bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Affecting the Accuracy of Pedicle Screw Placement in Robot-Assisted Surgery: A Multi-Center Study
Authors: Toossi Nader , Vardiman Arnold B. , Benech Carlo A. , Kanaly Charles W. , Maltenfort Mitchell G. , Backes Danielle M. , Bucklen Brandon 
Published: October 2022

Study Design.
Retrospective Multi-Center

Objective.
To investigate the factors involved in, and their relative contributions to, the overall accuracy of robot-assisted pedicle screw placement

Summary of Background Data.
Robot-assisted surgery has reportedly resulted in greater accuracy for placement of pedicle screws than conventional methods. There are many potential factors affecting the accuracy of pedicle screws placed with a robot. No study has investigated these factors in a robust way.

Methods.
Radiographic and clinical data of three centers were pooled. Pre- and post-operative computerized tomographies were obtained by all three centers to assess the accuracy of the placed screws. The primary outcome measured was accuracy of pedicle screws placed with the robot. The authors performed a multivariate regression analysis to determine the significant patient- and screw-related variables and their relative contribution to the overall accuracy. In addition, an ordinal regression analysis was conducted to investigate the effects of different variables on accuracy of robot-placed screws graded by Gertzbein-Robbins grading system (GRS).

Results.
The total contribution of all studied variables to overall accuracy variation as measured by offsets between the placed and planned screws was only 18%. Obesity, long constructs, female gender, surgeon, and vertebral levels were among the factors that had small contributions to the different screw offsets. For GRS grades, significant variables were gender (Log odds:0.62, 95% CI: 0.38-0.85), age (Log odds: 0.02, 95% CI: 0.01-0.03), length of constructs (Log odds: 0.07, 95% CI: 0.02-0.11), screw diameter (Log odds: 0.55, 95% CI: 0.39-0.71), and length of the screws (Log odds: 0.03, 95% CI: 0.01-0.05). However, these variables too, regardless of their significant association with the accuracy of placed screws, had little contribution to overall variability of accuracy itself (only about 7%).

Conclusion.
The accuracy of screws placed with robotic assistance, as graded by GRS or measured offsets between planned and placed screw trajectories, is minimally affected by different patient- or screw-related variables due to the robustness of the robotic navigation system used in this study.
The Impact of the COVID-19 Pandemic on the Presentation of Patients With Spinal Metastases
Authors: Mika Aleksander P. , Wollenman Colby , Steinle Anthony M. , Chanbour Hani , Vaughan Wilson , Croft Andrew , Lugo-Pico Julian , Zuckerman Scott L. , Abtahi Amir M. , Stephens Byron F. 
Published: October 2022

Study Design.
Retrospective review.

Objective.
The aim was to determine if preoperative spinal instability neoplastic scores (SINSs) and Tokuhashi prognostication scores differed in patients receiving surgical care before and during the coronavirus disease-2019 (COVID-19) pandemic.

Summary of Background Data.
The COVID-19 pandemic has caused delays in scheduling nonemergent surgeries. Delay in presentation and/or surgical treatment for oncology patients with metastatic spinal disease could result in progression of the disease, which can complicate surgical care and worsen patient outcomes.

Materials and Methods.
Retrospective review of electronic medical records between March 1, 2019 and March 1, 2021 at a tertiary medical center was performed to identify patients who underwent surgery for metastatic spine disease. Primary spinal tumors were excluded. Patients were separated into two groups base on their surgery date: before the COVID-19 pandemic (March 1, 2019–February 29, 2020) and during the COVID-19 pandemic (March 1, 2020–March 1, 2021). Primary outcomes included SINS and Tokuhashi scores. A variety of statistical tests were performed to compare the groups.

Results.
Fifty-two patients who underwent surgery before the COVID-19 pandemic were compared to 41 patients who underwent surgery during the COVID-19 pandemic. There was a significant difference between the before and during groups with respect to SINS (9.31±2.39 vs. 11.00±2.74, P=0.002) and Tokuhashi scores (9.27±2.35 vs. 7.88±2.85, P=0.012). Linear regression demonstrated time of surgery (before or during COVID-19 restrictions) was a significant predictor of SINS (β=1.55, 95% CI: 0.42–2.62, P=0.005) and Tokuhashi scores (β=−1.41, 95% CI: −2.49 to −0.34, P=0.010).

