bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Good Are Surgeons at Achieving Their Preoperative Goal Sagittal Alignment Following Adult Deformity Surgery?
Authors: Smith Justin S. , Elias Elias , Sursal Tolga , Line Breton , Lafage Virginie , Lafage Renaud , Klineberg Eric , Kim Han Jo , Passias Peter , Nasser Zeina , Gum Jeffrey L. , Eastlack Robert , Daniels Alan , Mundis Gregory , Hostin Richard , Protopsaltis Themistocles S. , Soroceanu Alex , Hamilton David Kojo , Kelly Michael P. , Lewis Stephen J. , Gupta Munish , Schwab Frank J , Burton Douglas , Ames Christopher P. , Lenke Lawrence G. , Shaffrey Christopher I. , Bess Shay ,   on behalf of International Spine Study Group
Published: February 2023

Study Design Multicenter, prospective cohort Objectives Malalignment following adult spine deformity (ASD) surgery can impact outcomes and increase mechanical complications. We assess whether preoperative goals for sagittal alignment following ASD surgery are achieved. Methods ASD patients were prospectively enrolled based on 3 criteria: deformity severity (PI-LL ≥25°, TPA ≥30°, SVA ≥15 cm, TCobb≥70° or TLCobb≥50°), procedure complexity (≥12 levels fused, 3-CO or ACR) and/or age (>65 and ≥7 levels fused). The surgeon documented sagittal alignment goals prior to surgery. Goals were compared with achieved alignment on first follow-up standing radiographs. Results The 266 enrolled patients had a mean age of 61.0 years (SD = 14.6) and 68% were women. Mean instrumented levels was 13.6 (SD = 3.8), and 23.2% had a 3-CO. Mean (SD) offsets (achieved-goal) were: SVA = −8.5 mm (45.6 mm), PI-LL = −4.6° (14.6°), TK = 7.2° (14.7°), reflecting tendencies to undercorrect SVA and PI-LL and increase TK. Goals were achieved for SVA, PI-LL, and TK in 74.4%, 71.4%, and 68.8% of patients, respectively, and was achieved for all 3 parameters in 37.2% of patients. Three factors were independently associated with achievement of all 3 alignment goals: use of PACs/equivalent for surgical planning ( P < .001), lower baseline GCA ( P = .009), and surgery not including a 3-CO ( P = .037). Conclusions Surgeons failed to achieve goal alignment of each sagittal parameter in ∼25-30% of ASD patients. Goal alignment for all 3 parameters was only achieved in 37.2% of patients. Those at greatest risk were patients with more severe deformity. Advancements are needed to enable more consistent translation of preoperative alignment goals to the operating room.
Acceptability of Australian prehospital care quality indicators: An explanatory sequential mixed methods study
Authors: Pap Robin , Stephenson Matthew , Simpson Paul , Lockwood Craig 
Published: February 2023

