Providence St. Joseph Health Digital Commons
Not a member yet
12290 research outputs found
Sort by
Rise of Big Data in Spine Surgery Research: A Bibliometric Analysis, 1993-2024.
No full textSpine surgery represents a dynamic and innovative specialty with a steady increase in annual publications since 1900. The introduction of large databases and registries marked a paradigm shift in research. Despite their quantitative superiority, databases are inherently limited in a number of ways. Spine surgery remains a somewhat controversial specialty with significant cost, population health, and outcomes implications, and has, not surprisingly, become more frequently associated with large-scale registry studies. The objective of this study was to descriptively characterize trends in large-database usage in spine surgery research over time, including publication volume, topic distribution, and geographic output. A database search in the Clarivate Analytics Web of Science (WoS) database with keywords ( big data OR large database OR registry OR national database ) AND spine surgery was conducted on July 7, 2025, and original and review articles published between 1993 and 2024 were included. Retrieved articles were categorized into seven areas based on primary research objectives, and data underwent descriptive quantitative analysis. Descriptive analyses were performed in Microsoft Excel (Microsoft® Corp., Redmond, WA, USA), and keyword co-occurrence network and overlay visualizations were generated using VOSviewer (Version 1.6.20, Centre for Science and Technology Studies, Leiden University, The Netherlands). A total of 633 articles were analyzed, revealing a more than 10-fold increase in publications from 2012 to 2024. The degenerative category was most common (189 articles), followed by public health (179) and infection (75). The United States dominated the research output (62.29%). Raw annual citation counts also significantly increased, from 146 in 2012 to 2,132 in 2024. The utilization of large databases in spine surgery research has substantially grown, reflecting a shift toward big data usage. Publications on spinal infections and public health outcomes have notably increased, while degenerative conditions consistently prevail. Geographic distribution remains skewed towards western countries, especially the United States. These trends suggest an expanding recognition of database studies as a critical tool for evidence-based research in spine surgery
Long-term outcomes of diaphragmatic relaxing incisions during challenging primary and revisional hiatal reconstruction: A propensity-matched analysis.
No full textOBJECTIVES: Diaphragmatic relaxing incisions reduce radial tension and may aid in preventing recurrences, but they lack long-term data. We describe the long-term outcomes after diaphragmatic relaxing incisions used during hiatal reconstruction.
METHODS: We performed a propensity-matched analysis of elective primary and revisional minimally invasive hiatal hernia repairs with and without diaphragmatic relaxing incisions between 2008 and 2020. Primary repairs with diaphragmatic relaxing incisions (N = 125) were matched 1:1 for age, Barrett\u27s esophagus length, hernia axial size, and type to primary controls, whereas the 43 revisional repairs with diaphragmatic relaxing incisions were similarly matched, excluding type, to revisional controls. Outcomes were radiological/endoscopic recurrence (\u3e2 cm), gastroesophageal reflux disease health-related quality of life, and diaphragmatic relaxing incision-related complications.
RESULTS: The primary repair cohorts were similar except the diaphragmatic relaxing incision group had more male patients, Nissen fundoplications, Collis gastroplasties, and hiatal mesh use. Median imaging follow-up was 58 months, and recurrences were similar (26/107 [24%] vs 27/106 [26%], P = .84). Gastroesophageal reflux disease health-related quality of life was also similar (2.5 [interquartile range, 0.0-6.5] vs 2.0 [interquartile range, 0.0-7.0], P = .82). The revisional groups were well matched except more male patients underwent diaphragmatic relaxing incisions. At a median follow-up of 63 months, recurrence between those with and without diaphragmatic relaxing incisions (9/38 [24%] vs 9/35 [26%], P = .84) was similar. There was no difference in gastroesophageal reflux disease health-related quality of life (4.0 [interquartile range, 1.5-7.5] vs 6.0 [interquartile range, 1.0-9.0], P = .47). During follow-up, 4 patients (2%) herniated through their diaphragmatic relaxing incisions, all requiring operative repair. No symptomatic diaphragmatic paralysis or other long-term diaphragmatic relaxing incision complications were identified.
