bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of the modified index of fragility in head and neck cancer surgery
Authors: Semsar-Kazerooni Koorosh , Richardson Keith , Forest Véronique-Isabelle , Mlynarek Alex , Hier Michael P. , Sadeghi Nader , Mascarella Marco. A. 
Published: January 2023

Background This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events. Method An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG. Results A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63–0.76) and 0.64 (95% CI: 0.63–0.66), respectively. The mIFG outperformed the modified Frailty index. Conclusion The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery. Graphical Abstract
Making use of climate information for sustainable preservation of cultural heritage: applications to the KERES project
Authors: Kotova Lola , Leissner Johanna , Winkler Matthias , Kilian Ralf , Bichlmair Stefan , Antretter Florian , Moßgraber Jürgen , Reuter Jürgen , Hellmund Tobias , Matheja Katharina , Rohde Michael , Mikolajewicz Uwe 
Published: January 2023

Abstract
According to the final report of the European Union OMC expert group on strengthening cultural heritage resilience for anthropogenic climate change, the impacts of climate change, particularly extreme weather events, on cultural heritage in Europe have become increasingly evident in recent years and are progressing at an unprecedented speed and scale. Archaeological sites, museum collections, and historical buildings and structures are affected, among others, by rising temperatures or by heavy storms and precipitation events. Deep scientific knowledge about future climate projections is required to develop appropriate preservation strategies and measures to protect and adapt cultural heritage. In this paper we present the first set of results of the KERES project. The project focuses on the impacts of future extreme climate events on the built heritage and historic gardens. An ensemble of climate simulations is used to analyze changes in both climatology and extreme events for several climate variables at two cultural heritage sites in Germany. In this study, a methodology was developed to guide climate scientists on how to better tailor climate information for the needs of stakeholders in the cultural heritage sector. It would help the stakeholders to integrate the results of climate projections into the prevention and emergency management, in particular for the risk assessment of extreme events. The effects of interpolation from a model grid to a location of cultural heritage site and advantages of an ensemble approach have been demonstrated in the study.
Optimal placement and sizing of photovoltaic power plants in power grid considering multi-objective optimization using evolutionary algorithms
Authors: Alizadeh Saeed , Mahdavian Mehdi , Ganji Ehsan 
Published: January 2023

AbstractDuring the past decade, the effect of renewable and non-renewable Distributed Generation (DG) sources of production has grown all over the world. Also, it has enhanced by national and international policies aimed at increasing the share of renewable energy sources and combining small high efficient heat and power plants to reduce greenhouse gas emissions, and global warming have been encouraged. Although the installation and operation of DGs have discussed for solving network problems in distribution networks, the fact is that in most cases, Distribution System Operator has no control or influence over DG placement and size. In this article, a meta-heuristic algorithm for management and decision-making for optimal selection is presented, and in choosing the optimal solution, the impact factor is suggested in the best case. Inappropriate DG placement may increase system losses, network investment, and operating costs. This paper determined the optimal capacity and placement of photovoltaic sources to reduce losses, improve the voltage profile, and increase the active power to reactive power lines in MATLAB software by the second version of the genetically engineered algorithm with unstable Non-dominated Sorting Genetic Algorithm (NSGA-II).
Structural brain correlates of childhood trauma with replication across two large, independent community-based samples
Authors: Madden Rebecca A. , Atkinson Kimberley , Shen Xueyi , Green Claire , Hillary Robert F. , Hawkins Emma , Såge Emma , Sandu Anca-Larisa , Waiter Gordon , McNeil Christopher , Harris Mathew , Campbell Archie , Porteous David , Macfarlane Jennifer A. , Murray Alison , Steele Douglas , Romaniuk Liana , Lawrie Stephen M. , McIntosh Andrew M. , Whalley Heather C. 
Published: January 2023

Abstract

Introduction
Childhood trauma and adversity are common across societies and have strong associations with physical and psychiatric morbidity throughout the life-course. One possible mechanism through which childhood trauma may predispose individuals to poor psychiatric outcomes is via associations with brain structure. This study aimed to elucidate the associations between childhood trauma and brain structure across two large, independent community cohorts.

