bluuebunny/crossref_metadata_2025 huggingface dataset:
Hitting the Target? Analysing the Use of Targets in Climate Law
Authors: Hilson Chris
Published: February 2020

Climate targets have become prominent in the media and public debate recently, largely as a result of pressure exerted by groups such as Extinction Rebellion, who have advocated a target of net zero emissions of greenhouse gases by as early as 2025. This article aims to draw some of the heat out of that debate and to shed some light on the issues raised by climate targets, including their level of ambition. It does so by developing a taxonomy of climate targets—setting out the choices confronting those designing national responses—and then examining those choices through a normative, values framework. Given the threat posed by climate change to humans and the ecosystems of which they are a part, it is important that climate targets are optimally constructed. The taxonomic and values framework laid out in this article is designed to help with this.
Radiographic factors associated with hip osteoarthritis: a systematic review
Authors: Shapira Jacob , Chen Jeffrey W , Bheem Rishika , Lall Ajay C , Rosinsky Philip J , Maldonado David R , Domb Benjamin G
Published: February 2020

The purpose of this study was to outline factors that contribute to the appearance of hip osteoarthritis (OA). Secondarily, this study aims to describe radiographic factors that are associated with the progression of OA in the arthritic hip. Pubmed/MEDLINE and Embase were searched in November 2018 for radiographic risk factors for hip OA. All articles were eligible if they (i) were written in the English language and (ii) commented on OA as it relates to radiographic description, appearance or progression of OA. Demographic characteristics of the study cohort, definition of OA, baseline OA and factors for prediction or progression of OA were recorded. Nine articles were included in this review. A total of 3268 patients were analyzed across all studies. The mean age was 60.0 years (range 18–91.5). The most common descriptors for OA were dysplasia and cam impingement. Six of the nine articles found acetabular under-coverage to be associated with developing OA. Four articles found cam morphology to be an associated factor. Finally, four articles commented on the factors associated with the progression to more severe grades of OA, reporting exclusively on acetabular under-coverage, whereas only one reported on cam morphology to be associated. This systematic review found acetabular under-coverage followed by cam morphology to be strongly associated with both the development and progression of hip OA. These findings define patients at risk for developing hip OA and emphasize the importance of early awareness of future joint degeneration.
Maternal Antenatal Depression and Early Childhood Sleep: Potential Pathways Through Infant Temperament
Authors: Kim Yunmi , Bird Amy , Peterson Elizabeth , Underwood Lisa , Morton Susan M B , Grant Cameron C
Published: February 2020

Objective

Maternal depression is associated with infant and child sleep patterns, and with infant temperament. Here, we examine whether infant temperament mediated an association between maternal antenatal depression and toddler sleep.

Method

Within the prebirth longitudinal cohort Growing Up in New Zealand, symptoms of antenatal and postnatal depression were measured in 5,568 women using the Edinburgh Postnatal Depression Scale (EPDS). Infant temperament was measured at age 9 months using the Very Short Form of Infant Behavior Questionnaire-Revised (IBQ-R VSF). Sleep duration and nighttime awakenings were reported by parents when children were 2 years old.

Results

Independent associations of maternal depression with child sleep patterns at age 2 years, adjusted for maternal demographics, physical health, family relationships, and child health and feeding, were determined using multivariate logistic regression analysis. The odds of having ≥2 nighttime awakenings were increased for children whose mothers had antenatal (1.36, 1.07–1.73) but not postnatal (1.22, 0.88–1.68) or both antenatal and postnatal depression (0.89, 0.56–1.36). There was no association of maternal depression with shorter sleep duration. Two of five dimensions of infant temperament (fear and negative affect) were associated with both antenatal depression scores and increased nighttime awakenings. Mediation analyses controlling for postnatal depression and other predictors of child sleep supported an indirect pathway of antenatal depression to child sleep through infant temperamental negative affectivity.

