bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin A-Induced Hypercalcemia in Burn Patients: A Case Study
Authors: Zeitouni Ferris , Zhu Christina , Pang Alan , O’Banion Scott , Bharadia Deepak , Griswold John
Published: July 2022

Vitamin and steroid supplementation such as oxandrolone are commonly given to speed the recovery process in severe burn injuries. Vitamin A is administered concurrently with steroids because of its pro-inflammatory and positive effects on wound healing. However, vitamin A supplementation warrants caution as hypercalcemia can result from vitamin A overdose. Our case involves an 18-year-old male injured in an oil field explosion who presented with 55% total body surface area (TBSA) partial- and full-thickness burns. Following successful resuscitation, he was given vitamin A, oxandrolone, vitamin C, and zinc sulfate as part of the standard vitamin supplementation. On hospital day (HD) 33, serum calcium levels were noted to be elevated and increased to 13 mg/dL a few days later. Parathyroid hormone and vitamin D levels were found to be within normal range, and urine analysis showed normal calcium excretion. Subsequent assessment of vitamin A levels revealed significantly elevated levels at 93 mcg/dL. Vitamin A supplementation was discontinued, and the patient was discharged on HD 42. At the 1-month follow-up, serum calcium levels were normal, which links the hypercalcemia to vitamin A overdose. This case highlights the importance of considering vitamin A overdose as a cause for asymptomatic hypercalcemia with a normal parathyroid and vitamin D workup. While routine, vitamin A supplementation in burn patients calls for assessment of both serum calcium and vitamin A levels throughout the hospital stay to prevent hypercalcemia and its negative effects.
Audiovisual Materiality and the Technopoetical Gesture in Recent Black Poetry and Performance
Authors: Rippeon Andrew
Published: July 2022

Drawing on Black posthumanist theory, I consider the related but discrete areas of performance, poetics, and audiovisual practice, contextualizing and examining the works of exploratory poet Claudia Rankine, Pulitzer Prize-winning hip-hop artist Kendrick Lamar, and poet and performer Douglas Kearney. Borrowing from and extending Louis Chude-Sokei’s ideas of “Black technopoetics” as “the self-conscious interaction of Black thinkers, writers, and sound producers with technology,” I focus on how Rankine, Lamar, and Kearney situate Black subjectivity in networks of technological and televisual mediation. With regard to Rankine, I focus on her “Situations”—short video collaborations with her partner John Lucas—and contextualizes these with reference to David Marriott and his analysis of media and surveillance. I then consider Kendrick Lamar’s music videos and their practice of sampling and self-reference within the context of Alexander Weheliye’s and Paul Miller/aka DJ Spooky that Subliminal Kid’s posthumanist theories of the voice. I conclude by attending to the work of Douglas Kearney, who combines expressive typographic forms and unconventional vocalizations in his performance practice. These analyses are situated against a backdrop of white-supremacist violence and the media spectacle of Black death—what Marriot calls “infotainment”—and I arrive at a speculative conclusion regarding the intersections of very recent AI and historical archives of Black life.
Dual-Energy, Dual-Exposure PA and Lateral Chest Radiograph: Not Your Father’s Chest X-Ray
Authors: Boswell Gilbert E , Wolfgramm Sione T , Fong Raynard K , Hawley Daniel B
Published: July 2022

In the last two decades, our military and federal health care facilities have transitioned from traditional X-rays exposing film screen systems, developed much like photographic film, to an entirely digital detection system that affords computer processing of images and digital image and report distribution. While health care providers are well aware of the practicality of these advancements, they may not be aware of the improved diagnostic capabilities afforded by these new methods. In this report, we outline how application of physical principles of X-rays, with digital detectors and computer data manipulation, can present images demonstrating chest and heart diseases that were previously not readily visible by traditional film screen systems. More recently, dual-energy, dual-exposure systems have been implemented. This commentary is to educate the medical community so that they may better understand not only the written report but the information on the images being provided, along with potential pitfalls to avoid. Specifically, we demonstrate improved detection of pulmonary nodules and coronary atherosclerosis with the dual-energy technique.
Impact of a Laboratory-Developed Phenotypic Rapid Susceptibility Test Directly From Positive Blood Cultures on Time to Narrowest Effective Therapy in Patients With Gram-Negative Bacteremia: A Prospective Randomized Trial
Authors: Christensen Alyssa B , Footer Brent , Pusch Tobias , Heath Kim , Iqbal Maha , Wang Lian , Tallman Gregory , Cover Cameron , Marfori Jennifer , Kendall Brian , Stucky Nick , Greckel Meagan , Thomas Ivor L , Tran Katelynn , Yip Salena , Oethinger Margret
Published: July 2022

Background

Antimicrobial susceptibility testing (AST) is often needed prior to antimicrobial optimization for patients with gram-negative bloodstream infections (GN-BSIs). Rapid AST (rAST) in combination with antimicrobial stewardship (AS) may decrease time to administration of narrower antibiotics.

Methods

This was a prospective, nonblinded, randomized trial evaluating the impact of a phenotypic rAST method vs conventional AST (cAST) in hospitalized patients with GN-BSI and source control. The primary outcome was time to narrowest effective therapy.

