burnett-Bowie Sherri-Ann M. , Cortés Yamnia I. , Neal-Perry Genevieve , Harlow Siobán D. 
Published: April 2024

Abstract

Objectives
Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women.

Methods
Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS.

Results
Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with “continuously high” (OR, 1.69 [1.03-2.77]) and “high pre-FMP-decline post-FMP” (OR, 1.70 [1.01-2.88]) versus “FMP-onset low” trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the “continuously high” any VMS trajectory remained elevated for Black versus White women.

Conclusions
Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.
ASSOCIATIONS BETWEEN CHOROIDAL ALTERATIONS AND EARLY NEURODEGENERATION IN DIABETES WITHOUT DIABETIC RETINOPATHY
Authors: Li Zhenping , Yang Fan , Deng Xiaowen , Yang Yao , Gong Haijun , Lan Yuqing 
Published: April 2024

Purpose:
To identify associations between choroidal alterations and the reduction of peripapillary retinal nerve fiber layer (pRNFL) thickness in diabetes without diabetic retinopathy (nondiabetic retinopathy, NDR).

Methods:
This retrospective cross-sectional study included 143 eyes from 83 patients with NDR and 124 eyes from 82 matched healthy controls. Ultra-widefield swept-source optical coherence tomography angiography was used to automatically measure retinal and choroidal thickness (ChT), retinal vascular density, and choroidal vascular metrics. Data were analyzed using Student’s t-tests, generalized estimating equations, and generalized linear mixed models.

Results:
Patients with NDR exhibited significant reductions in perifoveal ChT (e.g., perifoveal inferior region: 253.42 ± 86.59 µm vs. 281.01 ± 80.25 µm, P = 0.026 in GEE test) compared with the controls. The NDR group showed a significant decrease in the choroidal vascular index (P = 0.012 in GEE test), and an increase in the choroidal stromal index (P = 0.012 in GEE test). The average pRNFL thickness significantly decreased in patients with NDR (114.58 ± 11.88 µm vs. 120.25 ± 16.36 µm, P = 0.005 in GEE test). The thickness of the outer nuclear layer and total retina significantly decreased in patients with NDR (P < 0.05). In multivariate models, ChT was significantly correlated with pRNFL thickness (β = 0.041, P = 0.001), even after adjusting by confounding factors (β = 0.056, P = 0.001).

Conclusion:
In NDR, there were decreases in ChT, choroidal vascular index, pRNFL thickness, and outer nuclear layer thickness. The reduction in ChT was independently associated with the reduction in pRNFL thickness, suggesting that ChT could serve as a predictor of retinal neurodegeneration in NDR.
Potential role of the light-adjustable lens in flanged intrascleral haptic fixation
Authors: LoBue Stephen A. , Saba Nicholas , Catapano Thomas M. , Martin Curtis R. , Shelby Christopher L. , Coleman Wyche T. 
Published: April 2024

Purpose:
To compare maximum tensile strength between commonly used 3-piece intraocular lens (IOL) for flanged intrascleral haptic fixation (FISHF).

Setting:
Willis-Knight Eye Institute, Shreveport, Louisiana.

Design:
Laboratory investigation.

Methods:
Haptic tensile strength was compared with MA60AC, CT Lucia 602, AR40E, and the light-adjustable lens (LAL). Haptic strength with a 24-diopter (D) IOL was compared across all lenses, as well as across a range of 10 to 30 D with the MA60AC. A custom device was created to hold the IOL in correct haptic orientation. The maximum tension (mean ± SD) was recorded in Newtons (N) when the haptic lost tension or broke.

Results:
CT Lucia was the strongest at 1.53 ± 0.11 N vs 1.00 ± 0.15 (MA60AC), 0.87 ± 0.19 (AR40E), and 0.83 ± 0.14 N (LAL) (P < .001). The LAL and AR40E were similar to a 9-0 polypropylene suture while being significantly stronger than 10-0 polypropylene suture (P < .001). No difference in haptic tension for the MA60AC from 10 to 30 D (P > .05). High magnification revealed the highest haptic fractures for MA60AC at 40% compared with LAL, AR40E, and CT Lucia at 0%. CT Lucia and AR40E had 100% of haptics disinserted from the IOL without any damage compared with 60% LAL and 60% MA60AC. CT Lucia, AR40E, and LAL have a flatter haptic angulation at 5 degrees.

Conclusions:
Haptic strength, durability, and angulation of the LAL may support the possibility of FISHF in the hands of experienced surgeons. However, further testing is strongly recommended to verify whether physiologic conditions or light treatments may compromise long-term haptic stability.
Phacoemulsification using an active fluidics system at physiologic vs high intraocular pressure: impact on anterior and posterior segment physiology
Authors: Rauen Matthew P. , Joiner Hillery , Kohler Robyn A. , O'Connor Sara 
Published: April 2024

Purpose:
Evaluate the impact of high vs low intraoperative intraocular pressure (IOP) during phacoemulsification on anterior and posterior physiology.