Conclusion

Antenatal depression is independently associated with more frequent nighttime awakenings in early childhood. Findings support an indirect pathway through infant negative affect characteristics.
Wearable health devices and personal area networks: can they improve outcomes in haemodialysis patients?
Authors: Kooman Jeroen P , Wieringa Fokko Pieter , Han Maggie , Chaudhuri Sheetal , van der Sande Frank M , Usvyat Len A , Kotanko Peter
Published: February 2020

Digitization of healthcare will be a major innovation driver in the coming decade. Also, enabled by technological advancements and electronics miniaturization, wearable health device (WHD) applications are expected to grow exponentially. This, in turn, may make 4P medicine (predictive, precise, preventive and personalized) a more attainable goal within dialysis patient care. This article discusses different use cases where WHD could be of relevance for dialysis patient care, i.e. measurement of heart rate, arrhythmia detection, blood pressure, hyperkalaemia, fluid overload and physical activity. After adequate validation of the different WHD in this specific population, data obtained from WHD could form part of a body area network (BAN), which could serve different purposes such as feedback on actionable parameters like physical inactivity, fluid overload, danger signalling or event prediction. For a BAN to become clinical reality, not only must technical issues, cybersecurity and data privacy be addressed, but also adequate models based on artificial intelligence and mathematical analysis need to be developed for signal optimization, data representation, data reliability labelling and interpretation. Moreover, the potential of WHD and BAN can only be fulfilled if they are part of a transformative healthcare system with a shared responsibility between patients, healthcare providers and the payors, using a step-up approach that may include digital assistants and dedicated ‘digital clinics’. The coming decade will be critical in observing how these developments will impact and transform dialysis patient care and will undoubtedly ask for an increased ‘digital literacy’ for all those implicated in their care.
SIRT2 is involved in cisplatin-induced acute kidney injury through regulation of mitogen-activated protein kinase phosphatase-1
Authors: Jung Yu Jin , Park Woong , Kang Kyung Pyo , Kim Won
Published: February 2020

Background

Activation of mitogen-activated protein kinase phosphatase-1 (MKP-1), a dual-specificity protein phosphatase, regulates mitogen-activated protein kinase signaling. C-Jun N-terminal kinase (JNK) and p38 are activated in cisplatin-induced renal injury. However, the change of MKP-1 expression in cisplatin-induced renal injury and the regulatory effect of sirtuin 2 (SIRT2), a nicotinamide adenine dinucleotide–dependent deacetylase, on MKP-1 remains unknown.

Methods

To address these issues, we used constitutional Sirt2 knockout (KO) mice, transgenic (TG) mice with increased expression of SIRT2 specifically in proximal tubular epithelial cellsand wild-type (WT) mice. Cisplatin nephrotoxicity was induced by intraperitoneal injection of cisplatin.

Results

MKP-1 expression in the kidney was decreased after cisplatin treatment. Cisplatin-induced downregulation of MKP-1 was reversed in Sirt2 KO mice kidney and further decreased in Sirt2 TG mice kidney. We observed similar phenomenon with SIRT2-knockdown or SIRT2-overexpressed tubular epithelial cells. Phosphorylation of p38 and JNK, a downstream signal pathway of MKP-1, increased in WT mice kidney following treatment with cisplatin. A decrease in SIRT2 suppressed cisplatin-induced phosphorylation of p38 and JNK in kidney and tubular epithelial cells. Overexpression of SIRT2 further increased phosphorylation of p38 and JNK in kidney and tubular epithelial cells. Acetylation of MKP-1 was significantly increased in SIRT2-knockdown cells and decreased in SIRT2-overexpressed cells after cisplatin stimulation. Sirt2 KO mice and Sirt2 TG mice showed amelioration and aggravation of renal injury, apoptosis, necroptosis and inflammation induced by cisplatin.

Conclusion

Our data show that SIRT2 is associated with cisplatin-induced renal injury through regulation of MKP-1 expression.
Wearable skin-like optoelectronic systems with suppression of motion artifacts for cuff-less continuous blood pressure monitor
Authors: Li Haicheng , Ma Yinji , Liang Ziwei , Wang Zhouheng , Cao Yu , Xu Yuan , Zhou Hua , Lu Bingwei , Chen Ying , Han Zhiyuan , Cai Shisheng , Feng Xue
Published: February 2020

