bluuebunny/crossref_metadata_2025 huggingface dataset:
When national identity meets conspiracies: the contagion of national identity language in public engagement and discourse about COVID-19 conspiracy theories
Authors: Chen Anfan , Chen Kaiping , Zhang Jingwen , Meng Jingbo , Shen Cuihua
Published: December 2022

There are growing concerns about the role of identity narratives in spreading misinformation on social media, which threatens informed citizenship. Drawing on the social identity model of deindividualization effects (SIDE) and social identity theory, we investigate how the use of national identity language is associated with the diffusion and discourse of COVID-19 conspiracy theories on Weibo, a popular social media platform in China. Our results reveal a pattern of identity communication contagion in public conversations about conspiracies: national identity language usage in original posts is associated with more frequent use of such language in all subsequent conversations. Users who engaged in discussions about COVID-19 conspiracies used more national identity expressions in everyday social media conversations. By extending the SIDE model and social identity theory to misinformation studies, our article offers theoretical and empirical insight into how identity–contagious communication might exacerbate public engagement with misinformation on social media in non-Western contexts.
The Preference for Spontaneity in Entertainment
Authors: Rifkin Jacqueline R , Du Katherine M , Cutright Keisha M
Published: December 2022

Whether watching a movie, sports game, or musical performance, consumers often seek entertainment experiences that are produced by one or more individuals. And although consumers often witness producers acting spontaneously, little is known about the preference for spontaneity in entertainment. Six studies, including real consumer-relevant decisions and a Facebook field experiment, reveal that consumers prefer spontaneity (vs. planned behavior) across several entertainment contexts, as spontaneous producers seem more authentic than planned producers. At the same time, however, spontaneous actions are also believed to beget lower-quality outcomes, suggesting that consumers generally prefer spontaneity even despite the possibility of reduced quality. Subsequent experiments examine the characteristics of the entertainment context and the producer to provide further insight into how consumers manage the authenticity–quality tradeoff: by shaping when and why spontaneity is associated with increased authenticity and decreased quality expectations, as well as the relative importance of these dimensions, higher-stakes contexts (e.g., when consumers’ outcomes are enmeshed with the producer’s), negative inferences about spontaneity (e.g., laziness, lack of concern), and low-competence producers attenuate the effects. Together, this research advances knowledge about spontaneity and authenticity and has implications for those seeking to produce appealing entertainment experiences.
Influence of Wireworm Diet on its Susceptibility to and Control With the Entomopathogenic FungusMetarhizium brunneum(Hypocreales: Clavicipitaceae) in Laboratory and Field Settings
Authors: Reinbacher Lara , Praprotnik Eva , Razinger Jaka , Bacher Sven , Grabenweger Giselher
Published: December 2022

Entomopathogenic fungi (EPF) represent promising control agents against wireworms but success in field experiments is inconsistent. The physiological condition of the targeted insect is crucial for its ability to withstand fungal infection. In particular, nutritional status is among the most important determinants of the insects’ immune defense. In this study, we investigated the effects of diet on the development of the wireworm Agriotes obscurus (L.) (Coleoptera: Elateridae) and its subsequent susceptibility to the fungal pathogen Metarhizium brunneum (Petch) (Hypocreales: Clavicipitaceae) in a pot experiment. After being reared on one of five plant diets for eight weeks, wireworms were exposed to an environment inoculated with the EPF and monitored for their susceptibility to fungal infection. We then performed a field experiment in which three plant diets (clover, radish, and a cover crop mix), selected according to the insects’ performance in the laboratory experiment, were grown as a cover crop with EPF application. Plant diet influenced growth and development of larvae, but there were no strong differences in susceptibility toward fungal infection in the laboratory experiment. Damage levels in EPF-treated plots in the field varied depending on the cover crop. Damage was highest in plots planted with a mix of cover crop species, whereas damage was lowest in plots with clover or radish alone. This agrees with the laboratory results where insect performance was inferior when fed on clover or radish. Cover crop effects on wireworm damage in the subsequent cash crop may thus vary depending on the cover crop species selected.
A reduction-based cut-free Gentzen calculus for dynamic epistemic logic
Authors: Wirsing Martin , Knapp Alexander
Published: December 2022

Dynamic epistemic logic (DEL) is a multi-modal logic for reasoning about the change of knowledge in multi-agent systems. It extends epistemic logic by a modal operator for actions which announce logical formulas to other agents. In Hilbert-style proof calculi for DEL, modal action formulas are reduced to epistemic logic, whereas current sequent calculi for DEL are labelled systems which internalize the semantic accessibility relation of the modal operators, as well as the accessibility relation underlying the semantics of the actions. We present a novel cut-free ordinary sequent calculus, called $ \textbf{G4}_{P,A}[] $, for propositional DEL. In contrast to the known sequent calculi, our calculus does not internalize the accessibility relations, but—similar to Hilbert style proof calculi—action formulas are reduced to epistemic formulas. Since no ordinary sequent calculus for full S5 modal logic is known, the proof rules for the knowledge operator and the Boolean operators are those of an underlying S4 modal calculus. We show the soundness and completeness of $ \textbf{G4}_{P,A}[] $ and prove also the admissibility of the cut-rule and of several other rules for introducing the action modality.
Circadian clock control of MRTF/SRF pathway suppresses beige adipocyte thermogenic recruitment
Authors: Xiong Xuekai , Li Weini , Liu Ruya , Saha Pradip , Yechoor Vijay , Ma Ke
Published: December 2022

