bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining the Role of Paraspinal Musculature in Postoperative Disability After Lumbar Fusion Surgery for Degenerative Spondylolisthesis
Authors: Schönnagel Lukas , Guven Ali E. , Camino-Willhuber Gaston , Caffard Thomas , Tani Soji , Zhu Jiaqi , Haffer Henryk , Muellner Maximilian , Zadeh Arman , Sanchez Leonardo A. , Shue Jennifer , Duculan Roland , Schömig Friederike , Sama Andrew A. , Cammisa Frank P. , Girardi Federico P. , Mancuso Carol A. , Hughes Alexander P. 
Published: October 2023

Study Design.
Retrospective analysis of prospectively enrolled patients.

Objective.
To evaluate the relationship between paraspinal muscle (PM) atrophy and Oswestry Disability Index (ODI) improvement after spinal fusion surgery for degenerative lumbar spondylolisthesis.

Background.
Atrophy of the PM is linked to multiple spinal conditions, sagittal malalignment, and increased postoperative complications. However, only limited evidence for the effect on patient-reported outcomes exists.

Methods.
Patients with degenerative lumbar spondylolisthesis undergoing decompression and fusion surgery were analyzed. Patients with missing follow-up, no imaging, or inadequate image quality were excluded. The ODI was assessed preoperatively and two years postoperatively. A cross-sectional area of the PM was measured on a T2-weighted magnetic resonance imaging sequence at the upper endplate of L4. On the basis of the literature, a 10-point improvement cutoff was defined as the minimum clinically important difference. Patients with a baseline ODI below the minimum clinically important difference were excluded. Logistic regression was used to calculate the association between fatty infiltration (FI) of the PM and improvement in ODI, adjusted for age, sex, and body mass index.

Results.
A total of 133 patients were included in the final analysis, with only two lost to follow-up. The median age was 68 years (IQR 62–73). The median preoperative ODI was 23 (IQR 17–28), and 76.7% of patients showed improvement in their ODI score by at least 10 points. In the multivariable regression, FI of the erector spinae and multifidus increased the risk of not achieving clinically relevant ODI improvement (P=0.01 and <0.001, respectively). No significant association was found for the psoas muscle (P=0.158).

Conclusions.
This study demonstrates that FI of the erector spinae and multifidus is significantly associated with less likelihood of clinically relevant ODI improvement after decompression and fusion. Further research is needed to assess the effect of interventions.
Association Between Osteoarthritis Burden and Intervertebral Disk Degeneration in Patients Undergoing Lumbar Spine Surgery for Degenerative Lumbar Spondylolisthesis
Authors: Schönnagel Lukas , Camino-Willhuber Gaston , Braun Sebastian , Zhu Jiaqi , Tani Soji , Guven Ali E. , Caffard Thomas , Chiapparelli Erika , Arzani Artine , Haffer Henryk , Muellner Maximilian , Shue Jennifer , Duculan Roland , Bendersky Mariana , Cammisa Frank P. , Girardi Federico P. , Sama Andrew A. , Mancuso Carol A. , Hughes Alexander P. 
Published: October 2023

Study Design.
A retrospective analysis of prospectively collected data.

Objective.
To assess the association between intervertebral disk degeneration and hip and knee osteoarthritis (OA) in patients with degenerative lumbar spondylolisthesis.

Background.
The co-occurrence of hip OA and degenerative spinal pathologies was first described as the “hip-spine syndrome” and has also been observed in knee OA. It remains unclear whether both pathologies share an underlying connection beyond demographic factors.

Materials and Methods.
Intervertebral disk degeneration was classified by the Pfirrmann Classification and intervertebral vacuum phenomenon. Intervertebral vacuum phenomenon was classified into mild (1 point), moderate (2 points), and severe (3 points) at each level and combined into a lumbar vacuum score (0–15 points). Similarly, a lumbar Pfirrmann grade was calculated (5–25 points). Patients with previous hip or knee replacement surgery were classified as having an OA burden. We used multivariable regression to assess the association between OA and disk degeneration, adjusted for age, body mass index, and sex.

Results.
A total of 246 patients (58.9% female) were included in the final analysis. Of these, 22.3% had OA burden. The multivariable linear regression showed an independent association between OA burden and lumbar vacuum (β = 2.1, P<0.001) and Pfirrmann grade (β = 2.6, P<0.001). Representing a 2.1 points higher lumbar vacuum and 2.6 points higher lumbar Pfirrmann grade after accounting for demographic differences.