Setting:
Private practice in Des Moines, Iowa.

Design:
Prospective, randomized, paired-eye clinical trial of patients anticipating bilateral cataract surgery.

Methods:
27 participants randomized at the time of their first cataract surgery to either low IOP or high IOP group. The subsequent cataract surgery was performed under the alternate condition. During phacoemulsification and cortex removal, IOP was maintained either at low (≤28 mm Hg) or at high (≥55 to 60 mm Hg) levels. The primary outcome was fluid usage, with secondary outcomes of central corneal thickness, foveal avascular zone area, foveal and macular thickness, endothelial cell density (ECD), and postoperative inflammation.

Results:
Surgery with low IOP settings used less fluid (40.0 mL vs 55.6 mL, P < .0001). Corneal thickness changes were smaller in low IOP eyes at 1 day and 1 week (3.0% vs 8.1%, P = .01; 3.1% vs 4.4%, P = .01) but were similar by 1 and 3 months. ECD dropped less in low IOP eyes at 1 and 3 months (−1.7% vs −12.3%, P = .001, 2.1% vs −8.9%, P = .0003.) IOP remained a significant predictor of ECD change when relationship was controlled for fluid use and phacoemulsification energy. Retinal parameters did not vary among all eyes or when compared by IOP setting. Visual acuity was similar at all timepoints.

Conclusions:
Low IOP settings resulted in less inflammation and less corneal trauma, as evidenced by a smaller drop in ECD and less postoperative corneal edema, when compared with high IOP settings. Retinal parameters did not change significantly. The different outcomes did not result in a difference in visual acuity.
Comparing the oncologic outcomes of local tumor destruction vs. local tumor excision vs. partial nephrectomy in T1a solid renal masses: a population-based cohort study from the SEER database
Authors: Guo Run-Qi , Zhao Peng-Jin , Sun Jie , Li Yuan-Ming 
Published: April 2024

Background:
There are few large-scale analyses comparing local tumor destruction (LTD) or local tumor enucleation/excision (LTE) relative to partial nephrectomy (PN) for patients with T1a renal masses in terms of cancer-specific survival (CSS) and overall survival (OS). The authors aimed to compare CSS and OS after LTD versus LTE versus PN.

Materials and methods:
Within the Surveillance, Epidemiology, and End Results (SEER) database (2000–2019), the authors identified patients with clinical T1a renal masses and histologically confirmed kidney cancer treated with LTD, LTE, or PN. After 1:1 ratio propensity score matching (PSM), comparisons between the groups were conducted. Kaplan–Meier analysis and log-rank tests were used to compare survival in the matched population.

Results:
In the overall cohort of 3717 LTD patients versus 1993 LTE patients versus 26 935 PN patients, 77.3% of LTD-treated patients and 74.4% of LTE-treated patients were over 60 years old, while only 50.3% of PN-treated patients were over 60 years old. PN was more strongly associated with CSS [hazard ratio ((HR)=1.276, P<0.001) and OS (HR=1.112, P<0.001)] than was LTD, while PN was less strongly associated with CSS (HR=1.040, P=0.230) and OS (HR=0.888, P=0.002) than was LTE, not only in the PSM cohort but also in the subgroups of patients with a tumor size ≤3 cm and patients with a tumor size of 3.1–4 cm.

Conclusions:
In clinical T1a solid renal mass patients, LTD was associated with lower CSS and OS than LTE and PN, while LTE demonstrated noninferior CSS and superior OS to PN regardless of tumor size.
Hospital Capital Assets, Community Health, and the Utilization and Cost of Inpatient Care
Authors: Gaffney Adam , McCormick Danny , Bor David , Woolhandler Steffie , Himmelstein David U. 
Published: April 2024

Background:
The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.

Objective:
To explore the distribution of physical hospital resources—that is, capital assets—in the United States; its correlation with indicators of community health and nonhealth factors; and the association between hospital capital density and regional hospital utilization and costs.

Research Design:
We created a dataset of n=1733 US counties by analyzing the 2019 Medicare Cost Reports; 2019 State Inpatient Database Community Inpatient Statistics; 2020–2021 Area Health Resource File; 2016–2020 American Community Survey; 2022 PLACES; and 2019 CDC WONDER. We first calculated aggregate hospital capital assets and investment at the county level. Next, we examined the correlation between community’s medical need (eg, chronic disease prevalence), ability to pay (eg, insurance), and supply factors with 4 metrics of capital availability. Finally, we examined the association between capital assets and hospital utilization/costs, adjusted for confounders.