The morphological transformation of adipogenic progenitors into mature adipocytes requires dissolution of actin cytoskeleton with loss of myocardin-related transcription factor (MRTF)/serum response factor (SRF) activity. Circadian clock confers temporal control in adipogenic differentiation, while the actin cytoskeleton–MRTF/SRF signaling transduces extracellular physical niche cues. Here, we define a novel circadian transcriptional control involved in actin cytoskeleton–MRTF/SRF signaling cascade that modulates beige fat thermogenic function. Key components of actin dynamic–MRTF/SRF pathway display circadian regulation in beige fat depot. The core clock regulator, brain and muscle arnt-like 1 (Bmal1), exerts direct transcriptional control of genes within the actin dynamic–MRTF/SRF cascade that impacts actin cytoskeleton organization and SRF activity. Employing beige fat-selective gene-targeting models together with pharmacological rescues, we further demonstrate that Bmal1 inhibits beige adipogenesis and thermogenic capacity in vivo via the MRTF/SRF pathway. Selective ablation of Bmal1 induces beigeing with improved glucose homeostasis, whereas its targeted overexpression attenuates thermogenic induction resulting in obesity. Collectively, our findings identify the clock–MRTF/SRF regulatory axis as an inhibitory mechanism of beige fat thermogenic recruitment with significant contribution to systemic metabolic homeostasis.
Gender differences and similarities in news media effects on political candidate evaluations: a meta-analysis
Authors: Rohrbach Tobias , Aaldering Loes , Van der Pas Daphne Joanna
Published: December 2022

How do different types of media coverage shape—and potentially bias—voter evaluations of women and men politicians? Theoretically reviewing 50 experimental studies and statistically synthesizing 671 evaluation outcomes from more than 23,000 participants, this meta-analytic review shows that gender bias in media-induced voter evaluations is conditional rather than universal. Our findings suggest that voters respond similarly to most media messages about women and men candidates. When gender-differentiated media effects are found, for instance, based on trait, appearance, or family coverage of politicians, this is mostly harmful for women candidates as it reaffirms gender stereotypical beliefs and lowers their viability ratings and vote preferences. Shedding light on the conditional nature of media-driven voter bias, this study adds to a better understanding of how the mediation of gender stereotypes sustains the underrepresentation of women in politics.
The nonlinear change in pollinator assemblages and self-mating syndromes ofPrimula atrodentataalong elevation gradients
Authors: Ma Yin-Mei , Cha Yong-Peng , Tong Zhao-Li , Zhang Jie , Li Qing-Jun
Published: December 2022

The reproductive strategies of alpine plants are often altered by environmental changes caused by changes in the spatial distribution of the gradient. However, few studies have investigated whether reproductive patterns of the same species vary with elevation. Three natural populations of Primula atrodentata, which are distributed in the eastern Himalayas and have a long flowering period, were selected along the elevation gradients in Shergyla Mountain, Tibet, China. Morph ratio investigation, floral trait measurement, pollinator observation and manipulated pollination experiments were conducted to explore the changes in self-compatibility and floral traits associated with the selfing syndrome along elevation gradients. We found that the breeding system of the S-morph is facultative outcrossing, and that of the L-morph is obligatory outcrossing. We further found that with increasing elevation, the number of pollen and ovules, anther–stigma distance, and inbreeding depression index first increased and then decreased, whereas the seeds per fruit and seed-setting rate under hand self-pollination, pollen limitation and self-incompatibility index tended to decrease first, but then increased. In addition, pollinator diversity and visiting frequency were the highest at the middle elevation (4050 population), which can better explain the nonlinear change in self-fertility with elevation. Our findings provide insights into the evolutionary pattern of self-compatibility in alpine plants along elevational gradients.
Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997–2019
Authors: Morton Zoey P , Christina Mehta C , Wang Tingyu , Palella Frank J , Naggie Susanna , Golub Elizabeth T , Anastos Kathryn , French Audrey L , Kassaye Seble , Taylor Tonya N , Fischl Margaret A , Adimora Adaora A , Kempf Mirjam-Colette , Tien Phyllis C , Ofotokun Ighovwerha , Sheth Anandi N , Collins Lauren F
Published: December 2022

Background

To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997–2019).

Methods

We included WWH with ≥2 plasma HIV-1 viral loads (VL) <200 copies/mL within a 2-year period (baseline) following self-reported ART use. Primary outcome was multimorbidity (≥2 nonacquired immune deficiency syndrome comorbidities [NACM] of 5 total assessed). The trapezoidal rule calculated viremia copy-years (VCY) as area-under-the-VL-curve. Cox proportional hazard models estimated the association of time-updated cumulative VCY with incident multimorbidity and with incidence of each NACM, adjusting for important covariates (eg, age, CD4 count, etc).