CONCLUSIONS: With approximately 5 years of follow-up, diaphragmatic relaxing incisions during primary and revisional hiatal reconstruction resulted in recurrence and quality of life similar to those undergoing repair without the need for diaphragmatic relaxing incisions
A 3D culture model facilitates mass production of in vitro Plasmodium falciparum haemolymph-like sporozoites.
No full textBackground: The in vitro cultivation of individual stages of the Plasmodium falciparum mosquito life cycle is notably challenging. The main difficulty is replicating the intricate nutrient and metabolite exchanges necessary for oocyst development and sporozoite (SPZ) formation in the three-dimensional environment of the mosquito midgut. Replicating these conditions is essential for understanding the biological interactions between mosquito and parasite, as well as advancing malaria vaccine development.
Methods: An in vitro three-dimensional system was developed that closely mimics the mosquito midgut epithelium, basal lamina, and haemolymph, facilitating the production of substantial quantities of haemolymph-like Pf SPZ.
Results: Use of an extracellular matrix-coated Alvetex® Strata scaffold, combined with optimized culture medium, supports efficient oocyst attachment and provides the necessary nutrients for robust production of haemolymph-like SPZ. This system enables full maturation of oocysts, as shown by immunofluorescence assays (IFA), and allows timely release of in vitro SPZ (IVS) between days 11 and 15, comparable to the in vivo mosquito timeline. Haemolymph-like SPZ generated were found to be infectious, as evidenced by successful HC04 infection in in vitro and in vivo studies using FRG-huHep mice. Similar outcomes were observed across different P. falciparum strains.
Conclusions: Implementation of the Alvetex Strata scaffold, optimized medium, and improved ookinete production consistently enables in vitro generation of large quantities of haemolymph-like SPZ
Electroencephalography-based diagnosis of schizophrenia using machine learning.
No full textSchizophrenia is a mental disorder with a high social burden. Identification of quantitative biomarkers has the potential to facilitate the diagnosis process. This study aims to explore a routine to gain such biomarkers using quantitative analysis of electroencephalography (EEG) data. Previous studies suggest that EEG data can be used to differentiate schizophrenia patients from healthy subjects. Various EEG features were used for such diagnostics using machine learning (ML) algorithms, but selecting the optimal EEG features and the classifiers is still insufficient. We propose an automatic selection of ML parameters using the Waikato Environment for Knowledge Analysis software. Using Waikato Environment for Knowledge Analysis\u27s Supervised Attribute Selection tool, we identified attributes that allow the identification of schizophrenia patients with a high accuracy of 93%. The attributes identified were EEG signals enriched for alpha and gamma frequencies from specific brain areas (frontal right, central, parietal, and occipital). This proposed strategy can effectively identify schizophrenia patients with high accuracy. It could be used as an ML tool to support diagnosis and potentially provide insights into the underlying disease mechanism of schizophrenia
AAPM medical physics practice guideline 13.a: HDR brachytherapy, part B.
No full textThe goal of this report is to assist the clinical medical physicist in assuring that key quality standards and practice considerations are met to ensure safe, reliable, and reproducible high dose rate (HDR) brachytherapy (BT) treatment. This guideline has been developed to provide appropriate minimum standards for such services. The secondary goal is to provide recommendations to the regulatory community from the experts to guide the adoption of regulations in the future. This MPPG is limited to iridium-192-based HDR brachytherapy and will not discuss electronic, low-dose rate, pulsed dose rate brachytherapy, or any alternative radionuclide. SCOPE: This MPPG 13a report is divided into two parts. Part A has been previously published1 and describes the infrastructure and program design in the creation of an afterloader-based HDR brachytherapy program. This publication, Part B, describes the clinical treatment processes including site-specific imaging, planning, and treatment delivery. MPPG 13a Part B starts with the arrival of the patient to the clinic and concludes with emergency procedures and error mitigation. DISCLAIMER: It is the responsibility of all healthcare staff to be familiar with state and federal guidelines that may take precedence over AAPM recommendations that are provided in this report. Each health care facility may have site-specific or state-mandated needs and requirements that may modify their usage of these recommendations
Phase 2 Study of Zilovertamab Vedotin in Participants with Metastatic Solid Tumors.