Results

Two hundred seventy-four patients were randomized and 205 underwent analysis (97 cAST, 108 rAST). Median (interquartile range [IQR]) time to susceptibility results was 23 hours shorter in the rAST group (cAST: 62 [59–67] hours vs rAST: 39 [IQR, 35–46] hours; P < .001). Median (IQR) time to narrowest effective therapy was similar between groups (cAST: 73 [44–138] hours vs rAST: 64 [42–92] hours; P = .10). Median (IQR) time to narrowest effective therapy was significantly shorter in a prespecified subgroup of patients not initially on narrowest therapy and during AS working hours (cAST: 93 [56–154] hours vs rAST: 62 [43–164] hours; P = .004). Significant decreases were observed in median (IQR) time to oral therapy (cAST: 126 [76–209] hours vs rAST: 91 [66–154] hours; P = .02) and median (IQR) length of hospital stay (cAST: 7 [4–13] days vs rAST: 5 [4–8] days; P = .04).

Conclusions

In patients with GN-BSI, rAST did not significantly decrease time to narrowest effective therapy but did decrease time to oral antibiotics and length of hospital stay. Rapid AST using existing microbiology platforms has potential to optimize patient outcomes.
Hepatitis C Virus Reinfection in People With HIV in Taiwan After Achieving Sustained Virologic Response With Antiviral Treatment: The RECUR Study
Authors: Liu Chen-Hua , Sun Hsin-Yun , Peng Cheng-Yuan , Hsieh Szu-Min , Yang Sheng-Shun , Kao Wei-Yu , Shih Yu-Lueng , Lin Chih-Lin , Liu Chun-Jen , Sheng Wang-Hui , Lo Yi-Chun , Liu Wen-Chun , Wu Jo-Hsuan , Su Tung-Hung , Tseng Tai-Chung , Chen Pei-Jer , Hung Chien-Ching , Kao Jia-Horng
Published: July 2022

Background

Data on hepatitis C virus (HCV) reinfection in East Asian people with HIV after treatment-induced sustained virologic response (SVR) are limited.

Methods

HIV/HCV-coinfected patients in Taiwan who achieved SVR12 with interferon (IFN) or direct-acting antivirals (DAAs) between 2005 and 2021 underwent HCV RNA measurements at SVR24 and then biannually. HCV reinfection was defined as the detection of different HCV strains beyond SVR12. HIV-negative, low-risk individuals with SVR12 served as reference patients. Crude reinfection rates and secular trends were assessed. Multivariate Cox regression analysis was performed to identify baseline factors associated with HCV reinfection.

Results

A total of 216 HIV-positive and 1589 reference patients were recruited, with median follow-up durations of 3.0 and 6.0 years, respectively. During a total of 772 person-years of follow-up (PYFU), the HCV reinfection rate in HIV-positive patients was 4.02 per 100 PYFU (95% CI, 2.85–5.65), while the HCV reinfection rate in reference patients was 0.14 per 100 PYFU (95% CI, 0.09–0.23) during 10 862 PYFU. HIV-positive patients had a higher risk of HCV reinfection than reference patients (hazard ratio [HR], 17.63; 95% CI, 7.10–43.80; P < .001). No baseline factors were predictive of HCV reinfection in HIV-positive patients. The incidence of HCV reinfection in HIV-positive patients increased after 2015, when DAAs were made available in Taiwan.

Conclusions

The risk of HCV reinfection remains high in HIV/HCV-coinfected patients with treatment-induced SVR12. In addition to mass screening and treatment scale-up, strategies to reduce reinfection are needed for HCV microelimination in HIV-positive patients in Taiwan.
Counterparty Risk: Implications for Network Linkages and Asset Prices
Authors: Grigoris Fotis , Hu Yunzhi , Segal Gill
Published: July 2022

We study the relation between trade credit, asset prices, and production-network linkages. Empirically, firms extending more trade credit earn 7.6$\%$ p.a. lower risk premiums and maintain longer relationships with customers. Using a production-based model, we quantitatively explain these novel facts. Trade credit reduces the departure probability of high-quality customers, thereby reducing firms’ exposures to systematic costs incurred in finding new customers. The mechanism predicts that the aggregate amount of trade credit proxies for customer-search costs and that suppliers with shorter-duration links to customers command higher expected returns. We confirm these and other novel predictions in the data.
Longitudinal changes in nailfold videocapillaroscopy findings differ by myositis-specific autoantibody in idiopathic inflammatory myopathy
Authors: Mugii Naoki , Hamaguchi Yasuhito , Horii Motoki , Fushida Natsumi , Ikeda Tomoyuki , Oishi Kyosuke , Yahata Tetsutarou , Someya Fujiko , Matsushita Takashi
Published: July 2022

Objective

To assess the longitudinal changes in nailfold videocapillaroscopy (NVC) in patients expressing myositis-specific autoantibodies [anti-aminoacyl-tRNA synthetase (ARS), anti-transcriptional intermediary factor 1 (TIF1), and anti-melanoma differentiation-associated gene 5 (MDA5)].

Methods

This study was performed retrospectively, at a single site, on an observational cohort. Seventy-one idiopathic inflammatory myopathy patients were included (25 patients expressed anti-MDA5 Abs, 24 patients expressed anti-TIF1 Abs, and 22 patients expressed anti-ARS Abs). NVC findings included giant, enlarged, and reduced capillaries, haemorrhages, capillary ramification, disorganization of the vascular array, and capillary loss. NVC findings were compared from baseline to after disease activity stabilization.