Results

Eight hundred six WWH contributed 6368 women-years, with median 12 (Q1–Q3, 7–23) VL per participant. At baseline, median age was 39 years, 56% were Black, and median CD4 was 534 cells/mm3. Median time-updated cumulative VCY was 5.4 (Q1–Q3, 4.7–6.9) log10 copy-years/mL. Of 211 (26%) WWH who developed multimorbidity, 162 (77%) had incident hypertension, 133 (63%) had dyslipidemia, 60 (28%) had diabetes, 52 (25%) had cardiovascular disease, and 32 (15%) had kidney disease. Compared with WWH who had time-updated cumulative VCY <5 log10, the adjusted hazard ratio of multimorbidity was 1.99 (95% confidence interval [CI], 1.29–3.08) and 3.78 (95% CI, 2.17–6.58) for those with VCY 5–6.9 and ≥7 log10 copy-years/mL, respectively (P < .0001). Higher time-updated cumulative VCY increased the risk of each NACM.

Conclusions

Among ART-treated WWH, greater cumulative viremia increased the risk of multimorbidity and of developing each NACM, and hence this may be a prognostically useful biomarker for NACM risk assessment in this population.
Avelumab Plus Axitinib as First-Line Therapy for Advanced Renal Cell Carcinoma: Long-Term Results from the JAVELIN Renal 100 Phase Ib Trial
Authors: Larkin James , Oya Mototsugu , Martignoni Marcella , Thistlethwaite Fiona , Nathan Paul , Ornstein Moshe C , Powles Thomas , Beckermann Kathryn E , Balar Arjun V , McDermott David , Gupta Sumati , Philips George K , Gordon Michael S , Uemura Hirotsugu , Tomita Yoshihiko , Wang Jing , Michelon Elisabete , di Pietro Alessandra , Choueiri Toni K
Published: December 2022

Background

Progression-free survival was significantly longer in patients who received avelumab plus axitinib versus sunitinib as first-line treatment for advanced renal cell carcinoma (aRCC) in a randomized phase III trial. We report long-term safety and efficacy of avelumab plus axitinib as first-line treatment for patients with aRCC from the JAVELIN Renal 100 phase Ib trial (NCT02493751).

Materials and Methods

In this open-label, multicenter, phase Ib study, patients with untreated aRCC received avelumab 10 mg/kg every 2 weeks plus axitinib 5 mg twice daily or with axitinib for 7 days followed by avelumab plus axitinib. Safety and efficacy were assessed in all patients receiving at least one dose of avelumab or axitinib.

Results

Overall, 55 patients were enrolled and treated. Median follow-up was 55.7 months (95% CI, 54.5-58.7). Treatment-related adverse events of any grade or grade ≥3 occurred in 54 (98.2%) and 34 (61.8%) patients, respectively. The confirmed objective response rate was 60.0% (95% CI, 45.9-73.0), including complete response in 10.9% of patients. Median duration of response was 35.9 months (95% CI, 12.7-52.9); the probability of response was 65.8% (95% CI, 46.7-79.4) at 2 years. Median progression-free survival was 8.3 months (95% CI, 5.3-32.0). Median overall survival was not reached (95% CI, 40.8-not estimable); the 5-year overall survival rate was 57.3% (95% CI, 41.2-70.5).

Conclusion

Five-year follow-up for combination treatment with avelumab plus axitinib in previously untreated patients with aRCC showed long-term clinical activity with no new safety signals, supporting use of this regimen within its approved indication in clinical practice (Clinicaltrials.gov NCT02493751).
A sorghum ascorbate peroxidase with four binding sites has activity against ascorbate and phenylpropanoids
Authors: Zhang Bixia , Lewis Jacob A , Vermerris Wilfred , Sattler Scott E , Kang ChulHee
Published: December 2022

In planta, H2O2 is produced as a by-product of enzymatic reactions and during defense responses. Ascorbate peroxidase (APX) is a key enzyme involved in scavenging cytotoxic H2O2. Here, we report the crystal structure of cytosolic APX from sorghum (Sorghum bicolor) (Sobic.001G410200). While the overall structure of SbAPX was similar to that of other APXs, SbAPX uniquely displayed four bound ascorbates rather than one. In addition to the ɣ-heme pocket identified in other APXs, ascorbates were bound at the δ-meso and two solvent-exposed pockets. Consistent with the presence of multiple binding sites, our results indicated that the H2O2-dependent oxidation of ascorbate displayed positive cooperativity. Bound ascorbate at two surface sites established an intricate proton network with ascorbate at the ɣ-heme edge and δ-meso sites. Based on crystal structures, steady-state kinetics, and site-directed mutagenesis results, both ascorbate molecules at the ɣ-heme edge and the one at the surface are expected to participate in the oxidation reaction. We provide evidence that the H2O2-dependent oxidation of ascorbate by APX produces a C2-hydrated bicyclic hemiketal form of dehydroascorbic acid at the ɣ-heme edge, indicating two successive electron transfers from a single-bound ascorbate. In addition, the δ-meso site was shared with several organic compounds, including p-coumaric acid and other phenylpropanoids, for the potential radicalization reaction. Site-directed mutagenesis of the critical residue at the ɣ-heme edge (R172A) only partially reduced polymerization activity. Thus, APX removes stress-generated H2O2 with ascorbates, and also uses this same H2O2 to potentially fortify cell walls via oxidative polymerization of phenylpropanoids in response to stress.
Multibiomarker disease activity score: an objective tool for monitoring rheumatoid arthritis? A systematic review and meta-analysis
Authors: Meznerics Fanni A , Kemény Lajos V , Gunther Emese , Bakó Eszter , Dembrovszky Fanni , Szabó Bence , Ascsillán Anna , Lutz Elmar , Csupor Dezsö , Hegyi Péter , Bánvölgyi András , Nagy György
Published: December 2022

Objectives

The multibiomarker disease activity (MBDA) score is an objective tool for monitoring disease activity in RA. Here we report a systematic review and meta-analysis of the clinical value of the MBDA score in RA.