Methods
The two samples comprised (i) a subsample of Generation Scotland (n=1,024); and (ii) individuals from UK Biobank (n=27,202). This comprised n=28,226 for mega-analysis. MRI scans were processed using Free Surfer, providing cortical, subcortical, and global brain metrics. Regression models were used to determine associations between childhood trauma measures and brain metrics and psychiatric phenotypes.

Results
Childhood trauma associated with lifetime depression across cohorts (OR 1.06 GS, 1.23 UKB), and related to early onset and recurrent course within both samples. There was evidence for associations between childhood trauma and structural brain metrics. This included reduced global brain volume, and reduced cortical surface area with highest effects in the frontal (β=−0.0385, SE=0.0048, p(FDR)=5.43x10−15) and parietal lobes (β=−0.0387, SE=0.005, p(FDR)=1.56x10−14). At a regional level the ventral diencephalon (VDc) displayed significant associations with childhood trauma measures across both cohorts and at mega-analysis (β=−0.0232, SE=0.0039, p(FDR)=2.91x10−8). There were also associations with reduced hippocampus, thalamus, and nucleus accumbens volumes.

Discussion
Associations between childhood trauma and reduced global and regional brain volumes were found, across two independent UK cohorts, and at mega-analysis. This provides robust evidence for a lasting effect of childhood adversity on brain structure.
Feasibility and Acceptability of a Preoperative Multimodal Mobile Health Assessment in Spine Surgery Candidates
Authors: Greenberg Jacob K. , Frumkin Madelyn R. , Javeed Saad , Zhang Justin K. , Dai Ruixuan , Molina Camilo A. , Pennicooke Brenton H. , Agarwal Nitin , Santiago Paul , Goodwin Matthew L. , Jain Deeptee , Pallotta Nicholas , Gupta Munish C. , Buchowski Jacob M. , Leuthardt Eric C. , Ghogawala Zoher , Kelly Michael P. , Hall Bruce L. , Piccirillo Jay F. , Lu Chenyang , Rodebaugh Thomas L. , Ray Wilson Z. 
Published: January 2023

BACKGROUND:
Rapid growth in smartphone use has expanded opportunities to use mobile health (mHealth) technology to collect real-time patient-reported and objective biometric data. These data may have important implication for personalized treatments of degenerative spine disease. However, no large-scale study has examined the feasibility and acceptability of these methods in spine surgery patients.

OBJECTIVE:
To evaluate the feasibility and acceptability of a multimodal preoperative mHealth assessment in patients with degenerative spine disease.

METHODS:
Adults undergoing elective spine surgery were provided with Fitbit trackers and sent preoperative ecological momentary assessments (EMAs) assessing pain, disability, mood, and catastrophizing 5 times daily for 3 weeks. Objective adherence rates and a subjective acceptability survey were used to evaluate feasibility of these methods.

RESULTS:
The 77 included participants completed an average of 82 EMAs each, with an average completion rate of 86%. Younger age and chronic pulmonary disease were significantly associated with lower EMA adherence. Seventy-two (93%) participants completed Fitbit monitoring and wore the Fitbits for an average of 247 hours each. On average, participants wore the Fitbits for at least 12 hours per day for 15 days. Only worse mood scores were independently associated with lower Fitbit adherence. Most participants endorsed positive experiences with the study protocol, including 91% who said they would be willing to complete EMAs to improve their preoperative surgical guidance.