Results

The frequency of enlarged capillaries at baseline was different among the three groups, and was significantly higher in patients with anti-TIF1 Abs compared with those with anti-ARS Abs (88% vs 55%, P < 0.05). Reduced capillaries were significantly increased in patients with anti-TIF1 Abs compared with those with anti-MDA5 (96% vs 44%, P < 0.0001) or anti-ARS Abs (96% vs 50%, P < 0.0005). Both enlarged and reduced capillaries improved after stabilization in patients with anti-MDA5 Abs (P < 0.0001 and P < 0.05, respectively). These improvements were not observed in patients expressing anti-TIF1 and anti-ARS Abs. However, a significant reduction in haemorrhages was observed in all three groups (P < 0.0001 for each group).

Conclusions

The results of this study demonstrate that longitudinal changes in NVC findings may vary depending on myositis-specific Ab expression. Therefore, it is crucial to assess individual NVC findings separately, as each finding may impact disease activity in a different manner.
The effect of time on task, sleep deprivation, and time of day on simulated driving performance
Authors: Marando Isabella , Matthews Raymond W , Grosser Linda , Yates Crystal , Banks Siobhan
Published: July 2022

Sleep deprivation and time of day have been shown to play a critical role in decreasing ability to sustain attention, such as when driving long distances. However, a gap in the literature exists regarding external factors, such as workload. One way to examine workload is via modulating time on task. This study investigated the combined effect of sleep deprivation, time of day, and time on task as a workload factor on driving performance. Twenty-one participants (18–34 years, 10 females) underwent 62 h of sleep deprivation within a controlled laboratory environment. Participants received an 8-h baseline and 9.5-h recovery sleep. Every 8 h, participants completed a Psychomotor Vigilance Task (PVT), Karolinska Sleepiness Scale (KSS), 30-min monotonous driving task and NASA-Task Load Index (TLX). Driving variables examined were lane deviation, number of crashes, speed deviation and time outside the safe zone. Workload was measured by comparing two 15-min loops of the driving track. A mixed model ANOVA revealed significant main effects of day and time of day on all driving performance measures (p < .001). There was a significant main effect of workload on lane deviation (p < .05), indicating that a longer time on task resulted in greater lane deviation. A significant main effect of day (p < .001) but not time of day for the NASA-TLX, PVT and KSS was found. Time on task has a significant further impact on driving performance and should be considered alongside sleep deprivation and time of day when implementing strategies for long-distance driving.
Does leaf gas exchange correlate with petiole xylem structural traits in Ulmus laevis seedlings under well-watered and drought stress conditions?
Authors: Gebauer Roman , Urban Josef , Volařík Daniel , Matoušková Marie , Vitásek Roman , Houšková Kateřina , Hurt Václav , Pantová Petra , Polívková Terezie , Plichta Roman
Published: July 2022

Several studies have shown that petiole xylem structure could be an important predictor of leaf gas exchange capacity, but the question of how petiole xylem structure relates to leaf gas exchange under different environment conditions remains unresolved. Moreover, knowledge of the amount of leaf gas exchange and structural variation that exists within a single species is also limited. In this study, we investigated the intraspecies coordination of leaf gas exchange and petiole xylem traits in 2-year-old seedlings of Ulmus laevis Pall. under well-watered and drought conditions. It was found that all studied petiole xylem traits of the elm seedlings were positively correlated with each other. This shows that the development of petiole xylem structure is internally well-coordinated. Nevertheless, the lower correlation coefficients between some petiole xylem traits indicate that the coordination is also individually driven. Drought stress reduced all studied leaf gas exchange traits and significantly increased intraspecies variation. In addition, drought stress also shifted the relationships between physiological traits and exhibited more structure–function relationships. This indicates the importance of petiole xylem structure in dictating water loss during drought stress and could partly explain the inconsistencies between leaf structure–function relationships studied under optimal conditions. Although several structure–function traits were related, the wide ranges of correlation coefficients indicate that the internal coordination of these traits substantially differs between individual elm seedlings. These findings are very important in the context of expected climatic change, as some degree of intraspecies variation in structure–function relationships could ensure the survival of some individuals under different environmental conditions.
Profiling of phytohormones in apple fruit and buds regarding their role as potential regulators of flower bud formation
Authors: Milyaev Anton , Kofler Julian , Moya Yudelsy Antonia Tandron , Lempe Janne , Stefanelli Dario , Hanke Magda-Viola , Flachowsky Henryk , von Wirén Nicolaus , Wünsche Jens-Norbert
Published: July 2022

Apple (Malus × domestica Borkh.) cropping behavior, if not regulated, is often manifested by high yields of small-sized fruit in so called ON-years, which are usually followed by strongly reduced crop loads in OFF-years. Such cropping pattern is defined as biennial bearing and causes significant losses in apple production. The growth of apple fruit overlaps with the formation of flower buds, which remain dormant until the following spring. Earlier works proposed that some fruit-derived mobile compounds, as e.g., phytohormones, could suppress flower bud formation that thereby leads to biennial bearing. We addressed this hypothesis by analyzing 39 phytohormones in apple seeds, fruit flesh and by measuring phytohormone export from the fruits of the biennial bearing cultivar ‘Fuji’ and of the regular bearing cultivar ‘Gala’. Moreover, we analyzed the same compounds in bourse buds from fruiting (ON-trees) and non-fruiting (OFF-trees) spurs of both apple cultivars over the period of flower bud formation. Our results showed that apple fruit exported at least 14 phytohormones including indole-3-acetic acid and gibberellin A3; however, their influence on flower bud formation was inconclusive. A gibberellin-like compound, which was detected exclusively in bourse buds, was significantly more abundant in bourse buds from ON-trees compared with OFF-trees. Cultivar differences were marked by the accumulation of trans-zeatin-O-glucoside in bourse buds of ‘Gala’ ON-trees, whereas the levels of this compound in ‘Gala’ OFF were significantly lower and comparable to those in ‘Fuji’ ON- and OFF-trees. Particular phytohormones including five cytokinin forms as well as abscisic acid and its degradation products had higher levels in bourse buds from OFF-trees compared with ON-trees and were therefore proposed as potential promotors of flower bud initiation. The work discusses regulatory roles of phytohormones in flower bud formation in apple based on the novel and to date most comprehensive phytohormone profiles of apple fruit and buds.
Integrated viral elements suggest the dual lifestyle of Tetraselmis spp. Polinton-like viruses
Authors: Chase Emily E , Desnues Christelle , Blanc Guillaume
Published: July 2022