Methods

We performed a systematic literature search in five medical databases—MEDLINE (via PubMed), Cochrane Library (CENTRAL), Embase, Scopus and Web of Science—from inception to 13 October 2021. Original articles reporting on the performance of the MBDA score’s correlation with conventional disease activity measures or the predictive and discriminative values of the MBDA score for radiographic progression, therapy response, remission and relapse were included.

Results

Our systematic search provided a total of 1190 records. After selection and citation searches, we identified 32 eligible studies. We recorded moderate correlations between MBDA score and conventional disease activity measures at baseline [correlation (COR) 0.45 (CI 0.28, 0.59), I2 = 71.0% for the 28-joint DAS with CRP (DAS28-CRP) and COR 0.55 (CI 0.19, 0.78), I2 = 0.0% for DAS28 with ESR] and at follow-up [COR 0.44 (CI 0.28, 0.57, I2 = 70.0% for DAS28-CRP) and found that the odds of radiographic progression were significantly higher for patients with a high baseline MBDA score (>44) than for patients with a low baseline MBDA score (<30) [OR 1.03 (CI 1.02–1.05), I2 = 10.0%].

Conclusion

The MBDA score might be used as an objective disease activity marker. In addition, it is also a reliable prognostic marker of radiographic progression.
Modeling Diagnostic Expertise in Cases of Irreducible Uncertainty: The Decision-Aligned Response Model
Authors: Pusic Martin V. , Cook David A. , Friedman Julie L. , Lorin Jeffrey D. , Rosenzweig Barry P. , Tong Calvin K.W. , Smith Silas , Lineberry Matthew , Hatala Rose
Published: December 2022

Purpose

Assessing expertise using psychometric models usually yields a measure of ability that is difficult to generalize to the complexity of diagnoses in clinical practice. However, using an item response modeling framework, it is possible to create a decision-aligned response model that captures a clinician’s decision-making behavior on a continuous scale that fully represents competing diagnostic possibilities. In this proof-of-concept study, the authors demonstrate the necessary statistical conceptualization of this model using a specific electrocardiogram (ECG) example.

Method

The authors collected a range of ECGs with elevated ST segments due to either ST-elevation myocardial infarction (STEMI) or pericarditis. Based on pilot data, 20 ECGs were chosen to represent a continuum from “definitely STEMI” to “definitely pericarditis,” including intermediate cases in which the diagnosis was intentionally unclear. Emergency medicine and cardiology physicians rated these ECGs on a 5-point scale (“definitely STEMI” to “definitely pericarditis”). The authors analyzed these ratings using a graded response model showing the degree to which each participant could separate the ECGs along the diagnostic continuum. The authors compared these metrics with the discharge diagnoses noted on chart review.

Results

Thirty-seven participants rated the ECGs. As desired, the ECGs represented a range of phenotypes, including cases where participants were uncertain in their diagnosis. The response model showed that participants varied both in their propensity to diagnose one condition over another and in where they placed the thresholds between the 5 diagnostic categories. The most capable participants were able to meaningfully use all categories, with precise thresholds between categories.

Conclusions

The authors present a decision-aligned response model that demonstrates the confusability of a particular ECG and the skill with which a clinician can distinguish 2 diagnoses along a continuum of confusability. These results have broad implications for testing and for learning to manage uncertainty in diagnosis.
Impact of Students’ Scheduling Choice on Clerkship Examination Score Performance in a Time-Varying Competency-Based Curriculum
Authors: Kraakevik Jeff A. , Haedinger Leslie A. , Guzman Cirila Estela Vasquez , Kahl Leslie , Smeraglio Anne , Bonura Erin , Hasan Reem , Paquin Ashley , Moulton Bart , Carney Patricia A.
Published: December 2022

Purpose

Standardized end-of-clerkship examinations typically occur on the last day of the clerkship. However, recent trends toward time-varying competency-based medical education have offered students more test scheduling flexibility, creating an opportunity to study the impact of student-selected examination timing.

Method

Starting with the graduating class of 2018, students took the required standardized end-of-core clerkship examinations at any available time they chose during their clinical years. Before this change, these examinations were administered to all students on the last day of the clerkship. Students’ examination dates relative to clerkship completion were analyzed between 2017 and 2020 (inclusive of before and after flexible exam timing) to assess the impact that student-selected exam timing had on test performance on National Board of Medical Examiners shelf clinical science examinations for required core clerkships.