CONCLUSION:
Spine fusion candidates successfully completed a preoperative multimodal mHealth assessment with high acceptability. The intensive longitudinal data collected may provide new insights that improve patient selection and treatment guidance.
Periprocedural Polypharmacy in Lumbar Fusions Performed Under Spinal Anesthesia Compared With General Anesthesia
Authors: Olmos Michelle , Hernandez Nicholas S. , Kanter Matthew , Liu Penny , Riesenburger Ron I. , Kryzanski James 
Published: January 2023

BACKGROUND:
Spinal anesthesia (SA) is a safe and effective alternative to general endotracheal anesthesia (GEA) for lumbar surgery. Foremost among the reasons to avoid GEA is the desire to minimize postoperative cognitive dysfunction (POCD). Although POCD is a complex and multifactorial entity, the risk of its development has been associated with anesthetic modality and perioperative polypharmacy, among others.

OBJECTIVE:
To determine whether SA reduced polypharmacy compared with GEA in patients undergoing transforaminal lumbar interbody fusion (TLIF).

METHODS:
Demographic and procedural data of 424 consecutive TLIF patients were extracted retrospectively. Patients undergoing single-level TLIF through GEA (n = 186) or SA (n = 238) were enrolled into our database. Perioperative medications, excluding antibiotic prophylaxis and local anesthetics, were classified into various categories.

RESULTS:
Patients in the SA cohort received a mean of 4.5 medications vs a mean of 10.5 medications in the GEA cohort (P < .0001). This reduction in perioperative medications remained significant after a multivariate analysis to control for confounders (P < .001 for all variables). The use of vasopressors was significantly reduced in the SA cohort (P < .001), which coincided with a significant reduction in hypotensive episodes (P < .001). Patients undergoing TLIF through GEA had 3.6 times greater odds of experiencing a hypotensive episode intraoperatively (odds ratio = 3.62, 95% CI [2.38-5.49]).

CONCLUSION:
Spinal anesthesia is associated with a significant decrease in perioperative medications and may confer superior intraoperative hemodynamic stability, which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs, although this requires further study.
Clival Chordomas in the Endoscopic Endonasal Era: Clinical Management, Outcomes, and Complications
Authors: Schnurman Zane , Benjamin Carolina Gesteira , Miceli Mary , Sen Chandranath 
Published: January 2023

BACKGROUND:
Surgical management of skull base chordomas has changed significantly in the past 2 decades, most notably with use of the endoscopic endonasal approach (EEA), although high quality outcome data using these modern approaches remain scarce.

OBJECTIVE:
To evaluate outcomes in a large series of patients treated by a single surgeon, using primarily the EEA.

METHODS:
Between 2006 and 2020, 68 patients with skull base chordoma underwent resection using mostly the EEA. Complications, outcomes, and potential contributing factors were evaluated using Kaplan-Meier survival analysis and univariable and multivariable Cox proportional hazards models.

RESULTS:
Overall 5-year survival was 76.3% (95% CI 61.5%-86.0%), and 5-year progression-free survival was 55.9% (95% CI 40.0%-69.0%). In multivariable analysis, radical resection was associated with significant reduction in risk of death (hazard ratio [HR] 0.04, 95% CI 0.005-0.33, P = .003) and disease progression (HR 0.05, 95% CI 0.01-0.18, P < .001). Better preoperative function status reduced risk of death (HR 0.42 per 10-point increase in Karnofsky Performance Scale, 95% CI 0.28-0.63, P < .001) and progression (HR 0.60 per 10-point increase in Karnofsky Performance Scale, 95% CI 0.45-0.78, P < .001). Localization at the clivus reduced risk of death (HR 0.02, 95% CI 0.002-0.15, P < .001) and progression (HR 0.24, 95% CI 0.09-0.68, P = .007) compared with tumors at the craniovertebral junction.

CONCLUSION:
In multivariable analysis, overall survival and progression-free survival of chordoma resection was most positively affected by radical resection, better preoperative functional status, and tumor location at the clivus rather than craniovertebral junction.
Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019
Authors: Hersh Andrew M. , Dedrickson Tara , Gong Jung Ho , Jimenez Adrian E. , Materi Joshua , Veeravagu Anand , Ratliff John K. , Azad Tej D. 
Published: January 2023

BACKGROUND:
An estimated 50 million Americans receive Medicare health care coverage. Prior studies have established a downward trend in Medicare reimbursement for commonly billed surgical procedures, but it is unclear whether these trends hold true across all neurosurgical procedures.