In this study, we aimed at exploring horizontal gene transfer between viruses and Chlorodendraceae green algae (Chlorophyta) using available genomic and transcriptomic sequences for twenty algal strains. We identified a significant number of genes sharing a higher sequence similarity with viral homologues, thus signalling their possible involvement in horizontal gene transfers with viruses. Further characterization showed that many of these genes were clustered in DNA regions of several tens to hundreds of kilobases in size, originally belonging to viruses related to known Tetraselmis spp. viruses (TetV and TsV). In contrast, the remaining candidate HGT genes were randomly dispersed in the algal genomes, were more frequently transcribed, and belonged to large multigene families. The presence of homologues in Viridiplantae suggested that the latter were more likely of algal rather than viral origin. We found a remarkable diversity in polinton-like virus (PLV) elements inserted in Tetraselmis genomes, all of which were most similar to the Tetraselmis striata virus (TsV). The genes of PLV elements are transcriptionally inactive with the notable exception of the homologue of the TVSG_00024 gene of TsV whose function is unknown. We suggest that this gene may be involved in a sentinel process to trigger virus reactivation and excision in response to an environmental stimulus. Altogether, these results provide evidence that TsV-related viruses have a dual lifestyle, alternating between a free viral phase (i.e. virion) and a phase integrated into host genomes.
Evaluation of Vasopressor Dose and the Incidence of Pressure Injuries in Critically Ill Patients
Authors: Holt Katlyn R. , Short Marintha R. , Berger Steven C. , McCalla Anna W.
Published: July 2022

OBJECTIVE:

To evaluate risk factors associated with vasopressor use and development of hospital-acquired pressure injuries (HAPIs).

METHODS:

The researchers conducted a retrospective chart review in a 12-bed medical ICU at a community hospital. A total of 123 patients who received a minimum of 24 hours of continuous vasopressor administration between January 2017 and January 2019 were included. The primary outcomes assessed were vasopressor dose and HAPI incidence, with a subgroup analysis based on type. Secondary outcomes included quantity of vasopressors, duration, mean arterial pressure, mechanical ventilation, time to injury, severity, and location.

RESULTS:

The overall incidence of HAPIs was 20.3%, with 17% incidence in the low-dose cohort and 22.4% in the high-dose cohort (P = .317). There were no differences in the subgroup analysis based on vasopressor type. The most common locations for injuries were the sacrum and coccyx, with the majority being stage 1 or 2 based on the National Pressure Injury Advisory Panel severity staging. No correlations were found between HAPI incidence and factors such as multiple vasopressors use, mechanical ventilation, mean arterial pressure, or duration of vasopressor administration. The documentation of time to injury was significantly shorter in the high-dose cohort compared with the low-dose cohort (157.58 vs 330.86 hours, P < .05).

CONCLUSIONS:

The incidence of HAPIs did not differ between the low- and high-dose vasopressor cohorts. However, patients who received higher doses of vasopressors had documented pressure injuries sooner than the low-dose cohort, emphasizing the importance of close monitoring for HAPIs in patients receiving vasopressors.
Rising US pregnancy-related deaths
Authors: Heavey Elizabeth
Published: July 2022

The US is the only developed country in the world with rising maternal mortality. This article discusses factors that contribute to this rise, disparities in maternal mortality, and steps nurses can take to help reverse this worsening trend.
Staff knowledge of orthostatic vital signs measurement
Authors: Schell Kathleen , Lyons Denise L.
Published: July 2022

Purpose:

To determine the nursing staff's knowledge of the proper procedure for measuring orthostatic vital signs.

Methods:

The Knowledge of Orthostatic Vital Signs Survey was sent via email to direct staff on 31 patient-care units in a large hospital system.

Results:

Eighty percent of the participants were RNs and 12% were unlicensed assistants. Survey results showed that many respondents did not know how to properly size the cuff and were uncertain about the timing of measurements with position changes. Fifty-seven percent of respondents did not correctly identify abnormal findings with regard to the systolic BP, but 80% were aware of the diastolic BP drop in orthostatic hypotension.

Conclusion:

This survey identified gaps in the staff's knowledge about the proper procedure for measuring orthostatic vital signs.
Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder
Authors: French Rachel , McHugh Matthew D. , Aiken Linda H. , Compton Peggy , Meghani Salimah H. , Brooks Carthon J. Margo
Published: July 2022

Objectives:

To determine whether better nursing resources (ie, nurse education, staffing, work environment) are each associated with improved postsurgical outcomes for patients with opioid use disorder (OUD).

Background:

Hospitalized patients with OUD are at increased risk of adverse outcomes. Evidence suggests that adverse postsurgical outcomes may be mitigated in hospitals with better nursing resources, but this has not been evaluated among surgical patients with OUD.