Conclusions.
Our study showed that OA burden was independently associated with the severity of the intervertebral disk degeneration of the lumbar spine. These findings give further weight to a shared pathology of OA of large joints and degenerative processes of the lumbar spine.

Level of Evidence:
3.
Idiopathic bilateral occlusion of Foramen of Monro treated by septostomy with unilateral foraminoplasty: a rare case report
Authors: Sattout Ghaith Izz Aldeen , Wardeh Abdulkareem Muhammad , Alhassoun Alia , Zain Aldain Rami Naji , Alshraikey Ahmad Mohammed 
Published: October 2023

Introduction:
Idiopathic occlusion of the Foramen of Monro is extremely rare in adults. The occlusion is classified into four types, with the first being the most infrequent. This condition induces noncommunicating hydrocephalus with the ensuing increased intracranial pressure symptoms. Headache is usually the chief complaint.

Presentation of the case:
The authors present a case of a 28-year-old female who presented with a chronic headache that was unresponsive to analgesics. No other neurological deficits were present. Fundoscopic examination revealed the presence of bilateral papillary edema. Computed tomography scan results showed bilateral enlargement of the lateral ventricles of the brain. A subsequent MRI scan ruled out secondary causes of occlusion, such as colloid cysts, meningiomas, or choroid plexus tumors, which entailed an idiopathic etiology.
Treatment options include ventriculoperitoneal shunt insertion and septostomy with foraminoplasty. The former option is currently the treatment of choice, yet it is notorious for its ramifications, including foreign body reaction, breakage, and mechanical problems. The latter option is free of these risks; however, it requires meticulousness and precision to avoid damaging the fornix, which leads to impaired memory function.

Conclusion:
Septostomy with unilateral foraminoplasty could yield better outcomes if it is performed fastidiously.
Evaluation of the Prognostic Role of Liver Metastases on Patient Outcomes
Authors: Waninger Jessica J. , Ma Vincent T. , Chopra Zoey , Pearson Ashley N. , Green Michael D. 
Published: October 2023

Abstract
The liver is a common site of metastasis for many primary malignancies, but the quantitative impact on survival is unknown. We performed a systematic review and meta-analysis of 83 studies (604,853 patients) assessing the overall hazard associated with liver metastases by primary tumor type and treatment regimen. The pooled overall survival hazard ratio (HR) for all included studies was 1.77 (95% confidence interval [CI], 1.62–1.93). Patients with breast cancer primaries fared the worst (HR, 2.37; 95% CI, 1.64–3.44), as did patients treated with immunotherapies (HR, 1.86; 95% CI, 1.42–2.42). Liver metastases negatively impact survival, necessitating new approaches to disease management.
What Role Does Radiotherapy Play in the Molecular Era for Intrahepatic Cholangiocarcinoma?
Authors: Koay Eugene J. , Javle Milind , Belknap Madeline , Derasari Shrey , Roach Millicent , Ludmir Ethan B. 
Published: October 2023

Abstract
Intrahepatic cholangiocarcinoma is a rare disease, yet with rising incidence globally. Most patients are not eligible for potentially curative surgical resection, and many patients with unresectable disease die within 12 months of diagnosis, primarily due to liver failure from the primary tumor. Recent prospective and retrospective studies indicate that local control of the primary tumor can be achieved with hypofractionated radiotherapy in patients with unresectable disease, translating into prolonged survival of these patients. During the time that these encouraging reports for radiotherapy have been published, numerous concurrent studies have also shown that intrahepatic cholangiocarcinoma is a molecularly diverse disease with multiple targetable genetic alterations and a complex tumor microenvironment. These biological insights have translated into new drug approvals for subsets of patients. We review the current knowledge about the biology and targeted treatment of intrahepatic cholangiocarcinoma and describe these developments in the context of modern radiotherapy.
Early Experience of Direct-to-Implant Breast Reconstruction Using Acellular Dermal Matrix after Robot-Assisted Nipple-Sparing Mastectomy
Authors: Kim Shin Hyun , Park Seonghyuk , Lee Dong Won , Park Hyung Seok , Lew Dae Hyun , Song Seung Yong 
Published: October 2023

Background:
The authors performed a retrospective review to analyze operative outcomes of breast mound reconstruction after robot-assisted mastectomy.