Background Systematically developed quality indicators (QIs) facilitate the measurement and monitoring of quality of care and ultimately meaningful quality improvement. The aim of this study was to evaluate the acceptability of a predetermined suite of 84 scientifically valid prehospital care QIs from the provider perspective. Methods An explanatory sequential mixed methods study design was used. Quantitative data were obtained from 36 participants of an online survey in which they rated the acceptability of the QIs using a five-point numerical rating scale. Qualitative data were gathered by conducting semi-structured interviews with a purposive sample of nine survey participants. The successional collection of quantitative and qualitative data facilitated integrated interpretations and conclusions about the acceptability of the QIs. Results Generally, the acceptability of all QIs in the suite was rated highly. Data suggested a positive association between acceptability and other key characteristics of QIs. QIs that were seen as clear, supported by scientific evidence, practical and meaningful tended to be more acceptable than those which were not. The benefits of outcome type QIs were recognised, but participants raised concerns about their sensitivity in the measurement of prehospital quality of care. To be acceptable, QIs which included time intervals needed to be specific about time-critical interventions. Further, the high acceptability of the QIs was explained by a connection to participants’ professional values and qualities. Assessing the QIs’ acceptability from a healthcare provider perspective meant that QIs on patient satisfaction frequently received lower ratings. Conclusion The findings of this study provide evidence of the acceptability of prehospital care providers of a proposed suite of QIs. Future research should evaluate the feasibility and reliability of the QIs. There is also a need to investigate how acceptable the proposed QIs are to patients and communities.
Risk factors for forced expiratory volume in 1 s decline in European patients with cystic fibrosis: data from the European Cystic Fibrosis Society Patient Registry
Authors: Hatziagorou Elpis , Fieuws Steffen , Orenti Annalisa , Naehrlich Lutz , Krivec Uros , Mei-Zahav Meir , Jung Andreas , De Boeck Kris ,   on behalf of the ECFSPR Collaborative Group,   ECFSPR Collaborative Group, Andreas Pfleger , Daneau Géraldine , Elise Lammertijn , Guergana Petrova , Drevinek Pavel , Macek Milan , Vebert Olesen Hanne , Burgel Pierre-Régis , Lemonnier-Videau Lydie , Párniczky Andrea , Fletcher Godfrey , Padoan Rita , Zolin Anna , Aleksejeva Elina , Malakauskas Kestutis , Gulmans Vincent , Fustik Stojka , Danevskai Ivana Arnaudova , Turcu Oxana , Pereira Luísa , Pop Liviu , Kondratyeva Elena , Rodić Milan , Kayserová Hana , Pastor-Vivero M. Dolores , de Monestrol Isabelle , Lindblad Anders , Dogru Deniz , Makukh Halyna , Carr SiobhÃ¡n B. , Cosgriff Rebecca 
Published: February 2023

AimTo examine the trajectory of forced expiratory volume in 1 s (FEV1) using data from the European Cystic Fibrosis Society patient registry (ECFPR) collected from 2008 to 2016,i.e.the era before highly effective modulator therapy (HEMT). We evaluated risk factors for FEV1decline.MethodsThe study population included patients with a confirmed diagnosis of cystic fibrosis recorded in the ECFPR (2008–2016). The evolution of FEV1% predicted (%FEV1) with age, and the yearly change in %FEV1were evaluated. Risk factors considered were cystic fibrosis transmembrane conductance regulator (­CFTR) mutation class, gender, age at diagnosis, neonatal screening, meconium ileus, sweat chloride concentration at diagnosis and country's income level.ResultsWe used 199 604 FEV1recordings from 38 734 patients. The fastest decline was seen during puberty and in patients diagnosed before the age of 10 years. Males had a higher %FEV1, but a higher yearly %FEV1loss between the ages of 15 and 25 years. We showed stabilisation and even improvement in %FEV1over age in adults with a class IIICFTRmutation, but a steady decline in patients homozygous for F508del or with both mutations of classes I/II. A faster decline in %FEV1was found in patients from low-income countries compared to a similar %FEV1evolution in patients from middle- and high-income countries.ConclusionsThese longitudinal FEV1data reflect the reality of cystic fibrosis across Europe in the era pre-HEMT, and can serve as baseline for comparison with the post-HEMT era. The similar evolution in middle- and high-income countries underlines opportunities for low-income countries.
Waterhouse-Friderichsen syndrome following a dog bite in an asplenic patient: case report and review of the literature
Authors: Berlot Giorgio , Tomasini Ariella , Zanchi Silvia , Moro Edoardo , Pinamonti Maurizio , Mohamed Sara , de Bellis Eleonora 
Published: February 2023

AbstractThe Waterhouse-Friderichsen syndrome represents a critical condition characterized by a septic shock associated with a disseminated intravascular coagulation causing the plugging of the microvascular network virtually all organs and systems, including the skin, the kidneys, the liver, and adrenal glands; the mortality rate is elevated, and survivors often must undergo multiple limb amputations. Here, we describe the uncommon case of an asplenic patient who developed this syndrome after a superficial wound caused by a dog bite causing an initial infection due to Capnocytophaga canimorsus that is part of the normal oral microbiome of pets. The clinical and pathological findings and the current and future therapeutic options are reviewed and discussed.
Epigenetic markers in the embryonal germ cell development and spermatogenesis
Authors: Odroniec Amadeusz , Olszewska Marta , Kurpisz Maciej 
Published: February 2023

