bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between inflammatory biomarkers, vitamin D levels, and depressive symptoms in late pregnancy and during the postpartum period: a prospective, observational study
Authors: Nassr Ola Ali , Mohammed Mohammed Mahmood , Showman Hind Abdulkhaliq 
Published: October 2022

Abstract
Background
Perinatal depression impacts maternal and fetal health, and exhibits a high rate of continuity postpartum. Not only does it impair the maternal quality of life, it also increases the risk of adverse birth and developmental problems in offspring. Vitamin D deficiency and excessive inflammation have been associated with perinatal depression. There is a scarcity of evidence regarding the biological causes of maternal depression in Iraq, therefore, the present study aims to assess perinatal depressive symptoms associations with inflammatory markers and vitamin D levels, and to investigate the interaction between vitamin D and the inflammatory markers. A prospective, observational study design was utilized to recruit healthy pregnant women from private obstetrics clinic in Baghdad, Iraq, from April to September 2021. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms during the third trimester and at 6 months postpartum. Serum levels of interleukin (IL)-6, C-reactive protein (CRP), and 25-hydroxy vitamin D (25-OH-D) were quantified, using a fully automated chemiluminescence immunoassay analyzer.

Results
Eighty patients were eligible for inclusion. The antenatal EPDS scores demonstrated a significant association with square root IL-6 (B = – 0.025, p = 0.040) and no association with CRP or vitamin D levels. The severity of postpartum depressive symptoms tended towards a positive association, with larger increases of CRP concentration (p = 0.065). In contrast, the association between marital relationship quality and CRP was statistically significant (p = 0.001). There was a statistically significant association between CRP and vitamin D concentration (p = 0.041). Antepartum EPDS significantly predicted the postpartum EPDS score (p = 0.000, B = 0.180, R2 for the model = 0.976, CI (0.17–0.19)).

Conclusions
The study findings show a significant association between third trimester depressive symptoms and IL-6 concentration. CRP and vitamin D levels do not correlate with perinatal depressive symptoms and a poor marital relationship significantly elevates the CRP level. In addition, vitamin D level was associated with CRP level and antepartum depressive symptoms predict postpartum EPDS score. Future studies involving a larger population and including women with pregnancy complications would provide a further insight into the role of inflammation and vitamin D deficiency in the etiology of perinatal depression.
Cautious Artificial Intelligence Improves Outcomes and Trust by Flagging Outlier Cases
Authors: Kanse Abhiraj S. , Kurian Nikhil C. , Aswani Himanshu P. , Khan Zakia , Gann Peter H. , Rane Swapnil , Sethi Amit 
Published: October 2022

PURPOSE Artificial intelligence (AI) models for medical image diagnosis are often trained and validated on curated data. However, in a clinical setting, images that are outliers with respect to the training data, such as those representing rare disease conditions or acquired using a slightly different setup, can lead to wrong decisions. It is not practical to expect clinicians to be trained to discount results for such outlier images. Toward clinical deployment, we have designed a method to train cautious AI that can automatically flag outlier cases. MATERIALS AND METHODS Our method—ClassClust—forms tight clusters of training images using supervised contrastive learning, which helps it identify outliers during testing. We compared ClassClust's ability to detect outliers with three competing methods on four publicly available data sets covering pathology, dermatoscopy, and radiology. We held out certain diseases, artifacts, and types of images from training data and examined the ability of various models to detect these as outliers during testing. We compared the decision accuracy of the models on held-out nonoutlier images also. We visualized the regions of the images that the models used for their decisions. RESULTS Area under receiver operating characteristic curve for outlier detection was consistently higher using ClassClust compared with the previous methods. Average accuracy on held-out nonoutlier images was also higher, and the visualizations of image regions were more informative using ClassClust. CONCLUSION The ability to flag outlier test cases need not be at odds with the ability to accurately classify nonoutliers in AI models. Although the latter capability has received research and regulatory attention, AI models for clinical deployment should possess the former as well.
A Pragmatic Cluster-Randomized Trial of a Standing Order Entry Intervention for Colony-Stimulating Factor Use Among Patients at Intermediate Risk for Febrile Neutropenia
Authors: Hershman Dawn L. , Bansal Aasthaa , Sullivan Sean D. , Barlow William E. , Arnold Kathryn B. , Watabayashi Kate , Bell-Brown Ari , Le-Lindqwister Nguyet A. , Dul Carrie L. , Brown-Glaberman Ursa A. , Behrens Robert J. , Vogel Victor , Alluri Nitya , Ramsey Scott D. 
Published: October 2022