Methods:
Patients who underwent nipple-sparing mastectomy (NSM) with a robotic device (Da Vinci Xi) and immediate prepectoral prosthetic reconstruction by lateral incision from June of 2018 to July of 2019 were enrolled. Patient characteristics, complications, and satisfaction rates as assessed by BREAST-Q were analyzed. The surgical technique was described in detail.

Results:
Thirty-nine cases, including 7 bilateral cases (total 46 breasts), underwent robot-assisted NSM followed by immediate prepectoral prosthetic implant reconstruction. The median patient age was 46.63 years (range, 21 to 63 years). The mean operation time for each prepectoral breast mound reconstruction using the direct-to-implant technique was 126.55 minutes. Robot-assisted reconstruction resulted in superior BREAST-Q scores compared with the conventional reconstruction method. Major infection occurred in 7 cases (15.2%), and complete nipple loss occurred in 3 cases (6.6%). Severe complications requiring breast implant removal occurred in 4 breasts (8.7%). Two cases were due to the coexistence of infection and skin necrosis; in 1 case, the skin flap became congested on postoperative day 3 and required additional surgery to change the expander. Other complications were resolved with conservative care or minor revision.

Conclusions:
This report is the first concerning robot-assisted NSM followed by prepectoral acellular dermal matrix–wrapped prosthetic reconstruction. This procedure was not inferior to other methods. Further prospective research to evaluate oncologic outcomes is warranted.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Septal Extension Graft in Cleft Rhinoplasty: Patients with Secondary Unilateral Cleft Lip Nasal Deformity
Authors: Saito Takafumi , Lonic Daniel , Lo Chi-Chin , Tu Junior Chun-Yu , Hattori Yoshitsugu , Lo Lun-Jou 
Published: October 2023

Background:
Tip refinement procedures are still controversial in secondary unilateral cleft rhinoplasty. The aim of this study was to assess whether the septal extension graft improved nasal and tip deformity and achieved a normal profile with clinical and three-dimensional morphometric analyses.

Methods:
A consecutive series of 194 skeletally mature patients with unilateral cleft were included and analyzed. All had undergone secondary open rhinoplasty, performed by a single surgeon, with the use of the septal extension graft between 2013 and 2021. Clinical data were collected, and three-dimensional morphometric measurements were performed. An age-, sex-, and ethnicity-matched normal group was included for comparisons.

Results:
The authors’ standard procedures included open approach combining reverse-U incision, septal extension graft, dorsal augmentation, lip revision, and vermilion augmentation. The postoperative outcome showed significantly increased numerical values (nasal bridge length, nasal height, nasal tip projection, nasal dorsum angle, columellar angle, columellar-lobule angle, nostril height ratio, nasal surface area, nasal volume) and decreased numerical values (alar width, tip/middle deviation, nasal tip angle, labial-columellar angle) compared with the preoperative morphology. The postoperative measurement showed significantly higher numerical values (nasal protrusion, tip/middle deviation, nasal dorsum angle) and lower numerical values (columellar-lobule angle, nostril height ratio, alar width ratio) compared with the control group.

Conclusions:
This study revealed that the authors’ secondary cleft rhinoplasty significantly improved the underprojected, up-rotated, deviated, and poorly defined tip and short nasal bridge deformities. The technique could result in the nose of the patients with cleft lip nasal deformity being closer to that of the normative profile.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Nature, Causes, and Clinical Impact of Errors in the Clinical Laboratory Testing Process Leading to Diagnostic Error: A Voluntary Incident Report Analysis
Authors: van Moll Christel , Egberts Toine , Wagner Cordula , Zwaan Laura , ten Berg Maarten 
Published: October 2023

Objectives
Diagnostic errors, that is, missed, delayed, or wrong diagnoses, are a common type of medical errors and preventable iatrogenic harm. Errors in the laboratory testing process can lead to diagnostic errors. This retrospective analysis of voluntary incident reports aimed to investigate the nature, causes, and clinical impact of errors, including diagnostic errors, in the clinical laboratory testing process.

Methods
We used a sample of 600 voluntary incident reports concerning diagnostic testing selected from all incident reports filed at the University Medical Center Utrecht in 2017–2018. From these incident reports, we included all reports concerning the clinical laboratory testing process. For these incidents, we determined the following: nature: in which phase of the testing process the error occurred; cause: human, technical, organizational; and clinical impact: the type and severity of the harm to the patient, including diagnostic error.