No full textPURPOSE: Zilovertamab vedotin, an antibody-drug conjugate targeting receptor tyrosine kinase-like orphan receptor 1 (ROR1), had manageable safety and promising antitumor activity in participants with relapsed or refractory non-Hodgkin lymphomas. We evaluated zilovertamab vedotin in participants with previously treated metastatic solid tumors.
PATIENTS AND METHODS: This phase 2, open-label, nonrandomized study (NCT04504916) enrolled participants with metastatic triple-negative breast cancer, hormone receptor-positive breast cancer, nonsquamous non-small-cell lung cancer, platinum-resistant ovarian cancer, or pancreatic cancer. Participants received zilovertamab vedotin ≤2.5 mg/kg once every 3 weeks (Q1/3W) or \u3c 1.75 mg/kg twice every 3 weeks (Q2/3W). The primary endpoint was objective response rate per RECIST version 1.1 by blinded independent central review. ROR1 protein expression was correlated with clinical outcomes.
RESULTS: A total of 102 participants were enrolled (Q1/3W, n = 70; Q2/3W, n = 32). The objective response rate was 1% [95% confidence interval (CI), 0%-8%] with Q1/3W dosing (one partial response, hormone receptor-positive/HER2-negative breast cancer cohort) and 0% with Q2/3W dosing. The median progression-free survival (95% CI) was 2.3 (2.0-4.1) and 1.9 (1.7-2.1) months, respectively; the median overall survival (95% CI) was 8.3 (5.2-10.3) and 5.5 (4.4-11.0) months, respectively. Across dosing regimens, treatment-related adverse events were reported in 85 participants (83%), most commonly fatigue (29%) and nausea (28%). Treatment-related peripheral neuropathy occurred in 8%. Treatment-related adverse events led to dose interruption/reduction in 32 participants (31%) and permanent treatment discontinuation in 7 (7%). Tissue for ROR1 IHC was available on 17 participants, with only 3 (all nonresponders) showing ROR1 expression.
CONCLUSIONS: Zilovertamab vedotin had minimal antitumor activity, with only a single responder, and manageable safety in participants with previously treated metastatic solid tumors.
SIGNIFICANCE: Zilovertamab vedotin had minimal antitumor activity and manageable safety in participants with previously treated metastatic solid tumors of various histologic subtypes. The results suggest that further development of zilovertamab vedotin in these solid tumors is not warranted
Musical auditory feedback BCI: clinical pilot study of the Encephalophone.
No full textINTRODUCTION: Therapeutic strategies for patients with severe acquired motor disability are relatively limited and show variable efficacy. Innovative technologies such as brain-computer interfaces (BCIs) have been developed recently that might benefit certain types of patients.
METHODS: Here, we tested a previously described auditory BCI, the Encephalophone, which may offer new options to improve quality of life and function. Eleven subjects with acquired moderate to severe motor disability, who had lost their ability to express themselves musically, were enrolled and 10 completed a clinical pilot study of the hands-free Encephalophone brain-computer interface (BCI). Subjects were briefly instructed on the use of the Encephalophone BCI, which uses EEG measured motor imagery to allow users to generate musical notes in real time without requiring movement. Subjects then underwent a pitch-matching task, a measure of accuracy, to attempt to match a given target pitch 3 times within 10 s. They were allowed free play, where they could improvise music over a backing track. After 2-3 songs - approximately 10 min - of freely improvised playing, subjects repeated the pitch-matching task. There were 3 sessions of testing and free play per subject, within 2 weeks, with at least 1 day separating sessions.
RESULTS: All subjects, on average, improved their pitch-matching accuracy by 15.6 percentage points and increased their number of hits by 58.7% over the 3 sessions, with all subjects scoring accuracy percentages significantly above random probability (19.05%). A subjective self-reporting survey of ratings of such factors as a feeling of expressing oneself, enjoyment, discomfort, and feeling of control showed a generally favorable response.