PURPOSE Primary prophylactic colony-stimulating factors (PP-CSFs) are prescribed to reduce febrile neutropenia (FN) but their benefit for intermediate FN risk regimens is uncertain. Within a pragmatic, randomized trial of a standing order entry (SOE) PP-CSF intervention, we conducted a substudy to evaluate the effectiveness of SOE for patients receiving intermediate-risk regimens. METHODS TrACER was a cluster randomized trial where practices were randomized to usual care or a guideline-based SOE intervention. In the primary study, sites were randomized 3:1 to SOE of automated PP-CSF orders for high FN risk regimens and alerts against PP-CSF use for low-risk regimens versus usual care. A secondary 1:1 randomization assigned 24 intervention sites to either SOE to prescribe or an alert to not prescribe PP-CSF for intermediate-risk regimens. Clinicians were allowed to over-ride the SOE. Patients with breast, colorectal, or non–small-cell lung cancer were enrolled. Mixed-effect logistic regression models were used to test differences between randomized sites. RESULTS Between January 2016 and April 2020, 846 eligible patients receiving intermediate-risk regimens were registered to either SOE to prescribe (12 sites: n = 542) or an alert to not prescribe PP-CSF (12 sites: n = 304). Rates of PP-CSF use were higher among sites randomized to SOE (37.1% v 9.9%, odds ratio, 5.91; 95% CI, 1.77 to 19.70; P = .0038). Rates of FN were low and identical between arms (3.7% v 3.7%). CONCLUSION Although implementation of a SOE intervention for PP-CSF significantly increased PP-CSF use among patients receiving first-line intermediate-risk regimens, FN rates were low and did not differ between arms. Although this guideline-informed SOE influenced prescribing, the results suggest that neither SOE nor PP-CSF provides sufficient benefit to justify their use for all patients receiving first-line intermediate-risk regimens.
Does a Screening Trial for Spinal Cord Stimulation in Patients With Chronic Pain of Neuropathic Origin Have Clinical Utility (TRIAL-STIM)? 36-Month Results From a Randomized Controlled Trial
Authors: Eldabe Sam , Nevitt Sarah , Griffiths Sara , Gulve Ashish , Thomson Simon , Baranidharan Ganesan , Houten Rachel , Brookes Morag , Kansal Anu , Earle Jenny , Bell Jill , Taylor Rod S. , Duarte Rui V. 
Published: October 2022

BACKGROUND:
Screening trials before full implantation of a spinal cord stimulation device are recommended by clinical guidelines and regulators, although there is limited evidence for their use. The TRIAL-STIM study showed that a screening trial strategy does not provide superior patient pain outcome at 6-month follow-up compared with not doing a screening trial and that it was not cost-effective.

OBJECTIVE:
To report the long-term follow-up results of the TRIAL-STIM study.

METHODS:
The primary outcome of this pragmatic randomized controlled trial was pain intensity as measured on a numerical rating scale (NRS) and secondary outcomes were the proportion of patients achieving at least 50% and 30% pain relief at 6 months, health-related quality of life, and complication rates.

RESULTS:
Thirty patients allocated to the “Trial Group” (TG) and 36 patients allocated to the “No Trial Group” (NTG) completed outcome assessment at 36-month follow-up. Although there was a reduction in NRS pain and improvements in utility scores from baseline to 36 months in both groups, there was no difference in the primary outcome of pain intensity NRS between TG and NTG (adjusted mean difference: −0.60, 95% CI: −1.83 to 0.63), EuroQol-5 Dimension utility values (adjusted mean difference: −0.02, 95% CI: −0.13 to 0.10), or proportion of pain responders (33% TG vs 31% NTG). No differences were observed between the groups for the likelihood of spinal cord stimulation device explant or reporting an adverse advent up to 36-month follow-up.

CONCLUSION:
The long-term results show no patient outcome benefit in undertaking an SCS screening trial.
Unilateral Approaches for Posterior Spinal Canal Decompression in Cervical Spondylotic Myelopathy—An Evaluation of Conceptual Feasibility
Authors: Siller Sebastian , Pannenbaecker Laura , Tonn Joerg-Christian , Zausinger Stefan 
Published: October 2022

BACKGROUND:
Patients with cervical spondylotic myelopathy (CSM) can be treated with posterior approaches for spinal canal decompression.

OBJECTIVE:
We compared the patients' outcome after 2 different unilateral and a bilateral posterior approach for decompression to elucidate feasibility and potential procedure-related differences.