Results
Three hundred twenty-seven reports were included in the analysis. In 77.1%, the error occurred in the preanalytical phase, 13.5% in the analytical phase and 8.0% in the postanalytical phase (1.5% undetermined). Human factors were the most frequent cause (58.7%). Severe clinical impact occurred relatively more often in the analytical and postanalytical phase, 32% and 28%, respectively, compared with the preanalytical phase (40%). In 195 cases (60%), there was a potential diagnostic error as consequence, mainly a potential delay in the diagnostic process (50.5%).

Conclusions
Errors in the laboratory testing process often lead to potential diagnostic errors. Although prone to incomplete information on causes and clinical impact, voluntary incident reports are a valuable source for research on diagnostic error related to errors in the clinical laboratory testing process.
68Ga-FAPI and 18F-FDG PET/CT in Intravenous Leiomyomatosis
Authors: Li Zhuoyuan , Su Dan , Chen Yue 
Published: October 2023

Abstract
Intravenous (IV) leiomyomatosis is a rare IV disease. Our case presents 68Ga-FAPI and 18F-FDG PET/CT findings of IV leiomyomatosis in a 37-year-old woman. Intravenous leiomyomatosis shows only mild FDG but intense 68Ga-FAPI activity on PET/CT studies. In this case, 68Ga-FAPI was superior to 18F-FDG PET/CT in detecting IV leiomyomatosis.
Skin and Subcutaneous Tissue Metastases of the Pulmonary Carcinoid Tumor on 68Ga-DOTATATE PET/CT
Authors: Filizoglu Nuh , Ozguven Salih 
Published: October 2023

Abstract
Pulmonary carcinoid tumors are a very rare type of neuroendocrine tumor, accounting for only 1% to 2% of all primary lung cancers. Pulmonary carcinoids most commonly metastasize to the mediastinal lymph nodes, liver, and bones. Metastasis of pulmonary carcinoids to the skin and subcutaneous tissue is extremely rare and has been reported in only a small number of cases. We presented 68Ga-DOTATATE PET/CT findings of an exceptional case of a pulmonary carcinoid tumor with extensive skin, subcutaneous, thyroid, and intramuscular metastases.
Defining Standards for Hepatopancreatobiliary Cancer Surgery in Ontario, Canada: A Population-Based Cohort Study of Clinical Outcomes
Authors: Hirpara Dhruvin H , Irish Jonathan , Rashid Mohammed , Martin Tharsiya , Zhu Alice , Hunter Amber , Jayaraman Shiva , Wei Alice C , Coburn Natalie G , Wright Frances C 
Published: October 2023

BACKGROUND:
In 2006, Cancer Care Ontario created Surgical Oncology Standards for the delivery of hepatopancreatobiliary (HPB) surgery including hepatectomy and pancreaticoduodenectomy (PD). Our objective was to identify the impact of standardization on outcomes after HPB surgery in Ontario, Canada.

STUDY DESIGN:
This study was a population-level analysis of patients undergoing hepatectomy or PD (2003 to 2019). Logistic regression models were used to compare 30- and 90-day mortality and length of stay (LOS) before (2003 to 2006), during (2007 to 2011), and after (2012 to 2019) standardization. Interrupted time series models were used to co-analyze secular trends.

RESULTS:
A total of 7,904 hepatectomies and 5,238 PDs were performed. More than 80% of all cases were performed at a designated center (DC) before standardization. This increased to >98% in the poststandardization era. Median volumes at DCs increased from 55 to 67 hepatectomies/year and from 22 to 50 PDs/year over time. In addition, 30-day mortality after hepatectomy was 2.6% before standardization and 2.3% after standardization (p = 0.9); 30-day mortality after PD was 3.6% before standardization and 2.4% after standardization (p = 0.1). Multivariable analyses revealed a significant difference in 90-day mortality following PD poststandardization (4.3% vs 6.3%; adjusted odds ratio, 0.7; p = 0.03). Median LOS was shorter for hepatectomy (6 days vs 8 days) and PD (9 days vs 14 days; p < 0.0001) after standardization. Immediate and late effects on mortality and LOS were likely attributable to secular trends, which predated standardization.