According to the statistics of the World Health Organization, an estimated 17.9 million people die from cardiovascular diseases each year, representing 31% of all global deaths. Continuous non-invasive arterial pressure (CNAP) is essential for the management of cardiovascular diseases. However, it is difficult to achieve long-term CNAP monitoring with the daily use of current devices due to irritation of the skin as well as the lack of motion artifacts suppression. Here, we report a high-performance skin-like optoelectronic system integrated with ultra-thin flexible circuits to monitor CNAP. We introduce a theoretical model via the virtual work principle for predicting the precise blood pressure and suppressing motion artifacts, and propose optical difference in the frequency domain for stable optical measurements in terms of skin-like devices. We compare the results with the blood pressure acquired by invasive (intra-arterial) blood pressure monitoring for >1500 min in total on 44 subjects in an intensive care unit. The maximum absolute errors of diastolic and systolic blood pressure were ±7/±10 mm Hg, respectively, in immobilized, and ±10/±14 mm Hg, respectively, in walking scenarios. These strategies provide advanced blood pressure monitoring techniques, which would directly address an unmet clinical need or daily use for a highly vulnerable population.
A Single-Center Prospective Cohort Study on Postsplenectomy Sepsis and its Prevention
Authors: Rieg Siegbert , Bechet Lena , Naujoks Kai , Hromek Julia , Lange Berit , Juzek-Küpper Marc-Fabian , Stete Katarina , Müller Matthias C , Jost Insa , Kern Winfried V , Theilacker Christian
Published: February 2020

Background

This study evaluated the impact of a dedicated outpatient service on vaccination uptake after splenectomy and on the incidence of postsplenectomy sepsis.

Methods

From 2009 to 2016 at the University Hospital Freiburg (Germany), asplenic patients were referred to a dedicated outpatient service, provided with comprehensive preventive care including vaccinations, and enrolled in a prospective cohort study. The impact of the service on vaccination uptake and the occurrence of severe sepsis/septic shock was compared between patients who had splenectomy (or were asplenic) within 3 months of study entry (“early study entry”) and those who had splenectomy (or were asplenic) >3 months before study entry (“delayed study entry”).

Results

A total of 459 asplenic patients were enrolled, and 426 patients were followed prospectively over a median period of 2.9 years. Pneumococcal vaccine uptake within 3 months of splenectomy or first diagnosis of asplenia was 27% vs 71% among delayed study entry and early study entry patients, respectively (P < .001). Forty-four episodes of severe sepsis or septic shock occurred in study patients: 22 after study entry and 22 before study entry. Streptococcus pneumoniae was more frequent among sepsis episodes that occurred before study entry (8/22) than after study entry (1/22 episodes). For episodes occurring after study entry, only a higher Charlson comorbidity index score was significantly associated with severe sepsis/septic shock postsplenectomy.

Conclusions

With dedicated outpatient care, high uptake of pneumococcal vaccination postsplenectomy was achieved. Sepsis episodes were largely of nonpneumococcal etiology in patients who had received dedicated postsplenectomy care.
‘Responsive’ Remodelling of Competition Law Enforcement
Authors: Ioannidou Maria
Published: February 2020

Over the years, regulators have sought to improve the effectiveness of both private and public competition law enforcement. In EU competition law, recent debates have concerned damages actions for competition law violations and the empowerment of national competition authorities. These debates are often premised on a clear dichotomy between public and private competition law enforcement, each pursuing a distinct set of aims. This article employs a novel holistic approach, which is informed by the theories of responsive regulation and restorative justice, and argues in favour of a ‘responsive’ remodelling of competition law enforcement. Such a ‘responsive’ remodelling advocates flexibility in enforcement mechanisms, with the consensual participation of the affected stakeholders and the adoption of remedies to restore the inflicted harm. The article discusses the current system and its respective aims and problems, and highlights an emerging hybridisation of remedies. Building on this emerging practice, it then constructs the ‘responsive’ remodelling benchmark for effective compliance. It discusses how this benchmark can inform competition law enforcement and it considers its potential to increase compliance, countenance various legitimacy and accountability concerns, increase consumers’ access to markets and bring benefits to the affected parties.
The Fate of Accessory Minerals and Key Trace Elements During Anatexis and Magma Extraction
Authors: Schwindinger Martin , Weinberg Roberto F , White Richard W
Published: February 2020