Methods:

Cross-sectional (2015–2016) data were utilized from the RN4CAST-US survey of hospital nurses, the American Hospital Association Annual Survey of hospitals, and state patient hospital discharge summaries. Multivariate logistic and zero-truncated negative binomial regression models were employed to examine the association between nursing resources and 30-day readmission, 30-day in-hospital mortality, and length of stay for surgical patients with OUD.

Results:

Of 919,601 surgical patients in 448 hospitals, 11,610 had identifiable OUD. Patients with compared to without OUD were younger and more often insured by Medicaid. Better nurse education, staffing, and work environment were each associated with better outcomes for all surgical patients. For patients with OUD, each 10% increase in the proportion of nurses with a bachelor’s degree in nursing was associated with even lower odds of 30-day readmission (odds ratio [OR] = 0.88; P = 0.001), and each additional patient-per-nurse was associated with even lower odds of 30-day readmission (OR = 1.09; P = 0.024).

Conclusions:

All surgical patients fare better when cared for in hospitals with better nursing resources. The benefits of having more nurses with a bachelor’s degree and fewer patients-per-nurse in hospitals appear greater for surgical patients with OUD.
Sagittal Balance Using Position and Orientation of Each Vertebra in an Asymptomatic Population
Authors: Gille Olivier , Skalli Wafa , Mathio Paul , Kouyoumdjian Pascal , Boishardy Alice , Gajny Laurent , Roscop Cecile
Published: July 2022

Study Design.

A monocentric, retrospective radiographic study with 99 asymptomatic volunteers.

Objective.

The authors performed the postural analysis commonly scheduled when evaluating sagittal balance in a vertebra-by-vertebra manner by enrolling an asymptomatic population. They measured the position and angulation of each vertebra to reveal those for which the spatial positioning could be relevant during spinal surgeries.

Summary of Background Data.

Several recent publications detailed the sagittal alignment parameters and focus on global analysis parameters. Some patients with identical commonly evaluated spinal parameters have exhibited very different profiles, with notable differences in vertebral positions and orientations. Therefore, a fine segmental analysis of position of each vertebra could be interest to gain understanding of spine alignment.

Materials and Methods.

The authors obtained full-spine EOS x-rays of 99 volunteers in the standard free-standing position. We used a validated three-dimensional reconstruction technique to extract current spinal parameters and the positions and angulations of all vertebrae and lumbar discs. Particular attention was paid to the positions and angulations of the apical and transitional vertebrae in the general population and in subgroups according to pelvic incidence (PI).

Results.

T1 was the most common transitional cervicothoracic vertebra (in 89.9% of subjects) and was oriented downwards by an average of 22.0° (SD=7.3°, minimum=2.3°, maximum=40.1°). The thoracic apex trio of T5 (22.2%), T6 (28.3%), and T7 (36.4%) were equally found. The transitional thoracolumbar vertebrae were L1 (39.4%) and T12 (33.3%). The lumbar apex was usually the L3-L4 disc (36.4%). T1 seemed to be the transitional vertebra (90%) irrespective of the PI. For the other relevant vertebrae, the greater the PI, the more cranial the vertebra.

Conclusions.

We performed a detailed three-dimensional assessment of overall spinal balance using positional and rotational parameters. The positions and orientations of all vertebrae were specified, particularly the apical and transitional vertebrae.

Level of Evidence.

Level 3.
A New Automated AI-Assisted System to Assess Cervical Disc Herniation
Authors: Fu Su , Zhang Chunlin , Yan Xu , Li Dongzhe , Wang Yongkui , Dong Chao , Cao Zhengming , Ning Yongming , Shao Chenglong , Yang Tengyue
Published: July 2022

Study Design.

An algorithm was developed with MATLAB platform to automatically quantify the volume of cervical disc herniation (CDH) based on the sagittal magnetic resonance images. This automated program was used for CDH data set, and then compared with manual measurement results confirming its reliability.

Objective.

The aim was to develop a new software for automated CDH volume measurement.

Summary of Background Data.

CDH compresses the spinal cord, regarding as the leading cause of cervical myelopathy. However, the CDH volume, of great value to clinical symptoms, can be only manually measured with no-excellent but acceptable interobserver reliability. This was due to the manual error of outlining CDH area and inclusion of structure posterior vertebra. No studies has proposed such an automated algorithm of CDH volume quantification which is standardised to quantify the accurate volume of CDH thus helping doctors easily evaluate CDH progressing.

Methods.

The algorithm of CDH volume measurement was proposed. This program was then tested for 490 CDHs data set, from 185 patients with two repeated magnetic resonance imaging detections. Three individual observers manually measured the volumes of these CDHs, to justify the accuracy of this software. CDH volume was either in the classic way or the revised way excluding the influence of structure posterior vertebra.

Results.

The automated software was successfully developed on MATLAB platform, with no difference found with manual measurements (average level) in CDH volume measurement. The change ratios in CDH volumes were profoundly consistent with manual observation, showing the error of 5.8% in median. The revised method elevated the absolute value of ratio by amplifying the percentage change.

Conclusion.

Our developed automated volumetry system was an standardized and accurate way, with selective removal module of structure posterior vertebra, replaceable for manual volume measurement of CDH, which was useful for spinal surgeons diagnosing and treating CDH disease.
Step Count in Patients With Lumbar Spinal Stenosis
Authors: Gustafsson Malin E.a.K. , Schiøttz-Christensen Berit , Wedderkopp Niels , Brønd Jan C.
Published: July 2022

Study Design.