AbstractSpermatogenesis is the process of generation of male reproductive cells from spermatogonial stem cells in the seminiferous epithelium of the testis. During spermatogenesis, key spermatogenic events such as stem cell self-renewal and commitment to meiosis, meiotic recombination, meiotic sex chromosome inactivation, followed by cellular and chromatin remodeling of elongating spermatids occur, leading to sperm cell production. All the mentioned events are at least partially controlled by the epigenetic modifications of DNA and histones. Additionally, during embryonal development in primordial germ cells, global epigenetic reprogramming of DNA occurs. In this review, we summarized the most important epigenetic modifications in the particular stages of germ cell development, in DNA and histone proteins, starting from primordial germ cells, during embryonal development, and ending with histone-to-protamine transition during spermiogenesis.
Patient characteristics and testing over COVID-19 waves 1 and 2 from the first German COVID-19 testing unit in Munich, Germany
Authors: Srinivasan Harinee , Hohl Hannah Tuulikki , Heumann Christian , Froeschl Guenter 
Published: February 2023

Abstract
Background
In Munich, the first German case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected on 27 January 2020 at the Division of Infectious Diseases and Tropical Medicine of the University Hospital LMU Munich (DIDTM), and consecutively the Covid Testing Unit was established. Germany advocated several public health measures to control the outbreak. This study investigates the effects of measures on health service utilization in the public, which in turn can alter case numbers and test positivity rates.

Method
Our retrospective observational study was conducted to determine the effects of public health measures on the utilization of a testing facility and positivity rates from the first operational COVID-19 testing facility in Munich for waves 1 and 2 over a period of 14 months. This was accomplished by comparing trends in client characteristics including age, gender, symptoms, and socio-demographic aspects over time to non-pharmaceutical measures in Germany. To depict trend changes in testing numbers over time, we developed a negative binomial model with multiple breakpoints.

Results
In total 9861 tests were conducted on 6989 clients. The clients were mostly young (median age: 34), female (60.58%), and asymptomatic (67.89%). Among those who tested positive for SARS-CoV-2, 67.72% were symptomatic while the percentage was 29.06% among those who tested negative. There are other risk factors, but a SARS-CoV-2-positive colleague at work is the most prominent factor. Trend changes in the clients’ testing numbers could be attributed to the implementation of various public health measures, testing strategies, and attitudes of individuals toward the pandemic. However, test positivity rates did not change substantially during the second wave of the pandemic.

Conclusion
We could show that implementation or changes in public health measures have a strong effect on the utilization of testing facilities by the general public, which independently of the true epidemiological background situation can result in changing test numbers.
Individualized estimates of intensity-modulated radiotherapy plans after breast conservation surgery for left-sided breast cancer
Authors: Wang Yong , Ni Lingqin , Ying Shenpeng , Xu Yuanyuan , Chen Weijun , Liu Yanmei 
Published: February 2023

Abstract
Objectives
The purpose of this study was to explore the influence of individual patient factors, such as volume of the planning target volume (PTV) (VPTV), cardiothoracic ratio (CTR), central lung distance (CLD), and maximal heart distance (MHD), on the design of treatment plans in terms of target dose coverage, integral dose, and dose to organs at risk (OAR) in early breast cancer.

Methods
Ninety-six patients were selected for this study. Radiation doses of 50 Gy and a simultaneous dose of 60 Gy in 25 fractions were administered to the whole breast and tumor bed, respectively. The intensity modulation plan (IMRT) of each patient uses both physical parameters and an equivalent uniform dose (EUD) to optimize the target function. Univariate and multivariate linear regression were used to analyze the relationship between predictive impact factors and OAR percent dose volume, conformity index (CI), and homogeneity index (HI).