Results

Data on 146 medical students in 2017 (fixed exam timing) and 466 medical students between 2018 and 2020 (flexible exam timing) were included. Among students offered flexible exam timing, between 2.7% (internal medicine) and 14.6% (psychiatry) took their exam before actually taking clerkship, while between 22.7% (psychiatry) and 40.0% (surgery) took their exam more than 90 days after the clerkship ended. Exam scores were statistically higher for those who took the exam at a time of their choosing compared with those who were required to take it at the end of individual rotations and when the exam scores were combined (fixed exam timing mean = 73.9, standard deviation [SD] = 7.8; flexible exam timing mean = 77.4, SD = 6.0, P < .001). The percent of students with passing scores was statistically higher in internal medicine, pediatrics, and psychiatry.

Conclusions

Self-selection of shelf exam timing appears to increase shelf exam scores. As more medical schools transition to competency-based medical education, providing scheduling flexibility appears not to negatively affect student achievement.
Promotion of a Mastery Orientation to Learning in Medical School: Implementation of the Not Yet Pass Grade
Authors: Colbert-Getz Jorie M. , Lindsley Janet , Moore Kathryn B. , Formosa Tim , Pippitt Karly
Published: December 2022

Problem

Using pass/fail (P/F) course grades may motivate students to perform well enough to earn a passing grade, giving them a false sense of competence and not motivating them to remediate deficiencies. The authors explored whether adding a not yet pass (NYP) grade to a P/F scale would promote students’ mastery orientation toward learning.

Approach

The authors captured student outcomes and data on time and cost of implementing the NYP grade in 2021 at the University of Utah School of Medicine. One cohort of medical students, who had experienced both P/F and P/NYP/F scales in years 1 and 2, completed an adapted Achievement Goal Questionnaire–Revised (AGQ-R) in fall 2021 to measure how well the P/NYP/F grading scale compared with the P/F scale promoted mastery orientation and performance orientation goals. Students who received an NYP grade provided feedback on the NYP process.

Outcomes

Students reported that the P/NYP/F scale increased their achievement of both mastery and performance orientation goals, with significantly higher ratings for mastery orientation goals than for performance orientation goals on the AGQ-R (response rate = 124/125 [99%], P ≤ .001, effect size = 0.31). Thirty-eight students received 48 NYP grades in 7 courses during 2021, and 3 (2%) failed a subsequent course after receiving an NYP grade. Most NYP students reported the NYP process enabled them to identify and correct a deficiency (32/36 [89%]) and made them feel supported (28/36 [78%]). The process was time intensive (897 hours total for 48 NYP grades), but no extra funding was budgeted.

Next Steps

The findings suggest mastery orientation can be increased with an NYP grade. Implementing a P/NYP/F grading scale for years 1 and/or 2 may help students transition to programmatic assessment or no grading later in medical school, which may better prepare graduates for lifelong learning.
Risk factors for local recurrence of giant cell tumor of bone of the extremities: a retrospective study
Authors: AbdelKawi Noureldin Mohamed , Abed Yasser Youssef , El-negery Abed Abdelatif , Kotb Samir Zaki Mohamed
Published: December 2022

Background:

Although considered as a benign tumor, giant cell tumor of bone (GCTB) has an aggressive biological behavior with high tendency for local recurrence (LR). The most commonly used method of treatment of GCTB is intralesional curettage augmented by various types of local adjuvants. The aim of this study was to evaluate the rate of recurrence of GCTB after surgical treatment to detect the risk factors that may influence the rate of LR.

Methods:

Fifty-two cases of GCTB that had been treated in a university hospital musculoskeletal oncology unit, between 2012 and 2017 were retrospectively reviewed after minimal follow-up of 4 yr and risk factors of LR were determined.

Results:

All LRs occurred within the first 3 yr (4 to 31 mo). Curettage was used to manage 34 patient cases, from which 11 patients (32.4%) showed LR. Only one patient (5.6%) of the 18 wide local excision patients developed recurrence. The highest recurrence rate was found among the lesions of the proximal femur. Neither the tumor volume nor the pathological grade had a significant impact on the rate of LR. The presence of soft-tissue invasion, occurrence of pathological fracture at presentation and using curettage as a method of treatment were associated with significantly higher rate of LR.

Conclusions:

Lesions in the proximal femur, occurrence of pathological fracture at presentation, soft-tissue invasion, and curettage as management option were found to be associated with an increased risk of LR of GCTB.

Level of Evidence:

Level III
Antibiotic prophylaxis for dental procedures after joint arthroplasty: a cross-sectional survey of orthopaedic surgeons about current practices
Authors: Del Prince Clayton , Pavlesen Sonja , DiPaola Matthew J.
Published: December 2022

Background:

Periprosthetic joint infection is a rare, but potentially devastating complication that can occur after prosthetic joint replacement. In 2016, the American Academy of Orthopaedic Surgeons (AAOS) revised its Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. The objective of this study was to survey orthopaedic surgeons regarding their use of prophylactic antibiotics in arthroplasty patients undergoing dental procedures. Additionally, the authors inquired whether surgeons who have undergone arthroplasty procedures themselves practice the antibiotic prophylaxis when faced with decisions regarding their own joints.

Methods:

The authors surveyed currently practicing orthopaedic surgeons in the United States who perform joint arthroplasty procedures. The questions pertained to demographic data, training background, type of employment, arthroplasty type and volume, antibiotic prophylaxis practices, and awareness of the AAOS/American Dental Association (ADA) recommendations.