This is a method development and validation study.

Objectives.

The purpose of this study was to develop and test a method for step detection using accelerometer data in patients with lumbar spinal stenosis (LSS). There are 2 objectives: (1) to describe a method for step detection from accelerations measured at the wrist, hip, lower back, thigh and ankle; (2) to assess the accuracy of the method during walking with and without walking aids and during nonwalking activities.

Summary of Background Data.

Loss of walking ability is one of the main symptoms of LSS, and there is no validated measure to assess walking activity in daily living in patients with LSS.

Materials and Methods.

Thirty patients with LSS performed a standardized movement protocol that included walking with and without walking aids and performing nonwalking activities while wearing accelerometers on five different wear-sites. After the walking tests, a method was designed for optimal step detection and compared with a gold standard of observed step count.

Results.

The method for step detection applied to accelerations from the lower back, hip, thigh, and ankle provided an accurate step counts during continuous walking without walking aids. Accuracy diminished at all wear-sites when walking with walking aids, except the ankle. The wrist provided the most inaccurate step count, and the accelerometers on the thigh and ankle were prone to falsely detecting steps during bicycling.

Conclusion.

The ankle-worn accelerometer provided the most accurate step count, but wrongly registered steps during nonwalking activities. The developed step detection method shows potential as a measure of walking activity why further development and testing under free-living conditions should be performed.
Outcomes Following Direct Versus Indirect Decompression Techniques for Lumbar Spondylolisthesis
Authors: McKeithan Lydia J. , Romano Joseph W. , Waddell William H. , Steinle Anthony M. , Pennings Jacquelyn S. , Nian Hui , Archer Kristin R. , Bydon Mohamad , Knightly John , Abtahi Amir M. , Zuckerman Scott L. , Stephens Byron F.
Published: July 2022

Study Design.

Retrospective review.

Objective.

The aim was to compare outcomes at 3 and 12 months for patients with lumbar spondylolisthesis treated with direct decompression (DD) versus indirect decompression (ID) techniques.

Summary of Background Data.

Debate persists regarding the optimal surgical strategy to treat lumbar spondylolisthesis. Novel techniques relying on ID have shown superior radiographic outcomes compared to DD, however, doubt remains regarding their effectiveness in achieving adequate decompression. Currently, there is a paucity of data comparing the clinical efficacy of DD to ID.

Methods.

The Quality Outcomes Database (QOD), a national, multicenter prospective spine registry, was queried for patients who underwent DD and ID between April 2013 and January 2019. Propensity scores for each treatment were estimated using logistic regression dependent on baseline covariates potentially associated with outcomes. The propensity scores were used to exclude nonsimilar patients. Multivariable regression analysis was performed with the treatment and covariate as independent variables and outcomes as dependent variables.

Results.

A total of 4163 patients were included in the DD group and 86 in the ID group. The ID group had significantly lower odds of having a longer hospital stay and for achieving 30% improvement in back and leg pain at 3 months. These trends were not statistically significant at 12 months. There were no differences in ED5D scores or Oswestry disability index 30% improvement scores at 3 or 12 months. ID patient had a significantly higher rate of undergoing a repeat operation at 3 months (4.9% vs. 1.5%, P=0.015).

Conclusion.

Our study suggests that both DD and ID for the treatment of lumbar spondylolisthesis result in similar clinical outcomes, with the exception that those treated with ID experienced a lower reduction in back and leg pain at 3 months and a higher 3-month reoperation rate. This data can provide surgeons with additional information when counseling patients on the pros and cons of ID versus DD surgery.
Cervical Sagittal Alignment in Patients with Basilar Invagination
Authors: Zhou Yang , Hou Juedong , Xiao Ruipei , Zheng Jintao , Zou Xiaobao , Zhu Yongjian , Yao Ling , Chen Jianting , Ma Xiangyang , Yang Jincheng
Published: July 2022

Study Design.

Retrospective study.

Objective.

To present a morphological map of cervical sagittal alignment in basilar invagination (BI), a congenital anomaly of the craniovertebral junction (CVJ), and contribute to a comprehensive understanding of cervical sagittal alignment in congenital cervical deformities.

Summary of Background Data.

Ideal cervical sagittal alignment and surgical targets are debated by scholars. However, most of the literature focuses on the description of cervical sagittal alignment in acquired cervical diseases and normal subjects and few on congenital cervical spine deformities.

Methods.

This study analyzed cervical spine lateral radiographs of 87 BI patients and 98 asymptomatic subjects. They were analyzed for cranial, cervical spine, and thoracic inlet parameters.

Results.

Patients with BI manifested significantly larger values for the following parameters than asymptomatic subjects: cranial tilt, cranial incidence angle, SVA CGH-C7, C2-C7 angle, cervical tilt, and significantly smaller values for the following parameters: cranial slope, C0-C2 angle, C0-C7 angle, SVA C2-C7, spine tilt, TIA, and neck tilt. In the BI group, SVA C2-C7 was the cervical parameter most strongly correlated with the cranial, cervical spine, and thoracic inlet parameters, and was smaller in BI patients with fusion (atlanto-occipital assimilation) than in those without.

Conclusion.