Conclusions.
Patients with metastatic spinal disease who underwent surgery during the COVID-19 pandemic had higher SINS, lower Tokuhashi scores and similar Skeletal Oncology Research Group scores compared to patients who underwent surgery before the pandemic. This suggests the pandemic has impacted the instability of disease at presentation in patients with spinal metastases, but has not impacted surgical prognosis, as there were no differences in Skeletal Oncology Research Group scores and the difference in Tokuhashi scores is most likely not clinically significant.
Propensity-matched Comparison Between Chronic Nonspecific Low Back Pain and Axial Spondyloarthritis: Impact on patient-perceived Quality of Life
Authors: Cheung Jason Pui Yin , Cheung Prudence Wing Hang , Wong Carlos King Ho , Chung Ho Yin , Tsang Helen Hoi Lun 
Published: October 2022

Study Design.
Prospective study.

Objective.
To compare the burden between chronic nonspecific low back pain (LBP) and axial spondyloarthropathy (SpA).

Summary of Background Data.
Chronic nonspecific LBP and SpA are two debilitating yet different chronic musculoskeletal disorders. To compare their burden, propensity score matching is used to control for potential confounders and match the study subjects.

Materials and Methods.
Two prospectively collected cohorts of LBP (n=269) and SpA (n=218) patients were studied. Outcomes included current LBP, 36-item Short Form Questionnaire, Oswestry Disability Index, EuroQol 5-dimension 5-level Questionnaire, and EuroQol Visual Analog Scale. With the inherent differences between the two types of patients, propensity score matching was performed for comparing the two groups. Baseline covariates of age, sex, education level, occupation, smoking, and drinking history were selected for the estimation of propensity scores for each subject with the logistic regression model. Significant independent variables for the outcome of current back pain were included in the multivariate logistic regressions.

Results.
A total of 127 matched pairs were identified, with 254 patients. In the matched cohort, more patients with chronic LBP had current back pain (95.3%) as compared with SpA (71.7%). Patients with SpA were younger (P<0.001), with more males (P<0.001), and better educated (P=0.001). There was less current back pain and higher nonsteroidal anti-inflammatory drug use (P<0.001). Most SpA patients had lower Oswestry Disability Index than LBP patients and with low disease activity. Patients with LBP had worse outcome scores as compared with SpA patients given the same Visual Analog Scale. LBP patients had 8.6 times the odds (95% CI: 3.341–20.671; P<0.001) of experiencing current back pain compared with SpA patients.

Conclusions.
The disease activity of SpA patients is well controlled. However, patients with chronic LBP have worse pain severity, disability, and health-related quality of life. This has implications on resource utilization and the necessity of advancing LBP understanding and management.

Level of Evidence.
Type I prognostic study.
Prevalence and prognostic impact of hepatopulmonary syndrome in patients with unresectable hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective cohort study
Authors: Zhao He , Tsauo Jiaywei , Zhang Xiaowu , Ma Huaiyuan , Weng Ningna , Yang Zhengqiang , Li Xiao 
Published: October 2022

Abstract

Background:
To determine the prevalence and prognostic impact of hepatopulmonary syndrome (HPS) in patients with unresectable hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE).

Methods:
Fifty-four patients with unresectable HCC undergoing TACE between December 2014 and December 2015 were prospectively screened for HPS and were followed up for a maximum of 2 years or until the end of this prospective study.

Results:
Nineteen of the 54 (35.2%) patients were considered to have HPS, including one (5.3%) with severe HPS, nine (47.4%) with moderate HPS, and nine (47.4%) with mild HPS. The median overall survival (OS) was 10.1 (95% confidence interval [CI], 3.9–16.3) months for patients with HPS and 15.1 (95% CI, 7.3–22.9) months for patients without HPS, which is not a significant difference (P = 0.100). The median progression-free survival was also not significantly different between patients with and without HPS (5.2 [95% CI, 0–12.8] vs. 8.4 [95% CI, 3.6–13.1] months; P = 0.537). In the multivariable Cox regression analyses, carbon monoxide diffusing capacity (hazard ratio [HR] = 1.033 [95% CI, 1.003–1.064]; P = 0.028) and Child-Pugh class (HR = 1.815 [95% CI, 1.011–3.260]; P = 0.046) were identified to be the independent prognostic factors of OS.