Results:

Two hundred, fourteen surveys were completed, though not all respondents answered every question. Most surgeons (149 of 200, 74.5%) routinely recommend prophylactic antibiotics for all patients with total joint arthroplasties who undergo dental procedures. The majority of the surgeons (163 of 199, 81.9%) reported that they are aware of the current AAOS/ADA guidelines, but that did not have a substantial effect on whether they routinely recommend prophylactic antibiotics (P=0.74).

Conclusions:

Most orthopaedic surgeons surveyed said they understand the AAOS/ADA guidelines, but that they routinely prescribe prophylactic antibiotics for arthroplasty patients undergoing dental procedures. These prescribing practices have no significant relationship with their knowledge of the AAOS AUC, years of experience, volume, specialty, employment, or personal history of joint replacement.

Level of Evidence:

Level IV, cross-sectional survey
Discordance in current procedural terminology coding for pediatric orthopaedic surgeries between residents and attending surgeons: a retrospective comparative study
Authors: Wolf G. Jacob , O’Leary Ryan J. , Tranchitella Nicholas M. , Johnson Charles A. , Van Nortwick Sara S. , Dow Matthew A. , Murphy Robert F.
Published: December 2022

Background:

The current procedural terminology (CPT) coding system is used in medical record maintenance and billing. CPT coding is a skill that residents should acquire through training. The purpose of this study was to assess concordance between attending and resident coding practices in pediatric orthopaedic surgery.

Methods:

Case log reports were collected from 14 residents on the pediatric orthopaedic surgery service over 2 yr, then compared to operating room billing records from three pediatric orthopaedic surgeons. CPT code concordance rates were generated between residents and attendings for individual cases.

Results:

Three attending surgeons performed 1,372 cases over the two years. To accommodate cases in which multiple residents participated, 38 cases were duplicated (1,410 total attending cases). There was no corresponding resident case entry for 31.3% of attending cases. Of the 968 cases logged by residents, a 78.2% concordance rate was observed. Residents who rotated on pediatric orthopaedics only as a post-graduate year (PGY) 3 during the study period exhibited 73.8% concordance rates, versus residents that rotated as both a PGY-3 and PGY-4 who exhibited 78.7% and those who rotated only as a PGY-4 who exhibited 82.0% (P<0.001). Closed reduction and percutaneous pinning of supracondylar humerus fractures had the highest concordance rate (93.5%) among ACGME-required minimum category cases.

Conclusions:

Residents and attendings demonstrate a relatively high CPT code concordance among pediatric orthopaedic surgeries. Concordance rates were significantly higher when reported by more experienced residents. Among minimum category cases, percutaneous pinning of supracondylar humeral fractures demonstrated the highest concordance rate.

Level of Evidence:

Level IV
Unexpected operative death from hemorrhage: a review of six cases and recommendations
Authors: Pritchett James W.
Published: December 2022

All busy surgeons will eventually face a severe intraoperative hemorrhage and about one-third will have an intraoperative death. Situational awareness is the key to good operating room leadership and clinical performance. Technical, emotional, and professional skills are equally necessary. When hemorrhage occurs, some surgeons are affected by a “startle” response and freeze. An immediate surgical plan to stop the hemorrhage by pressure or direct vascular control is required. A stable patient presents other options such as waiting for additional surgical or interventional help; an unstable patient does not. The operating room team and family look to the surgeon as the threat-and-error manager. The surgeon must fill this role with a skilled, open, and compassionate approach rather than a hesitant, protective, or defensive approach. The urgent needs of the patient can require a surgeon to perform an unfamiliar or unpracticed exposure when there is no safe alternative. The emotional and professional cost of a fatal intraoperative hemorrhage is significant. With preparation, a better path for the surgeon, operating room staff and patient is possible. This review presents six actual scenarios of managing hemorrhage in orthopaedic surgery.
Assessment of risk-stratified approach to thromboprophylaxis in hip arthroplasty patients: a prospective cohort study
Authors: Bhaskarwar Ajit P. , Kumar Narinder
Published: December 2022

Background:

Venous thromboembolism (VTE) is a frequent and serious complication in orthopaedic surgeries of the lower limbs. Subsequent pulmonary embolism (PE) makes it the most common cause of death after joint replacement surgeries of the lower limbs. In this study, a multimodal approach for thromboprophylaxis was adopted in patients undergoing total hip replacement (THR) and hemiarthroplasty (HA), including pharmaceutical and mechanical agents recommended by the American Academy of Orthopaedic Surgeons (AAOS) as per risk stratified approach, and the effectiveness of the same was measured by clinical and radiographic assessment.

Methods:

This was a prospective observational longitudinal study with evaluation at multiple points of time carried out at a tertiary care orthopaedic center. The study included 66 consecutive patients who underwent hip replacement arthroplasty (45 THR, 21 HA). Mechanical and pharmacological (soluble aspirin) prophylaxis modalities for deep venous thrombosis (DVT) were administered to all patients after risk stratification. Patients were assessed for evidence of DVT at 2,6, and 12 wk postoperatively by clinical tests and color Doppler flow imaging (CDFI).

Results:

This study confirmed efficacy of AAOS recommended risk stratified approach of thromboprophylaxis by combined use of soluble aspirin and various other mechanical measures in patients having standard risk for PE and bleeding undergoing THR or HA because none of the patients developed DVT per clinical assessment and confirmed by CDFI carried out at follow-up.