A significant difference was observed between BI patients and asymptomatic subjects. BI patients have craniums tilted forward and downward, smaller upper cervical lordosis, larger lower cervical lordosis, and smaller thoracic inlet angle. In BI patients, the SVA C2-C7 is an important parameter in cervical sagittal alignment. In both individuals with congenital anomalies of the CVJ and the asymptomatic population, cervical spine alignment is significantly associated with cranial alignment, particularly thoracic inlet alignment.
A Short-Term Assessment of Lumbar Sagittal Alignment Parameters in Patients Undergoing Anterior Lumbar Interbody Fusion
Authors: Lambrechts Mark J. , Siegel Nicholas , Karamian Brian A. , Fredericks Donald J. , Curran John , Safran Jordan , Canseco Jose A. , Woods Barrett I. , Kaye David , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: July 2022

Study Design.

Retrospective cohort.

Objective.

To determine if intraoperative on-table lumbar lordosis (LL) and segmental lordosis (SL) coincide with perioperative change in lordosis.

Summary of Background Data.

Improvements in sagittal alignment are believed to correlate with improvements in clinical outcomes. Thus, it is important to establish whether intraoperative radiographs predict postoperative improvements in LL or SL.

Materials and Methods.

Electronic medical records were reviewed for patients ≥18 years old who underwent single-level and two-level anterior lumbar interbody fusion with posterior instrumentation between 2016 and 2020. LL, SL, and the lordosis distribution index were compared between preoperative, intraoperative, and postoperative radiographs using paired t tests. A linear regression determined the effect of subsidence on SL and LL.

Results.

A total of 118 patients met inclusion criteria. Of those, 75 patients had one-level fusions and 43 had a two-level fusion. LL significantly increased following on-table positioning [delta (Δ): 5.7°, P<0.001]. However, LL significantly decreased between the intraoperative to postoperative radiographs at two to six weeks (Δ: −3.4°, P=0.001), while no change was identified between the intraoperative and more than three-month postoperative radiographs (Δ: −1.6°, P=0.143). SL was found to significantly increase from the preoperative to intraoperative radiographs (Δ: 10.9°, P<0.001), but it subsequently decreased at the two to six weeks follow up (Δ: −2.7, P<0.001) and at the final follow up (Δ: −4.1, P<0.001). On linear regression, cage subsidence/allograft resorption was predictive of the Δ SL (β=0.55; 95% confidence interval: 0.16–0.94; P=0.006), but not LL (β=0.10; 95% confidence interval: −0.44 to 0.65; P=0.708).

Conclusion.

Early postoperative radiographs may not accurately reflect the improvement in LL seen on intraoperative radiographic imaging, but they are predictive of long-term lumbar sagittal alignment. Each millimeter of cage subsidence or allograft resorption reduces SL by 0.55°, but subsidence does not significantly affect LL.

Levels of Evidence:

4
A Modified Anterior Column Realignment With Partial Anterior Longitudinal Ligament Release in Oblique Lateral Interbody Fusion
Authors: Jeon Jong-Min , Chung Hee-Woong , Lee Han-Dong , Jeon Chang-Hoon , Chung Nam-Su
Published: July 2022

Study Design.

Retrospective radiological analysis.

Objective.

To demonstrate the radiological outcome after a modified anterior column realignment (mACR) with partial anterior longitudinal ligament (ALL) release in oblique lateral interbody fusion (OLIF).

Summary of Background Data.

Anterior column realignment (ACR) remains a powerful sagittal correction technique in minimally invasive adult spinal deformity surgery and is often combined with posterior column osteotomy (PCO) to achieve more lordosis. OLIF is ideal for ACR because the anterior-to-psoas corridor typically involves the anterolateral half of the disk.

Methods.

This study included 112 operated disk levels of 101 consecutive patients who underwent OLIF between L2–L3 and L4–L5 using a 12° lateral cage. The mACR was performed at 73 (65.2%) levels with 30% to 50% sectioning of the ALL. Each operated level was grouped according to the mACR and additional PCO as: (1) no mACR, OLIF only (n=39); (2) mACR with no PCO (n=18); (3) mACR with grade 1 PCO (n=27); (4) mACR with grade 2 PCO (n=22); or (5) mACR with grade 3 PCO (n=6).

Results.

At the last follow-up, the mean disk lordotic angles were 10.9±2.9°, 12.6±3.0°, 13.3±3.9°, 16.7±3.2°, and 16.8±2.4° in the no mACR, mACR with no PCO, mACR with grade 1 PCO, mACR with grade 2 PCO, and mACR with grade 3 PCO groups, respectively (P<0.001). The mean increases in disk lordotic angle were 5.8±4.1°, 12.1±6.1°, 13.5±8.7°, 15.8±6.7°, and 17.9±6.2° in each group, respectively (P<0.001).

Conclusions.

ACR can be performed with partial ALL release under direct vision in OLIF without deep dissection into the ventral disk space. The mACR in OLIF is a simple, safe, and effective technique for anterior column lengthening.

Level of Evidence:

4.
Using Qualitative Synthesis to Explore Heterogeneity of Randomized Trials on ICU Diaries*
Authors: Brandao Barreto Bruna , Luz Mariana , Gusmao-Flores Dimitri
Published: July 2022

Objective:

We aimed to identify which set of components differentiates the ICU diaries that were effective in reducing psychologic symptoms after critical illness.

Data Sources:

We searched the online databases MEDLINE, OVID, Embase, and EBSCOhost from inception to December 2021.

Study Selection:

Randomized controlled trials (RCTs) of the ICU diary were included, irrespective of the language, with samples of adult patients (≥ 18 yr old) and/or their relatives hospitalized in an ICU for more than 24 hours. Two qualitative syntheses on patients’ and healthcare providers’ perceptions on the ICU diary were included.