METHODS:
Medical records of 98 patients with CSM undergoing posterior decompression between 2012 and 2018 were assessed. Patients were divided into 3 groups: (1) unilateral interlaminar fenestration with over-the-top “undercutting” (laminotomy) for compression limited to a ligamentum flavum hypertrophy, (2) unilateral hemilaminectomy for lateralized compression with a combination of ligamentous hypertrophy and osseus stenosis, and (3) laminectomy/laminoplasty for circular osseous-ligamentous spinal canal narrowing.

RESULTS:
The mean age was 73 years (m:f = 1.4:1), and most frequent symptoms (mean duration: 15 months) were ataxia (69%) and sensory changes (57%). Main location of stenoses (median Naganawa Score = 3; mean anteroposterior spinal canal diameter = 7.7 ± 2.2 mm) was C3 to C6. Thirty-one percent of the patients were assigned for a laminotomy procedure, 20% for a hemilaminectomy, and 49% for a laminectomy/laminoplasty. There were no significant differences of patients' characteristics, blood loss, and operation time between the 3 groups. Independent from the mode of surgery, the spinal canal was significantly widened (median Naganawa Score = 0; mean anteroposterior diameter = 11.4 ± 3.6 mm) and myelopathy (mJOA Score) improved (P < .001); a higher body mass index was significantly correlated with a worse mJOA improvement (r = 0.293/P = .003). Quality of life (Short-Form 36v2 Health Survey/Neck Disability Index) and reduction of the neck pain level were similar in the 3 groups at last follow-up (mean: 28 months).

CONCLUSION:
To minimize patients' periprocedural burden in CSM with dorsal compression, individual tailoring of the posterior approach according to the underlying compressive pathology achieves sufficient decompression and comparable long-term results.
Ten-Step 3-Dimensional-Navigated Single-Stage Lateral Surgery With Microtubular Decompression: A Case Series
Authors: McGrath Lynn B. , Gadjradj Pravesh S. , Hussain Ibrahim , Takoushian Eric , Kirnaz Sertac , Goldberg Jacob L. , Sommer Fabian , Navarro-Ramirez Rodrigo , Mykolajtchuk Catherine , Ng Amanda Z. , Basilious Mark , Medary Branden , Härtl Roger 
Published: October 2022

BACKGROUND:
Single-stage lateral lumbar interbody fusion is a safe and effective procedure that relies on indirect decompression and fusion to treat various lumbar pathologies. This technique, however, has an overall 9% rate of indirect decompression failure, which may require additional surgery to achieve adequate direct decompression. To address this concern, we modified this technique by adding a minimally invasive, direct tubular decompression in lateral position when indicated. No study has described the technical nuances of incorporating a microtubular decompression into the single-stage lateral lumbar interbody fusion workflow (SSLLIF+).

OBJECTIVE:
To report on the procedural steps and clinical outcomes of the SSLLIF+.

METHODS:
In this retrospective case series of prospectively collected data, we present the detailed surgical approach of the SSLLIF+ with a single-center case series over a 5-year period. Surgical and clinical outcomes are presented.

RESULTS:
A total of 7 patients underwent a SSLLIF+ with a total of 18 levels fused and 7 levels decompressed. The SSLLIF+ was successfully performed in all cases without the occurrence of intraoperative complications in this case series. There was 1 revision after 20 months of follow-up because of adjacent segment disease. There was no need for further direct decompression in a delayed fashion.

CONCLUSION:
SSLLIF with direct microtubular decompression in lateral position is a safe and effective procedure in patients where indirect decompression alone may not achieve the surgical goal. Adherence to minimally invasive spine surgery principles and thoughtful patient selection facilitate the successful management of these patients while demonstrating short hospital stay and low-risk of perioperative complications.
Diaphragmatic Hernia With Incarcerated Spleen as a Complication After Lateral Anterior Column Realignment
Authors: Jamshidi Aria M. , Martin Joel R. , Kutlu Onur C. , Wang Michael Y. 
Published: October 2022

BACKGROUND:
The creation of sagittal balance of the spine is critical in the treatment adult spinal deformity. Anterior column release (ACR) has gained traction as a minimally invasive alternative to pedicle subtraction osteotomy. By releasing the anterior longitudinal ligament, the anterior column can be lengthened and physiologic lordosis restored. Risks such as transient psoas weakness and thigh numbness have been well documented in the literature; however, diaphragmatic hernia has never been reported.

OBJECTIVE:
To highlight the difficulties encountered in diagnosing, managing, and treating iatrogenic diaphragmatic hernia in the setting of ACR and stress the relevant retropleural, retroperitoneal, and diaphragmatic structures during the surgical approach.