Results:
Counties with older and sicker populations generally had less aggregate hospital capital per capita, per hospital day, and per hospital discharge, while counties with higher income or insurance coverage had more hospital capital. In linear regressions controlling for medical need and ability to pay, capital assets were associated with greater hospital utilization and costs, for example, an additional $1000 in capital assets per capita was associated with 73 additional discharges per 100,000 population (95% CI: 45–102) and $19 in spending per bed day (95% CI: 12–26).

Conclusions:
The level of investment in hospitals is linked to community wealth but not population health needs, and may drive use and costs.
Axial Spondyloarthritis: Does Magnetic Resonance Imaging Classification Improve Report Interpretation
Authors: O'Neill John , Dhillon Sandeep S. , Ma Christina Tianyun , Stubbs Euan Graeme Crowther , Khalidi Nader A. , Ioannidis George , Beattie Karen A. , Carmona Raj 
Published: April 2024

Objective
The interpretation of magnetic resonance imaging (MRI) reports is crucial for the diagnosis of axial spondyloarthritis, but the subjective nature of narrative reports can lead to varying interpretations. This study presents a validation of a novel MRI reporting system for the sacroiliac joint in clinical practice.

Methods
A historical review was conducted on 130 consecutive patients referred by 2 rheumatologists for initial MRI assessment of possible axial spondyloarthritis. The original MRI reports were interpreted by the rheumatologists and the radiologist who originally read the images and then categorized according to the novel system. Two musculoskeletal radiologists then reinterpreted the original MRI scans using the new system, and the resulting reports were interpreted and categorized by the same rheumatologists. The quality of the new framework was assessed by comparing the interpretations of both reports.

Results
Ninety-two patients met the study criteria. The rheumatologists disagreed on the categorization of the original MRI reports in 12% of cases. The rheumatologists and original radiologists disagreed on the categorization of the initial report in 23.4% of cases. In contrast, there was 100% agreement between the rheumatologists and radiologists on the categorization of the new MRI report.

Conclusion
The new MRI categorization system significantly improved the agreement between the clinician and radiologist in report interpretation. The system provided a standard vocabulary for reporting, reduced variability in report interpretation, and may therefore improve clinical decision-making.
Intense 68Ga-OncoFAP Uptake as a New Promising Diagnostic Biomarker in Cardiac Sarcoidosis
Authors: Ventura David , Schäfers Michael , Yilmaz Ali , Eckardt Lars , Korthals Dennis 
Published: April 2024

Abstract
A 72-year-old man revealed typical findings of cardiac sarcoidosis on cardiovascular MRI. However, 18F-FDG PET showed no hypermetabolism. Therefore, immunosuppression was not initiated. After 2 years, ventricular arrhythmias and heart failure worsened. 68Ga–fibroblast activation protein inhibitor PET was initiated to evaluate potential adverse remodeling due to progressive myocardial fibrosis. A second 18F-FDG PET still revealed no hypermetabolism, and the patient received an implanted cardioverter defibrillator after electrophysiological risk stratification. We present a case of intense fibroblast activation despite a missing 18F-FDG uptake (mismatch).
Anthropometric Analysis of the Faces of Chinese Women in Leadership Roles
Authors: Gyun Jung Sung , Wu Xiajing , Hwang Kun , Han Seung-Ho 
Published: April 2024

The aim of this study was to investigate the appearance of the faces of Chinese women in leadership positions through an anthropometric analysis of Women of China from 1949 to 2022. Photographs of cover women of Women of China were gathered and a total of 380 frontal and 101 lateral photographs were collected. The photographs were divided into 3 time phases: phase I (1949–1978): from the launch of Women of China magazine, up until the time of reform and opening; phase II (1978–2010): from the time of reform and opening until when Google China was blocked; and phase III (2010–2022): to the present. The horizontal corneal diameter (11.52 mm) was set as the reference value for the frontal face. The anthropometric results showed the width of the face, midface, and lower face decreased over time. The women at phase I had larger and round faces, smaller and narrower eyes, wider noses, and thicker lips; relatively masculine and hard-working woman image, as the occupations of women were mainly described as workers, farmers, and civil servants. Phase II showed smaller but still round faces, relatively wide-set round eyes, narrower noses, and smaller lips than in phase I; neutral features as skilled workers, engineers, entrepreneurs, civil servants, and researchers. Phase III showed oval faces, almond eyes, narrower noses, smaller full lips, and wider chins, reflecting a process of feminization; working in entertainment, sports, and science. The data from this study might serve as the recommended aesthetic proportions when performing plastic surgical procedures for talented woman.