Data Extraction:

Four findings were extracted from the qualitative synthesis of patients’ perspectives on the ICU diary. From the RCTs, we extracted the components of the ICU diary and whether the patients were ventilated for at least 3 days. We reported the outcome as effective or not, regardless of the psychiatric symptoms and diagnostic tools used for evaluation. We built a matrix in which each column represented a recommendation for an intervention component derived from the qualitative review, and each row represented whether the components of an individual trial’s intervention matched any of the recommendations.

Data Synthesis:

Eight RCTs were included in the final analysis. The sample of five studies consisted of patients under mechanical ventilation (MV) for at least 3 days. Two were positive trials. Three RCTs included family members, and two of those were positive trials.

CONCLUSIONS:

For patients under MV for at least 3 days, the ICU diaries that were effective in preventing psychiatric symptoms after critical illness were written by the ICU staff, delivered after hospital discharge, and read with a healthcare professional in order to better understand the diary and the ICU stay. For family members, the presence of photographs was the only characteristic identified a successful ICU diary.
Current status and prospects of hematopoietic stem cell transplantation in China
Authors: Wang Xiaoqi , Huang Ruihao , Zhang Xiaohui , Zhang Xi
Published: July 2022

Hematopoietic stem cell transplantation (HSCT) is a highly effective and unique medical procedure for the treatment of most hematological malignancies. The first allogeneic transplantation was performed by E. Donnall Thomas in 1957. Since then, the field has evolved and expanded worldwide. The first successful allogenic HSCT (allo-HSCT) in China was conducted in 1981. Although the development of allo-HSCT in China lagged, China has since made considerable contributions to the process of HSCT worldwide, with more than 10,000 HSCTs performed annually. In particular, haploid HSCT (haplo-HSCT) technology represented in the Beijing Protocol has demonstrated similar efficacy to human leukocyte antigen-matched HSCT and has gradually become the pre-dominant choice for allo-HSCT in China. Currently, the number of haplo-HSCT procedures exceeds 5000 per year, and the Beijing Protocol has been greatly improved by implementing updated individualized strategies for controlling complications, relapse, and infection management. In addition, innovative haplo-HSCT technologies developed by different medical transplantation centers, such as Soochow, Zhejiang, Fujian, Chongqing, and Anhui, have emerged, providing inspiration for the refinement of global practice. This review will focus on the current activity in this field and highlight important trends that are vital in China's allo-HSCT process, examining the current viewpoint and future directions.
Image-Enhanced Endoscopy Surveillance of Colon and Pouch Dysplasia in IBD
Authors: Parigi Tommaso Lorenzo , Nardone Olga Maria , Iacucci Marietta
Published: July 2022

BACKGROUND:

Patients with longstanding ulcerative colitis and Crohn’s colitis are at risk for developing colorectal cancer and need regular endoscopic surveillance to detect and remove precursor lesions. To do so, different technologies are available.

DATA SOURCES:

The sources are observational and controlled studies, meta-analysis, and expert consensus articles available on PubMed.

STUDY SELECTION:

The selected materials include articles reporting outcomes of and recommendations on endoscopic surveillance and resection of dysplasia in the gastrointestinal tract, including the ileoanal pouch and the anal transition zone, in patients with inflammatory bowel disease.

MAIN OUTCOME MEASURES:

Incidence and detection rate of dysplasia and cancer with different endoscopic techniques in patients with inflammatory bowel disease.

RESULTS:

Risk of cancer is proportional to the duration and extent of the disease, and surveillance interval should be tailored on the individual risk in a range of 1 to 5 years. High-definition imaging and virtual chromoendoscopy have improved the detection of dysplasia and are now comparable with conventional dye spray chromoendoscopy. After restorative proctocolectomy with ileoanal pouch, the risk of cancer is modest, but its high mortality warrants endoscopic surveillance. The evidence to guide pouch surveillance is limited, and recently, the first expert consensus provided a framework of recommendations, which include an initial assessment 1 year after surgery and follow-up depending on individual risk factors.

LIMITATIONS:

The limitation includes scarcity of data on ileoanal pouch surveillance.

CONCLUSIONS:

Virtual chromoendoscopy and high-definition imaging have improved endoscopic surveillance, and more progress is expected with the implementation of artificial intelligence systems.
Fetal Growth Restriction: Mechanisms, Epidemiology, and Management
Authors: Kamphof Hester D. , Posthuma Selina , Gordijn Sanne J. , Ganzevoort Wessel
Published: July 2022

Fetal growth restriction (FGR) is the condition in which a fetus does not reach its intrinsic growth potential and in which the short-term and long-term risks of severe complications are increased. FGR is a frequent complication of pregnancy with a complex etiology and limited management options, other than timely delivery. The most common pathophysiological mechanism is placental insufficiency, due to many underlying causes such as maternal vascular malperfusion, fetal vascular malperfusion and villitis.

Identifying truly growth restricted fetuses remains challenging. To date, FGR is often defined by a cut-off of the estimated fetal weight below a certain percentile on a population-based standard. However, small fetal size as a single marker does not discriminate adequately between fetuses or newborns that are constitutionally small but healthy and fetuses or newborns that are growth restricted and thus at risk for adverse outcomes. In 2016, the consensus definition of FGR was internationally accepted to better pinpoint the FGR population.

In this review we will discuss the contemporary diagnosis and management issues. Different diagnostic markers are considered, like Doppler measurements, estimated fetal growth, interval growth, fetal movements, biomarkers, and placental markers.