OBJECTIVE:
To assess trends in utilization, charges, and reimbursement by Medicare for neurosurgical procedures after passage of the Affordable Care Act in 2010.

METHODS:
We review yearly Physician/Supplier Procedure Summary datasets from the Centers for Medicare and Medicaid Services for all procedures billed by neurosurgeons to Medicare Part B between 2011 and 2019. Procedural coding was categorized into cranial, spine, vascular, peripheral nerve, and radiosurgery cases. Weighted averages for charges and reimbursements adjusted for inflation were calculated. The ratio of the weighted mean reimbursement to weighted mean charge was calculated as the reimbursement-to-charge ratio, representing the proportion of charges reimbursed by Medicare.

RESULTS:
Overall enrollment-adjusted utilization decreased by 12.1%. Utilization decreased by 24.0% in the inpatient setting but increased by 639% at ambulatory surgery centers and 80.2% in the outpatient setting. Inflation-adjusted, weighted mean charges decreased by 4.0% while reimbursement decreased by 4.6%. Procedure groups that saw increases in reimbursement included cervical spine surgery, cranial functional and epilepsy procedures, cranial pain procedures, and endovascular procedures. Ambulatory surgery centers saw the greatest increase in charges and reimbursements.

CONCLUSION:
Although overall reimbursement declined across the study period, substantial differences emerged across procedural categories. We further find a notable shift in utilization and reimbursement for neurosurgical procedures done in non-inpatient care settings.
Postoperative Gravity Line-Hip Axis Offset as a Substantial Risk Factor for Mechanical Failure After Adult Spinal Deformity Correction Surgery
Authors: An Sungjae , Hyun Seung-Jae , Lee Jae-Koo , Yang Seung Heon , Kim Ki-Jeong 
Published: January 2023

BACKGROUND:
Mechanical failure (MF) is a serious burden for patients with adult spinal deformity (ASD) who have undergone deformity correction surgery. Surgeons have sought to understand the mechanism and prevent this problematic complication, but this goal remains to be achieved. The gravity line (GL) of the whole body is a noteworthy parameter that represents global sagittal balance, for which normative values for the axial skeleton have been studied.

OBJECTIVE:
To assess postoperative GL-hip axis (GL-HA) offset as a critical risk factor for MF after ASD correction surgery.

METHODS:
Consecutive patients who underwent initial surgery for ASD at a single academic center were retrospectively included. Demographics, operative details, preoperative and postoperative spinopelvic parameters, global sagittal balance parameters, and Scoliosis Research Society-22 score were evaluated. These variables were analyzed for differences and correlations with MF.

RESULTS:
Thirty-five patients without MF and 30 patients with MF were identified in the study. Two groups showed no significant differences in baseline demographics, operative characteristics, preoperative global sagittal balance parameters, or preoperative and postoperative Scoliosis Research Society-22 scores. Significant differences and correlations with MF were observed for postoperative GL-HA offset using a cutoff value of 49.3 mm from logistic regression analysis, with an odds ratio of 11.0 (95% confidence interval: 3.45-35.01, P < .0001).

CONCLUSION:
Postoperative GL-HA offset is a substantial risk factor for MF after ASD surgery. Surgical correction of ASD with a GL-HA offset greater than 5 cm is significantly related to MF. The GL should be located near the HA after ASD surgery.
Pipeline Embolization Device for Small and Medium Vertebral Artery Aneurysms: A Multicenter Study
Authors: Zhang Hongyun , Zhang Hongqi , Liu Jianmin , Song Donglei , Zhao Yuanli , Guan Sheng , Maimaitili Aisha , Wang Yunyan , Feng Wenfeng , Wang Yang , Wan Jieqing , Mao Guohua , Shi Huaizhang , Luo Bin , Shao Qiuji , Chang Kaitao , Zhang Qianqian , He Yingkun , Zhang Peng , Yang Xinjian , Li Li , Li Tian xiao 
Published: January 2023

BACKGROUND:
Pipeline embolization devices (PEDs) have been increasingly used for the treatment of posterior circulation aneurysms.