Conclusion:
Mild or moderate HPS is common in patients with unresectable HCC undergoing TACE, but it does not seem to have a significant prognostic impact.
Ferroptosis and its emerging roles in acute pancreatitis
Authors: Li Hongyao , Lin Yujie , Zhang Ling , Zhao Jing , Li Peiwu 
Published: October 2022

Abstract
Acute pancreatitis (AP) is a common and potentially life-threatening pancreatic inflammatory disease. Although it is usually self-limiting, up to 20% of patients will develop into severe AP. It may lead to systemic inflammatory response syndrome and multiple organ dysfunction, affecting the lungs, kidneys, liver, heart, etc. Surviving patients usually have sequelae of varying degrees, such as chronic hyperglycemia after AP (CHAP), pancreatic exocrine insufficiency, and chronic pancreatitis. Lacking specific target treatments is the main reason for high mortality and morbidity, which means that more research on the pathogenesis of AP is needed. Ferroptosis is a newly discovered regulated cell death (RCD), originally described in cancer cells, involving the accumulation of iron and the depletion of plasma membrane polyunsaturated fatty acids, and a caspase-independent RCD. It is closely related to neurological diseases, myocardial infarction, ischemia/reperfusion injury, cancer, etc. Research in the past years has also found the effects of ferroptosis in AP, pancreatic cancer, and AP complications, such as acute lung injury and acute kidney injury. This article reviews the research progress of ferroptosis and its association with the pathophysiological mechanisms of AP, trying to provide new insight into the pathogenesis and treatment of AP, facilitating the development of better-targeted drugs.
The Umbilical Cord and Complications of Twin Gestations
Authors: Van Grambezen Aurianne , Steenhaut Patricia , Van Grambezen Bénédicte , Debiève Frédéric , Bernard Pierre , Hubinont Corinne 
Published: October 2022

Abstract
The rate of twin pregnancies has increased over the last decades, largely because of the ongoing development of assisted reproductive technology and increased maternal age at childbearing. Twins have a higher risk of adverse outcomes during pregnancy and the perinatal period. The prevalence of umbilical cord abnormalities is higher for twin pregnancies compared with singleton pregnancies. Some of these abnormalities are nonspecific to twinning and can also be found in singleton gestations (such as velamentous cord insertion, vasa previa, and single umbilical artery). Other abnormalities are associated with monochorionic twins, such as umbilical cord entanglement, and umbilical proximate cord insertion. Most of these abnormalities can be detected by ultrasound evaluation. The early and accurate ultrasound diagnosis of chorionicity, amnionicity, and placental and umbilical cord characteristics is crucial if we are to predict the risk of complications and to determine the best management for twin pregnancies. Histopathological examination of the placenta and umbilical cord after delivery can help to confirm prenatal diagnosis and to provide a better understanding of the physiopathology of their abnormalities. The aim of this review was to emphasize the role that the umbilical cord plays in twin complications and to describe the management of these high-risk pregnancies.
Influence of ABCB1, CYP3A5 and CYP3A4 gene polymorphisms on prothrombin time and the residual equilibrium concentration of rivaroxaban in patients with non-valvular atrial fibrillation in real clinical practice
Authors: Sychev Dmitry Alekseevitch , Sokolov Aleksey Vladimirovich , Reshetko Olga Vilorovna , Fisenko Vladimir Petrovich , Sychev Igor Nikolaevich , Grishina Elena Anatolievna , Bochkov Pavel Olegovich , Shevchenko Roman Vladimirovich , Abdullaev Sherzod Pardaboevich , Denisenko Natalia Pavlovna , Ivashchenko Dmitry Vladimirovich , Sozaeva Zhannet Alimovna , Kachanova Anastasia Alekseevna 
Published: October 2022

Objective
The study of ABCB1 and CYP3A4/3A5 gene polymorphism genes is promising in terms of their influence on prothrombin time variability, the residual equilibrium concentration of direct oral anticoagulants (DOACs) in patients with atrial fibrillation and the development of new personalized approaches to anticoagulation therapy in these patients. The aim of the study is to evaluate the effect of ABCB1 (rs1045642) C>T; ABCB1 (rs4148738) C>T and CYP3A5 (rs776746) A>G, CYP3A4*22(rs35599367) C>T gene polymorphisms on prothrombin time level and residual equilibrium concentration of rivaroxaban in patients with atrial fibrillation.

Methods
In total 86 patients (42 men and 44 female), aged 67.24 ± 1.01 years with atrial fibrillation were enrolled in the study. HPLC mass spectrometry analysis was used to determine rivaroxaban residual equilibrium concentration. Prothrombin time data were obtained from patient records.

Results
The residual equilibrium concentration of rivaroxaban in patients with ABCB1 rs4148738 CT genotype is significantly higher than in patients with ABCB1 rs4148738 CC (P = 0.039). The analysis of the combination of genotypes did not find a statistically significant role of combinations of alleles of several polymorphic markers in increasing the risk of hemorrhagic complications when taking rivaroxaban.