Conclusions:

Prevention of DVT as recommended by AAOS has proven to be effective as well as cheaper in moderate-risk patients undergoing hip replacement surgery. Though there were no major differences in complication rates in respect to other prophylaxis except prevalence of major bleeding was very low.

Level of Evidence:

Level II
Incidence and risk factors of ankle fusion after pilon fracture: a retrospective review
Authors: Massey Lauren E. , Oladeji Lasun O. , Esposito Ennio Rizzo , Cook James L. , Della Rocca Gregory J. , Crist Brett D.
Published: December 2022

Background:

Pilon fractures are associated with a high incidence of complications, yet there continues to be uncertainty regarding variables associated with adverse outcomes after pilon open reduction and internal fixation (ORIF). This study sought to characterize the rate of arthrodesis and identify risk factors that increase the likelihood of ankle arthrodesis in patients with ORIF pilon fractures.

Methods:

After institutional review board approval, a retrospective review was conducted to identify patients who underwent ORIF of pilon fractures at an ACS Level I trauma center from 2005 to 2014. Medical records and radiographs were reviewed retrospectively for patient demographics, comorbidities, fracture characteristics, associated injuries, mechanism of injury, and functional activity. Logistic regression analyses were performed to identify risk factors associated with arthrodesis.

Results:

282 pilon fractures (279 patients) met inclusion criteria. There were 182 men and 97 women with an average age of 43.8±15.2 yr. Overall, 15 pilon fractures (5.3%) in six male patients and nine female patients were treated with an ankle arthrodesis an average of 1.73±5.15 yr after their initial injury. Following multivariable logistic regression analysis, age greater than 40 yr, tobacco use, and nonunion were identified as independent predictors of arthrodesis.

Conclusions:

This study found a number of patient-related factors associated with an increased risk of arthrodesis after a pilon fracture was sustained. Multivariable logistical analysis identified age greater than 40 yr, tobacco use, and nonunion as independent predictors of arthrodesis following pilon fracture ORIF.

Level of Evidence:

Level III
The safety of intraarticular injection prior to total hip arthroplasty: a review
Authors: Chan Peter Y.W. , Huo Michael H.
Published: December 2022

Osteoarthritis is a chronic and debilitating condition, and the hip joint is commonly affected. Total hip arthroplasty is an effective treatment for end-stage osteoarthritis. Intraarticular injections may be used to treat pain relief before total hip arthroplasty. There are controversies on whether intraarticular injections prior to total hip arthroplasty are safe because of concerns that they may increase the risk of infection after surgery. This study reviewed the most current published evidence from the past 20 yr regarding the risks of infection from intraarticular injections before total hip arthroplasty.
Vitamin D supplementation is a cost-effective intervention after posterolateral lumbar fusion: a systematic review
Authors: Patel Dhiraj , Lippel Matthew , Lunardini David , Monsey Robert , Ziino Chason
Published: December 2022

Background:

This study investigated the role of preoperative supplementation of 25(OH)D, a precursor of the active form of vitamin D, as a cost-effective strategy to decrease pseudarthrosis rates and overall healthcare burden after posterolateral fusion (PLF). Previous literature has emphasized the importance of vitamin D in bone health maintenance, spinal health, and outcomes in spinal fusion. Inadequate preoperative 25(OH)D levels may increase pseudarthrosis rates after PLF. Thus, a cost-estimation model was developed to determine the cost-effectiveness of both selective and nonselective 25(OH)D supplementation in PLF.

Methods:

Prevalence and cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean, lower, and upper bounds of 1-year cost-savings were calculated for both supplementation scenarios.

Results:

Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost-savings of $10,978,440 ($9,969,394 to $11,987,485) per 10,000 PLF cases. Nonselective 25(OH)D supplementation of all PLF patients was calculated to result in a mean cost-savings of $11,213,318 ($10,204,272 to $12,222,363) per 10,000 cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where revision PLF costs exceed $781.89 and prevalence of 25(OH)D deficiency ≥0.612%. Nonselective supplementation is cost-effective in clinical scenarios where revision PLF cost ≥$198.09 and prevalence of 25(OH)D deficiency ≥0.1645%.

Conclusions:

This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce overall healthcare burden after PLF. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the relatively lower cost of 25(OH)D supplementation compared with serum assays.

Level of Evidence:

Level III
Discordance in online commercial ratings of orthopaedic surgeons: a retrospective review of online rating scores
Authors: Romere Chase M. , Shah Romil F.
Published: December 2022

Background:

Patients use online physician ratings to select an orthopaedic surgeon. The objectives of this paper were to investigate whether ratings are concordant among online review sites rating orthopaedic surgeons and examine physician practice characteristics associated with higher physician ratings.

Methods:

Orthopaedic surgeons in Illinois who accepted Medicare patients in 2015 were included in this study. Physician practice characteristics, demographics, and information regarding their Medicare volume were obtained for each surgeon. Information regarding each surgeon’s average and number of ratings was collected from Yelp, Healthgrades, Google, and Vitals.com. The authors examined concordance between sites by investigating how many physicians were given high ratings on one site (>4/5), but low ratings on another site (<2 .5/5). Finally, a multivariable regression model was developed to investigate the association between physician characteristics and online ratings.