METHODS:
In this technical note, we discuss the relevant anatomy in a direct lateral approach to the thoracolumbar junction and the management of an iatrogenic diaphragmatic hernia, which occurred in a patient who underwent a L1 ACR.

RESULTS:
Three months after surgery, our patient was assessed in clinic and endorsed significant improvements in her pain and mobility. Her 3-month postoperative scoliosis x-rays demonstrated a significant improvement in her sagittal alignment, and she experienced no further negative sequelae from the iatrogenic hernia.

CONCLUSION:
Iatrogenic diaphragmatic hernia with an intrathoracic spleen after direct lateral ACR is a risk spine surgeons should be aware of and address promptly.
Techniques for Safe Removal of Spinal Cord Stimulation Paddle Leads
Authors: Topp Gregory , Harland Tessa , Spurgas Morgan , Rock Andrew , Pilitsis Julie G. 
Published: October 2022

BACKGROUND:
Spinal cord stimulation (SCS) is a safe neuromodulatory treatment used to treat failed back surgery syndrome, chronic neuropathic pain, and complex regional pain syndrome. Despite its efficacy, some patients fail to achieve pain relief and elect to undergo removal of SCS paddle leads. The safety and best practices of these procedures have not been defined.

OBJECTIVE:
In this article, we describe our technique and complication rate in a series of SCS paddle removals.

METHODS:
All patients who underwent SCS paddle removal at the Albany Medical Center between 2011 and 2020 were identified. Medical charts were reviewed for demographic data, operative technique, and incidence of complications within 30 days of the procedure.

RESULTS:
Thirty-two (91%) patients underwent a thoracic paddle removal, whereas 3 (9%) underwent a cervical paddle removal. All cases underwent preoperative imaging with computed tomography or MRI, and all cases were performed with neuromonitoring and fluoroscopy. The technique required for paddle removal depended on the extent of local scar formation and ranged from soft tissue dissection to additional laminectomy at an adjacent level. Cases took on average 2 ± 0.09 hours with 23.21 ± 4.29 cc blood loss. Two patients had superficial infections, which were cleared with 1 week of oral antibiotics. There were no other adverse events.

CONCLUSION:
Thirty-five patients successfully underwent paddle removal with the minor complications reported. In this article, we show that by using neuromonitoring, fluoroscopy, and the techniques described, SCS paddle removal can be performed with minimal risk.
Arteriovenous Fistulas Fed by Spinal Arterial Feeders at the Craniocervical Junction Region
Authors: Song Zihao , Ma Yongjie , Hong Tao , Zhang Hongqi 
Published: October 2022

BACKGROUND:
Arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) region with spinal arterial feeders are rare. There are few reports on such diseases. This study retrospectively reviewed 20 consecutive cases with CCJ AVFs with spinal arterial feeders from our neurosurgical center, which can enrich the experience of diagnosis and treatment of such arteriovenous fistulas.

OBJECTIVE:
To further explain the clinical manifestations, angiographic characteristics, and treatment strategies of CCJ AVFs with spinal arterial feeders and share the treatment experience of our neurosurgical center.

METHODS:
A total of 113 patients with CCJ AVFs treated at our institution between January 2013 and December 2020 were enrolled. After analyzing their imaging data, 20 patients with CCJ AVFs with spinal arterial feeders were included. Clinical presentation, angiographic characteristics, intraoperative findings, and treatment outcomes were analyzed.

RESULTS:
The median age was 52 years (IQR 45-58 years). Twenty-four fistulas were included in this study and were classified based on angiographic characteristics: dural AVF (1 [4.2%] of 24), radicular AVF (15 [62.5%] of 24), epidural AVF (2 [8.3%] of 24), and perimedullary AVF (6 [25.0%] of 24). Subarachnoid hemorrhage occurred in 19 cases (95.0%) and was the main clinical manifestation. Thirteen patients (65.0%) were treated with microsurgery only, 6 (30.0%) with embolization and microsurgery, and 1 (5.0%) with interventional electrocoagulation. Nineteen patients (95.0%) had favorable outcomes.

CONCLUSION:
Subarachnoid hemorrhage was the most common presentation of CCJ AVFs with spinal arterial feeders. Different treatment strategies should be selected based on different angioarchitecture.
The Lingual Process of the Sphenoid Bone and the Petrolingual Ligament: Surgical Anatomy, Landmarks, and Clinical Relevance
Authors: Leonel Luciano César P. C. , Rezende Natalia Cerqueira , Alexander Alex Yohan , Agosti Edoardo , Rush Deja , Kenning Tyler J. , Link Michael J. , Pinheiro-Neto Carlos D. , Peris-Celda Maria 
Published: October 2022

BACKGROUND:
The lingual process of the sphenoid bone (LP) and the petrolingual ligament (PLL) surround laterally the internal carotid artery within the middle cranial fossa (MCF).