Conclusion
Patients with ABCB1 rs4148738 CT genotype have a statistically significantly higher residual equilibrium concentration of rivaroxaban in blood than patients with ABCB1 rs4148738 CC genotype, which should be considered when assessing the risk of hemorrhagic complications and risk of drug–drug interactions. Further studies of the effect of rivaroxaban pharmacogenetics on the safety profile and efficacy of therapy are needed.
Population Pharmacokinetic Model and Dosing Simulation of Meropenem Using Measured Creatinine Clearance for Patients with Sepsis
Authors: Fukumoto Shiori , Ohbayashi Masayuki , Okada Akira , Kohyama Noriko , Tamatsukuri Tatsuro , Inoue Hideki , Kato Akihito , Kotani Toru , Sagara Hironori , Dohi Kenji , Kogo Mari 
Published: October 2022

Purpose:
Creatinine clearance (CCr) and pharmacokinetic parameters are markedly affected by pathophysiological changes in patients with sepsis. However, only a few reports have assessed renal function in patients with sepsis using the measured CCr. Furthermore, the administration regimen has not been sufficiently evaluated using a population PK (PPK) model across renal function broad ranges. Therefore, this study was performed to construct a meropenem PPK model for patients with sepsis using the measured CCr and evaluate the optimized meropenem dosing regimen based on the CCr.

Methods:
Patients with sepsis who received intravenous meropenem at the Showa University Hospital were enrolled in this prospective observational study. The PPK model was constructed using blood samples and clinical information of patients. The probability of target attainment (PTA) indicates the likelihood of achieving 50% time above the minimum inhibitory concentration (% T > MIC) based on 10,000 virtual patients using Monte Carlo simulations. The PTA for each meropenem regimen was 50% T > MIC based on different renal functions using the Monte Carlo simulation.

Results:
One hundred samples were collected from 31 patients. The final PPK model incorporating the measured CCr as a covariate in CL displayed the best fit. The recommended dosing regimen to achieve a PTA of 50% T > MIC of 4 mcg/mL was 1 g every 8 hours as a 3-hour prolonged infusion for patients with CCr 85–130 mL/min and 1 g every 8 hours as an 8-hour continuous infusion for patients with CCr ≥ 130 mL/min.

Conclusions:
This model precisely predicted meropenem concentrations in patients with sepsis by accurately evaluating renal function using the measured CCr. Extended dosing was demonstrated to be necessary to achieve a PTA of 50% T > MIC for patients with CCr ≥ 85 mL/min. Meropenem effectiveness can be maximized in patients with sepsis by selecting the appropriate dosing regimen based on renal function and the MIC.
A dietary intervention for vasomotor symptoms of menopause: a randomized, controlled trial
Authors: Barnard Neal D. , Kahleova Hana , Holtz Danielle N. , Znayenko-Miller Tatiana , Sutton Macy , Holubkov Richard , Zhao Xueheng , Galandi Stephanie , Setchell Kenneth D. R. 
Published: October 2022

Abstract

Objective
Postmenopausal vasomotor symptoms disrupt quality of life. This study tested the effects of a dietary intervention on vasomotor symptoms and menopause-related quality of life.

Methods
Postmenopausal women (n = 84) reporting at least two moderate-to-severe hot flashes daily were randomly assigned, in two successive cohorts, to an intervention including a low-fat, vegan diet and cooked soybeans (½ cup [86 g] daily) or to a control group making no dietary changes. During a 12-week period, a mobile application was used to record hot flashes (frequency and severity), and vasomotor, psychosocial, physical, and sexual symptoms were assessed with the Menopause-Specific Quality of Life questionnaire. Between-group differences were assessed for continuous (t tests) and binary (χ
2/McNemar tests) outcomes. In a study subsample, urinary equol was measured after the consumption of ½ cup (86 g) of cooked whole soybeans twice daily for 3 days.

Results
In the intervention group, moderate-to-severe hot flashes decreased by 88% (P < 0.001) compared with 34% for the control group (P < 0.001; between-group P < 0.001). At 12 weeks, 50% of completers in the intervention group reported no moderate-to-severe hot flashes at all. Among controls, there was no change in this variable from baseline (χ
2 test, P < 0.001). Neither seasonality nor equol production status was associated with the degree of improvement. The intervention group reported greater reductions in the Menopause-Specific Quality of Life questionnaire vasomotor (P = 0.004), physical (P = 0.01), and sexual (P = 0.03) domains.