Results
The average CI and HI values of the left breast cancer plan were 0.595 ± 0.071 (0.3–0.72) and 1.095 ± 0.023 (1.06–1.18), respectively. The CTR (B = 0.21, P = 0.045), VPTV (B = 0.63, P = 0.000), volume of the lung (Vlung) (B =  − 0.29, P = 0.005), and MHD (B = 0.22, P = 0.041) were identified as factors influencing the CI index of the left breast cancer intensity modulation plan. VPTV (B = 1.087, P = 0.022) was identified as the influencing factor of the HI index of the left breast cancer intensity modulation plan. volume of the heart (Vheart) (B =  − 0.43, P = 0.001) and CLD (B = 0.28, P = 0.008) were influencing factors of the volume of lung (Vlung20) of the lung. The prediction formulas for left-sided breast cancer are noted as follows: CI = 0.459 + 0.19CTR-0.16CLD, Vlung10 = 35.5–0.02Vheart; and Vlung20 = 21.48 + 2.8CLD-0.018Vheart.

Conclusions
CTR, CLD, and MHD can predict the rationality of the parameters of the left breast cancer IMRT. The calculation formula generated based on this information can help the physicist choose the optimal radiation field setting method and improve the quality of the treatment plan.
A rare lumpy inflammatory lesion of the orbit: a unique case report
Authors: Liu Rui , Li Jing , Ren Tingting , Zhang Hong , Ma Jianmin 
Published: February 2023

Abstract
Background
Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory lesion, especially in orbit. EAF is believed to be related to IgG4-related disease (IgG4-RD), but the clinical manifestations of systemic involvement are relatively rare and easy to be confused with tumors or other inflammatory diseases. Histopathological examination is the most important way of its diagnosis and differentiation.

Case presentation
We presented a 55-year-old female patient presented with recurrent swelling of the right lower eyelid for more than 2 months. The pathological diagnosis was EAF. Positive immunostaining for IgG, CD34, κ, and λ, while negative immunostaining for IgG4.

Conclusions
Complete surgical resection is the preferred treatment, histopathological examination is the main diagnostic standard.
Can preoperative magnetic resonance imaging be used for sagittal kyphotic flexibility assessment in patients with kyphosis secondary to symptomatic old osteoporotic thoracolumbar fracture?
Authors: Wang Kangkang , Zhang Feng , Zhai Yunlei , Zhang Wei , Yin Wen , Sun Lele , Cui Xilong , Yu Haiyang 
Published: February 2023

Abstract
Objective
This study aimed to investigate whether preoperative magnetic resonance imaging (MRI) can be used for sagittal kyphotic (SK) flexibility assessment in patients with kyphosis secondary to symptomatic old osteoporotic thoracolumbar fracture (so-OTLF).

Methods
The authors evaluated the radiographic data of patients with kyphosis secondary to so-OTLF. All patients underwent posterior corrective fusion surgery in the hospital. Spinal sagittal parameters were measured on standing radiographs preoperatively. The regional kyphosis angle (RKA) was also measured on preoperative supine MRI and intraoperative prone radiographs on the surgical frame. The SK flexibility in patients with kyphosis secondary to so-OTLF was defined as the difference from the RKA measured on the standing radiographs to that measured on the intraoperative prone radiographs or preoperative supine MRI. The difference and the correlation between the SK flexibility measured by these two methods were compared and analyzed.

Results
Thirty-seven patients were included. The RKA measured on standing radiographs, supine MRI, and intraoperative prone radiographs were 48.0°, 34.4°, and 32.0°, respectively. Compared with the RKA measured in standing position, the RKA measured on supine MRI decreased by 13.6° (95% confidence interval 11.4°–15.8°), whereas that measured on intraoperative prone radiographs decreased by 16.1° (95% confidence interval 13.7°–18.5°). A linear correlation existed between the SK flexibility measured on supine MRI and that measured on intraoperative prone radiographs, with a mean difference of 2.4° (R2 = 0.912, p < 0.001).