CONCLUSIONS:
Standardization was associated with a higher volume of hepatectomy and PDs with further concentration of care at DCs. Pre-existing quality initiatives may have attenuated the effect of standardization on quality outcomes. Our data highlight the merits of a multifaceted provincial system for enabling consistent access to high quality HPB care throughout a region of 15 million people over a 16-year period.
GLUD1 dictates muscle stem cell differentiation by controlling mitochondrial glutamate levels
Authors: Soro-Arnáiz Inés , Cherkaoui Sarah , Fitzgerald Gillian , Zhang Jing , Gilardoni Paola , Ghosh Adhideb , Bar-Nur Ori , Masschelein Evi , Maechler Pierre , Zamboni Nicola , Poms Martin , Cremonesi Alessio , García Cañaveras Juan Carlos , De Bock Katrien , Morscher Raphael J. 
Published: October 2023

SummaryMuscle stem cells (MuSCs) enable muscle growth and regeneration after exercise or injury. Upon activation MuSCs metabolically rewire to meet the changing demands of proliferation. Here we describe that primary changes in metabolism itself can dictate MuSC fate decisions to control differentiation and fusion. We found that glutamine anaplerosis into the TCA cycle decreases during MuSC differentiation and coincides with decreased expression of the mitochondrial glutamate deaminase GLUD1. Genetic deletion ofGlud1in proliferating MuSCs resulted in precocious differentiation and imbalanced fusion combined with loss of self-renewalin vitroandin vivo. Mechanistically, deletingGlud1caused mitochondrial glutamate accumulation in proliferating MuSCs and inhibited the malate-aspartate shuttle (MAS). Restoring MAS activity by supplementation of alanine normalized differentiation. In conclusion, high GLUD1 activity in proliferating MuSCs prevents deleterious mitochondrial glutamate accumulation and inactivation of the MAS. It thereby acts as a compartment specific metabolic brake on MuSC differentiation.Graphical AbstractHighlightsGlutamine is the major TCA cycle substrate in MuSCs with decreasing contribution upon differentiation.Loss ofGlud1impairs MuSC self-renewal capacity and causes imbalanced fusionin vitroandin vivo.Glud1deletion leads to mitochondrial glutamate trapping and malate-aspartate shuttle (MAS) dysfunction.Restoration of MAS activity inGlud1deficient MuSCs reverses precocious differentiation and imbalanced fusion.
Analysis of the Diverse Antigenic Landscape of the Malaria Invasion Protein RH5 Identifies a Potent Vaccine-Induced Human Public Antibody Clonotype
Authors: Barrett Jordan R. , Pipini Dimitra , Wright Nathan D. , Cooper Andrew J. R. , Gorini Giacomo , Quinkert Doris , Lias Amelia M. , Davies Hannah , Rigby Cassandra , Aleshnick Maya , Williams Barnabas G. , Bradshaw William J. , Paterson Neil G. , Martinson Thomas , Kirtley Payton , Picard Luc , Wiggins Christine D. , Donnellan Francesca R. , King Lloyd D. W. , Wang Lawrence T. , Popplewell Jonathan F. , Silk Sarah E. , Swain Jed de Ruiter , Skinner Katherine , Kotraiah Vinayaka , Noe Amy R. , MacGill Randall S. , King C. Richter , Birkett Ashley J. , Soisson Lorraine A. , Minassian Angela M. , Lauffenburger Douglas A. , Miura Kazutoyo , Long Carole A. , Wilder Brandon K. , Koekemoer Lizbé , Tan Joshua , Nielsen Carolyn M. , McHugh Kirsty , Draper Simon J. 
Published: October 2023

SUMMARYThe highly conserved and essentialPlasmodium falciparumreticulocyte-binding protein homolog 5 (PfRH5) has emerged as the leading target for vaccines that seek to protect against the disease-causing blood-stage of malaria. However, the features of the human vaccine-induced antibody response that confer highly potent inhibition of malaria parasite invasion into red blood cells are not well defined. Here we characterize over 200 human IgG monoclonal antibodies induced by the most advanced PfRH5 vaccine. We define the antigenic landscape of this molecule, and establish epitope specificity, antibody association rate and intra-PfRH5 antibody interactions are key determinants of functional anti-parasitic potency. In addition, we identify a germline gene combination that results in an exceptionally potent class of antibody and demonstrate its prophylactic potential to protect againstP. falciparumparasite challengein vivo. This comprehensive dataset provides a framework to guide rational design of next-generation vaccines and prophylactic antibodies to protect against blood-stage malaria.