DISCUSSION: We suggest that this training approach using an auditory BCI may provide an innovative solution to challenges in recovery from motor disability.
CLINICAL TRIAL REGISTRATION: https://research.providence.org/clinical-research, Swedish Health Services #: STUDY2017000301
Noncardiac Pain Prevalence, Pain Intensity, Pain Interference, Sleep, and Cardiopulmonary Function in Outpatient Cardiac Rehabilitation.
No full textOBJECTIVES: To examine relationships between noncardiac pain, cardiopulmonary function, and sleep quality in the context of outpatient cardiac rehabilitation (CR). A secondary purpose was to determine whether sleep quality was predictive of pain and cardiopulmonary function.
DESIGN: A cross-sectional cohort study.
SETTING: Outpatient cardiac rehabilitation program.
PARTICIPANTS: A total of 100 participants (N=100) were enrolled.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Participants completed the Brief Pain Inventory, Pittsburgh Sleep Quality Index (PSQI), and 6-Minute Walk Test (6MWT) near CR admission. The 6MWT was completed again near CR discharge (11wk).
RESULTS: Of the 72% of participants who reported the presence of noncardiac pain, the mean (±SD) Brief Pain Inventory pain intensity was 5.04 (±2.69) at its worst, 2.06 (±2.00) at its least, and 3.67 (±1.90) on average. The mean total PSQI score was 8.81 (±4.57), and significantly greater (poorer) for those with the presence of pain (9.54±4.57) than those with the absence of pain (6.81±3.88). Those with poor sleep (total PSQI score \u3e5; sleeper status ) had greater pain intensity on all pain scales (P\u3c .05), more pain interference on all interference items (P\u3c .02), and a trend toward poorer 6MWT scores at baseline (P=.06). Total PSQI score and sleeper status each independently predicted the presence versus absence of pain (χ
CONCLUSIONS: Poor sleep and noncardiac pain are highly prevalent in CR and are therefore targets for therapeutic intervention. Poor sleep, as assessed by the PSQI, is predictive of pain and cardiopulmonary function at the initiation of CR
Outcomes of endoscopic management for upper tract urothelial carcinoma: A multi-center international cohort analysis.
No full textINTRODUCTION: Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy with significant morbidity, often requiring radical nephroureterectomy (RNU) as the standard of care. Endoscopic ablation has emerged as a kidney-sparing alternative, particularly for low-risk UTUC. Given the rarity of UTUC, generating high-quality evidence for treatment strategies remains challenging. This study presents a large, multi-institutional analysis of outcomes following primary endoscopic ablation for UTUC.
METHODS: A retrospective analysis of 432 patients across 11 institutions who underwent first-time endoscopic treatment for UTUC with curative intent between December 2003 and January 2023 was performed. Baseline demographics, tumor characteristics, and procedural details were collected. Recurrence was categorized as ipsilateral, distant, or bladder recurrence, with overall survival (OS) as the primary outcome. Univariate and multivariate Cox regression models were used to identify predictors of recurrence and survival.
RESULTS: At a median follow-up of 21 months, ipsilateral recurrence occurred in 232 patients (54%), while 55 (13%) developed distant metastases. The OS rate was 86%, with 29 patients (6.7%) dying within the first 12 months. On univariate analysis, the presence of a tumor not involving the renal pelvis (HR 0.71, P = 0.04) and use of a ureteral access sheath (UAS) (HR 0.65, P = 0.03) were associated with lower ipsilateral recurrence rates. On multivariate analysis, only UAS use remained significant (HR 0.39, P \u3c 0.01). High-grade tumors were significantly associated with poorer OS (HR 3.59, P \u3c 0.01).
CONCLUSIONS: Endoscopic ablation is a feasible kidney-sparing alternative for UTUC. Ipsilateral recurrence rate is approximately 50% with over 10% of patients developing metastatic disease. UAS use may reduce UTUC recurrence risk