OBJECTIVE:
To study the LP and the PLL and anatomical variations considering their relationships with different structures and landmarks within the MCF, especially oriented toward the endoscopic endonasal approaches.

METHODS:
Seventy-two sides of dry skulls and 20 sides of embalmed specimens were studied. The measurements of the LP and the PLL were obtained, considering important landmarks in the MCF.

RESULTS:
The LP had a mean length and height of 5 mm and 3 mm, respectively. Its distance from the foramen lacerum was 6 mm, from the foramen ovale 10 mm, foramen rotundum 15 mm, and petrous apex 9 mm. In 44 sides (61.11%), the LP partially closed the lateral aspect of the carotid sulcus; in 17 sides (23.61%), it was found as a near-ring; and in 11 sides (15.2%), it was considered rudimentary. Considering the PLL, its length and height were, respectively, 9 mm, and 4 mm.

CONCLUSION:
The LP and PLL separate the carotid artery at the inferior aspect of Meckel's cave and constitute important landmarks for endoscopic endonasal approaches to Meckel's cave and MCF, and their identification and removal is essential for internal carotid artery mobilization in this area.
Drosophila hemocytes recognize lymph gland tumors of mxc mutants and activate the innate immune pathway in a reactive oxygen species-dependent manner
Authors: Kinoshita Suzuko , Takarada Kazuki , Kinoshita Yuriko , Inoue Yoshihiro H. 
Published: October 2022

ABSTRACT
Mechanisms of cancer cell recognition and elimination by the innate immune system remains unclear. The immune signaling pathways are activated in the fat body to suppress the tumor growth in mxcmbn1 hematopoietic tumor mutants in Drosophila by inducing antimicrobial peptides (AMP). Here, we investigated the regulatory mechanism underlying the activation in the mutant. Firstly, we found that reactive oxygen species (ROS) accumulated in the hemocytes due to induction of dual oxidase and one of its activators. This was required for the AMP induction and the tumor growth suppression. Next, more hemocytes transplanted from normal larvae were associated with the mutant tumor than normal lymph glands (LGs). Matrix metalloproteinase 1 and 2 (MMP2) were highly expressed in the tumors. The basement membrane components in the tumors were reduced and ultimately lost inside. Depletion of the MMP2 rather than MMP1 resulted in a significantly reduced AMP expression in the mutant larvae. The hemocytes may recognize the disassembly of basement membrane in the tumors and activate the ROS production. Our findings highlight the mechanism via which macrophage-like hemocytes recognize tumor cells and subsequently convey the information to induce AMPs in the fat body. They contribute to uncover the role of innate immune system against cancer.
High-resolution ribosome profiling reveals translational selectivity for transcripts in bovine preimplantation embryo development
Authors: Zhu Linkai , Zhou Tong , Iyyappan Rajan , Ming Hao , Dvoran Michal , Wang Yinjuan , Chen Qi , Roberts R. Michael , Susor Andrej , Jiang Zongliang 
Published: October 2022

ABSTRACT
High-resolution ribosome fractionation and low-input ribosome profiling of bovine oocytes and preimplantation embryos has enabled us to define the translational landscapes of early embryo development at an unprecedented level. We analyzed the transcriptome and the polysome- and non-polysome-bound RNA profiles of bovine oocytes (germinal vesicle and metaphase II stages) and early embryos at the two-cell, eight-cell, morula and blastocyst stages, and revealed four modes of translational selectivity: (1) selective translation of non-abundant mRNAs; (2) active, but modest translation of a selection of highly expressed mRNAs; (3) translationally suppressed abundant to moderately abundant mRNAs; and (4) mRNAs associated specifically with monosomes. A strong translational selection of low-abundance transcripts involved in metabolic pathways and lysosomes was found throughout bovine embryonic development. Notably, genes involved in mitochondrial function were prioritized for translation. We found that translation largely reflected transcription in oocytes and two-cell embryos, but observed a marked shift in the translational control in eight-cell embryos that was associated with the main phase of embryonic genome activation. Subsequently, transcription and translation become more synchronized in morulae and blastocysts. Taken together, these data reveal a unique spatiotemporal translational regulation that accompanies bovine preimplantation development.