Conclusions
A dietary intervention consisting of a plant-based diet, minimizing oils, and daily soybeans significantly reduced the frequency and severity of postmenopausal hot flashes and associated symptoms.
Isolated vitamin D supplementation improves the adipokine profile of postmenopausal women: a randomized clinical trial
Authors: Schmitt Eneida B. , Orsatti Claudio L. , Cangussu Luciana , Bueloni-Dias Flavia N. , Poloni Priscila F. , Spadoto-Dias Daniel , Nahas Eliana A. P. 
Published: October 2022

Abstract

Objective
The aim of the study is to evaluate the effect of vitamin D supplementation alone on the adipokine profile of postmenopausal women.

Methods
In this randomized clinical trial, 160 women were randomized to 2 groups: oral supplementation with 1,000 IU cholecalciferol/d (vitamin D, n = 80) or placebo (PL, n = 80). Women with amenorrhea 12 months or more and aged 50 to 65 years were included. Women with established cardiovascular disease, insulin-dependent diabetes, renal failure, liver diseases, and previous use of menopausal hormone therapy and vitamin D were excluded. The intervention lasted 9 months and serum adiponectin, resistin, and adipsin levels were determined at the start and end of treatment. Intention to treat was adopted as the statistical method using a repeated measures design, followed by Wald's multiple comparison test adjusted for group × time interaction.

Results
After 9 months, 25-hydroxyvitamin D concentrations increased from 15.0 ± 7.5 to 27.5 ± 10.4 ng/mL (+45.4%) in the vitamin D group and decreased from 16.9 ± 6. to 13.8 ± 6.0 ng/mL (−18.5%) in the PL group (P < 0.001). In the vitamin D group, there was an increase in adiponectin (+18.6%) and a decrease in resistin (−32.4%, P < 0.05). At the end point, a difference was observed between the PL and vitamin D groups in mean adiponectin and resistin levels (11.5 ± 5.5 vs 18.5 ± 21.8 ng/mL, P = 0.047, and 16.5 ± 3.5 vs 11.7 ± 3.3 ng/mL, P = 0.027, respectively). There were no significant intervention effects on serum adipsin levels.

Conclusions
Daily supplementation with 1,000 IU of vitamin D alone was associated with an increase in adiponectin and a decrease in resistin, suggesting a beneficial effect on the adipokine profile of postmenopausal women with vitamin D deficiency.
Menopause hormone therapy and complementary alternative medicine, quality of life, and racial/ethnic differences: the Study of Women's Health Across the Nation (SWAN)
Authors: Christmas Monica , Janssen Imke , Joffe Hadine , Upchurch Dawn , Santoro Nanette , Kravitz Howard M. 
Published: October 2022

Abstract

Objective
We hypothesized that, among midlife women with vasomotor and/or genitourinary symptoms of menopause, (1) hormone therapy (HT) compared with complementary alternative medicine (CAM) will be associated with higher quality of life (QoL), and (2) race/ethnicity would modify associations of HT and CAM with QoL.

Methods
Cross-sectional and longitudinal analyses of QoL in the Study of Women's Health Across the Nation participants using HT, CAM, or both. Women (n = 2,514) completed a CAM use questionnaire and QoL assessments at baseline and every 1 to 2 years from 2002 to 2013. Associations between QoL and treatment, adjusted for covariates, and race/ethnicity-by-treatment interactions were analyzed using linear and mixed effects regression models.

Results
During 7.8 (SD, 2.9) years of follow-up, 732 women (29%) reported HT of 2.4 (SD, 1.7) years, and 798 women (32%) reported CAM use of 2.1 (SD, 1.4) years. Overall, neither HT nor CAM was associated with QoL. However, the treatment-by-race/ethnicity interaction was significant for self-reported QoL (P = 0.034 at baseline, P = 0.044 longitudinal). Among White women, self-reported QoL was higher in HT-only users than in those who used neither (P = 0.030; d = 0.11; 95% confidence interval, 0.01-0.21). In contrast, Black women using HT only had lower self-reported QoL compared with Black women using neither (P = 0.027; d = −0.21; 95% confidence interval, −0.40 to −0.02).

Conclusion
Comparisons between treatment type within each racial/ethnic group yielded significant differences in self-reported QoL. Clinicians should be aware of racial/ethnic differences in treatment preferences when counseling patients on treatment options for menopausal symptoms to provide optimal care.

Video Summary

http://links.lww.com/MENO/B33.