Results:

Two hundred ninety-five orthopaedic surgeons were included in the study sample. The number of reviews per physician varied greatly, with some surgeons having as high as 300 and many having no reviews. Of the physicians reviewed as low-performing on one site, 65.9% were rated as high-performing on another site. Physicians were more likely to have better ratings if they graduated after 1995 (P<0.05) or performed a higher volume of Medicare services (P<0.05). Total number of reviews had a statistically significant positive correlation with average rating (r=0.26, P<0.001).

Conclusions:

The discordance among review sites for orthopaedic surgeons suggests that patients should exercise caution when using online reviews. As their use increases, the healthcare community should take a closer look at standardizing reviews.

Level of Evidence:

Level III
Comparison of MRI and bolster hyperextension radiography in determining the flexibility of thoracic curves in Scheuermann kyphosis: a retrospective cross-sectional study
Authors: Chehrassan Mohammadreza , Shakeri Mohammadreza , Nikouei Farshad , Toulany Mahtab , Faraji Mitra , Habibollahzadeh Ali , Ghandhari Hasan
Published: December 2022

Background:

The flexibility of the thoracic curve is important for the preoperative planning for patients with Scheuermann kyphosis (SK), and a lateral bolster hyperextension radiograph (HE) is the standard available method for this purpose. In this study, the authors aimed to evaluate how the flexibility of the thoracic curve in classic SK patients correlates between supine MRI and HE radiography.

Methods:

In a retrospective cross-sectional study, 38 SK patients who underwent surgical correction were included. Cobb angles were measured on three different images: lateral standing radiographs (EOS), lateral supine bolster HE radiography, and T2-weighted sagittal MRI. The mean differences between the Cobb angles measured on standing radiographs (EOS) and supine modalities (HE and MRI) was considered as the flexibility of the thoracic curve. Measurements were done two times by two orthopaedic spine surgeons, and acceptable intraobserver and interobserver reliability was observed using an intraclass correlation coefficient test.

Results:

The study population included 23 (60.5%) male patients and 15 (39.5%) female patients with a mean age of 23.4±8.8 yr (range 13 to 48). The mean flexibility of the thoracic curve was 31±10.9 degrees (40.5%) on supine MRIs and 36.1±11.5 degrees (47.25%) on bolster HE radiographs. A significant correlation was observed between the mean flexibility of the thoracic curve on MRI and HE radiographs (r=0.601, P<0.001).

Conclusions:

Supine MRI can be regarded as a promising alternative to bolster HE radiography in determining the flexibility of thoracic curves in patients with classic SK.

Level of Evidence:

Level III
Pharmacotherapies in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis
Authors: Sreenivasan Jayakumar , Malik Aaqib , Khan Muhammad Shahzeb , Lloji Amanda , Hooda Urvashi , Aronow Wilbert S. , Lanier Gregg M. , Pan Stephen , Greene Stephen J. , Murad M. Hassan , Michos Erin D. , Cooper Howard A. , Gass Alan , Gupta Rahul , Desai Nihar R. , Mentz Robert J. , Frishman William H. , Panza Julio A.
Published: December 2022

Various pharmacotherapies exist for heart failure with preserved ejection fraction (HFpEF), but with unclear comparative efficacy. We searched EMBASE, Medline, and Cochrane Library from inception through August 2021 for all randomized clinical trials in HFpEF (EF >40%) that evaluated beta-blockers, mineralocorticoid receptor antagonist (MRA), angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitor (ARNI), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Outcomes assessed were cardiovascular mortality, all-cause mortality, and HF hospitalization. A frequentist network meta-analysis was performed with a random-effects model. We included 22 randomized clinical trials (30,673 participants; mean age = 71.7 ± 4.2 years; females = 49.3 ± 7.7%; median follow-up = 24.4 ± 11.1 months). Compared with placebo, there was no statistically significant difference in cardiovascular mortality [beta-blockers; odds ratio (OR) 0.79 (0.46–1.34), MRA; OR 0.90 (0.70–1.14), ACE OR 0.95 (0.59–1.53), ARB; OR 1.02 (0.87–1.19), ARNI; OR 0.97 (0.74–1.26) and SGLT2i; OR 1.00 (0.84–1.18)] or all-cause mortality [beta blockers; OR 0.75 (0.54–1.04), MRA; OR 0.90 (0.75–1.08) ACE; OR 1.05 (0.71–1.54), ARB; OR 1.03 (0.91–1.15), ARNI; OR 0.99 (0.82–1.20) and SGLT2i; OR 1.00 (0.89–1.13)]. The certainty in these estimates was low or very low. There was a significantly reduction in HF hospitalization with the use of SGLT2i [OR 0.71 (0.62–0.82), moderate certainty], ARNI [OR 0.77 (0.63–0.94), low certainty], and MRA [OR 0.81 (0.66–0.98), moderate certainty]; with corresponding P scores of 0.84, 0.68, and 0.58, respectively. In HFpEF, the use of beta-blockers, MRA, ACE/ARB/ARNI, or SGLT2i was not associated with improved cardiovascular or all-cause mortality. SGLT2i, ARNI, and MRA reduced the risk of HF hospitalizations.