OBJECTIVE:
To investigate the safety and efficacy of PED in the treatment of small to medium unruptured vertebral artery intracranial aneurysms (VAIAs).

METHODS:
Data from 76 patients with 78 unruptured small and medium (≤12 mm) VAIAs were analyzed. Data for this study come from the PLUS study, which was conducted at 14 centers in China from 2014 to 2019. Univariate analyses were performed to evaluate predictors of the occlusion and complication.

RESULTS:
Seventy-eight aneurysms in 76 patients were treated with PED. The mean aneurysm size was 8.28 ± 2.13 mm, and all PEDs were successfully placed. The median follow-up was 7 months and available for 67 (85.9%) aneurysms. Complete occlusion was seen in 60 (89.6%) aneurysms, which 86.6% met the primary efficacy outcome. All patients received clinical follow-up, the combined major morbidity and mortality was 2.6%, and 98.7% of patients had a good prognosis. Ischemic stroke occurred in 10.5% of patients, and adjuvant coil and successful after adjustment were predictors of ischemic stroke in the early postoperative and follow-up, respectively. There was no significant difference in the occlusion rate of aneurysm involving posterior inferior cerebellar artery (P = .78). In cases where posterior inferior cerebellar artery was covered by PED, there was no significant difference in ischemic stroke.

CONCLUSION:
In the treatment of unruptured ≤12 mm VAIAs, PED has a high surgical success rate, a high degree of occlusion, and low morbidity and mortality. PED may be a promising endovascular technique.
Reinnervation of Paralyzed Limb Muscle by Nerve-Muscle-Endplate Grafting Technique
Authors: Sobotka Stanislaw , Mu Liancai , Chen Jingming , Li Jing , Nyirenda Themba 
Published: January 2023

BACKGROUND:
We have developed a novel reinnervation technique called nerve-muscle-endplate grafting in the native motor zone (NMEG-NMZ). However, it remains unknown whether the NMEG-NMZ is effective for limb reinnervation.

OBJECTIVE:
To evaluate the efficacy of the NMEG-NMZ in limb muscle reinnervation.

METHODS:
Forty-five adult rats were divided into 3 groups: NMEG, end-to-end anastomosis (EEA, technique control), and denervation control (DC). The left tibialis anterior muscle was denervated by resecting its nerve. For NMEG-NMZ, the denervated tibialis anterior was reinnervated by transferring a NMEG pedicle from the lateral gastrocnemius muscle. Three months after surgery, static toe spread analysis was performed for all rats and muscle force was measured for the rats treated with NMEG and EEA. Muscle weight, myofiber morphology, regenerated axons, and reinnervated motor endplates in the treated muscles were also quantified and compared with those in the DC group.

RESULTS:
NMEG-NMZ technique resulted in better muscle force recovery (79% of the control) compared with EEA (51% of the control, P = .048). Toe spread analysis in NMEG-NMZ reinnervated muscles showed static sciatic index = −16.8, whereas −41.4 in EEA, P < .0001). The average weight of the NMEG-NMZ reinnervated muscles (86%) was greater than those of the EEA treated (71%) and DC (26%) muscles (all P < .0001). The mean count of the regenerated axons in the muscles with NMEG-NMZ was 76% of the control, which was larger than that in the muscles with EEA (46%), P < .0001.

CONCLUSION:
NMEG-NMZ technique has unique advantages and is superior to EEA for muscle reinnervation and functional recovery.