Conclusion
The degree of regional kyphosis deformity was reduced by self-reduction of the intraoperative surgical frame. With a predictive value similar to an intraoperative prone radiograph, preoperative supine MRI can be used for SK flexibility assessment in patients with kyphosis secondary to so-OTLF. The ability to predict the intraoperative degree of regional kyphosis deformity with positioning before an operation may help with surgical planning and patient counseling regarding expectations and risks of surgery.
An unusual association of type II Mayer-Rokitansky-Kuster-Hauser syndrome, turner mosaic syndrome and tubo-ovarian inguinal hernia– case report and review of literature
Authors: Mahey Reeta , Rana Anubhuti , Cheluvaraju Rohitha , Vyas Surabhi , Raj Ritu , Bhatla Neerja 
Published: February 2023

Abstract
Background
Herniation of ovaries and Mullerian structures into inguinal canal is usually reported in infants and is rare among adults. We are presenting a rare case of Mullerian agenesis and Turner mosaic syndrome with tubo-ovarian inguinal hernia.

Case presentation
A 17-year-old girl presented with complaints of primary amenorrhea, phenotypical features of Turner syndrome with left inguinal hernia and severe hypertension. Baseline hormonal analysis was normal. Karyotype revealed Turner mosaic with 46XX (85%); 45XO (15%). MRI showed Mullerian agenesis with normally located right ovary in pelvis and left ovary prolapsed through deep inguinal ring into the canal of Nuck. Anti-hypertensives were started and patient optimized for surgery. Laparoscopic hernia repair and repositioning of left ovary into the pelvis was done. Patient had uneventful post-operative course and was discharged in stable condition on anti-hypertensive medication. Future reproductive issues and need of passive vaginal dilatation or vaginoplasty before marriage were explained to the patient and family.

Conclusion
This is the first ever reported case with unusual association of atypical MRKH, Turner mosaic syndrome and tubo-ovarian hernia into the inguinal canal. The case emphasizes the need and importance of complete work up of these atypical cases as patients may have more than one cause of primary amenorrhea and complete evaluation is must before any medical or surgical intervention.
Characterizing modifications to a comparative effectiveness research study: the OPTIMIZE trial—using the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME)
Authors: Fritz Julie M. , Greene Tom , Brennan Gerard P. , Minick Kate , Lane Elizabeth , Wegener Stephen T. , Skolasky Richard L. 
Published: February 2023

Abstract
Background
The OPTIMIZE trial is a multi-site, comparative effectiveness research (CER) study that uses a Sequential Multiple Assessment Randomized Trial (SMART) designed to examine the effectiveness of complex health interventions (cognitive behavioral therapy, physical therapy, and mindfulness) for adults with chronic low back pain. Modifications are anticipated when implementing complex interventions in CER. Disruptions due to COVID have created unanticipated challenges also requiring modifications. Recent methodologic standards for CER studies emphasize that fully characterizing modifications made is necessary to interpret and implement trial results. The purpose of this paper is to outline the modifications made to the OPTIMIZE trial using the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions (FRAME) to characterize modifications to the OPTIMIZE trial in response to the COVID pandemic and other challenges encountered.

Methods
The FRAME outlines a strategy to identify and report modifications to evidence-based interventions or implementation strategies, whether planned or unplanned. We use the FRAME to characterize the process used to modify the aspects of the OPTIMIZE trial. Modifications were made to improve lower-than-anticipated rates of treatment initiation and COVID-related restrictions. Contextual modifications were made to permit telehealth delivery of treatments originally designed for in-person delivery. Training modifications were made with study personnel to provide more detailed information to potential participants, use motivational interviewing communication techniques to clarify potential participants’ motivation and possible barriers to initiating treatment, and provide greater assistance with scheduling of assigned treatments.

Results
Modifications were developed with input from the trial’s patient and stakeholder advisory panels. The goals of the modifications were to improve trial feasibility without compromising the interventions’ core functions. Modifications were approved by the study funder and the trial steering committee.

Conclusions
Full and transparent reporting of modifications to clinical trials, whether planned or unplanned, is critical for interpreting the trial’s eventual results and considering future implementation efforts.

Trial registration
ClinicalTrials.gov NCT03859713. Registered on March 1, 2019