Granite genesis and crustal evolution are closely associated with partial melting in the lower or middle crust and extraction of granite magmas to upper crustal levels. This is generally thought to be the leading mechanism by which the upper continental crust became enriched in incompatible components such as the heat-producing elements U and Th through time. However, field evidence from anatectic terrains, the source rocks of granite magmas, raises doubt about the efficiency of this process. Leucosomes and associated leucogranites, representative of melts in such terrains, are often depleted in U, Th and REE compared to their source and therefore unable to enrich the upper crust in these elements. This paper demonstrates using anatectic turbidites exposed on Kangaroo Island that accessory minerals, the main hosts of U, Th and REE, become preferentially concentrated in the melanosomes, effectively removing these elements from the melt. Whole rock geochemistry and detailed petrography suggests that (1) peraluminous melts dissolve only small fractions of monazite and xenotime, because efficient apatite dissolution saturates melt early in phosphorous; and (2) local melt–host reaction emerging from melt migration may cause melt to crystallize in the magma extraction channelways in or close to the magma source region. Crystallization causes oversaturation of the magma triggering crystallization and capture of accessory minerals in the growing biotite-rich selvedge rather than in the melt channel itself. Crystallization of accessory minerals away from the leucosome explains the apparent under-saturation of elements hosted by these accessory minerals in the leucosome and leucogranites. While intense reworking of thick piles of turbidites, common in accretionary orogens, reflect important processes of crustal formation, the fate of accessory phases and the key elements they control, such as the heat producing elements U and Th, are strongly dependent on the interaction between melt and surrounding solids during segregation and extraction.
Outcomes of membranous and proliferative lupus nephritis – analysis of a single-centre cohort with more than 30 years of follow-up
Authors: Farinha Filipa , Pepper Ruth J , Oliveira Daniel G , McDonnell Thomas , Isenberg David A , Rahman Anisur
Published: February 2020

Objectives

To compare membranous lupus nephritis (MLN) and proliferative lupus nephritis (PLN) with respect to survival, demographic, clinical and laboratory characteristics; and to investigate predictors of renal and patient survival.

Methods

Single-centre retrospective observational study. Patients with biopsy-proven PLN, MLN and mixed lupus nephritis were included. Groups were compared using appropriate statistical tests and survival was analysed through the Kaplan-Meier method. Cox regression analysis was performed to investigate predictors of renal and patient survival.

Results

A total of 187 patients with biopsy-proven lupus nephritis (135 with PLN, 38 with MLN and 14 with mixed LN) were followed for up to 42 years (median 12 years). There was a higher proportion of MLN amongst Afro-Caribbeans than amongst Caucasians (31% vs 15%, P = 0.010). Patients with MLN had significantly lower anti-dsDNA antibodies (P = 0.001) and higher C3 levels (P = 0.018) at diagnosis. Cumulative renal survival rates at 5, 10, 15 and 20 years were 91, 81, 75 and 66% for PLN and 100, 97, 92 and 84% for MLN, respectively (P = 0.028). Cumulative patient survival at 5, 10, 15 and 20 years was 94, 86, 80 and 76%, with no difference between PLN and MLN. Urinary protein-creatinine ratio above 42 mg/mmol and eGFR below 76 ml/min/1.73 m2, one year after the diagnosis of LN, were the strongest predictors of progression to end-stage renal disease. eGFR below 77 ml/min/1.73 m2, at one year, development of end-stage renal disease and Afro-Caribbean ethnicity were associated with higher mortality.

Conclusion

Patients with MLN and PLN differ significantly regarding serological profiles and renal survival, suggesting different pathogenesis. Renal function at year one predicts renal and patient survival.
Social Cognition Training for People With a Psychotic Disorder: A Network Meta-analysis
Authors: Nijman Saskia A , Veling Wim , van der Stouwe Elisabeth C D , Pijnenborg Gerdina H M
Published: February 2020

Deficits in social cognition are common in people with psychotic disorders and negatively impact functioning. Social Cognition Training (SCT) has been found to improve social cognition and functioning, but it is unknown which interventions are most effective, how characteristics of treatments and participants moderate efficacy, and whether improvements are durable. This meta-analysis included 46 randomized studies. SCTs were categorized according to their focus (targeted/broad-based) and inclusion of cognitive remediation therapy (CRT). Network meta-analysis was conducted, using both direct (original) and indirect (inferred from the network of comparisons) evidence. All SCT types were compared to treatment as usual (TAU; the chosen reference group). Moderators of outcome were investigated with meta-regression and long-term efficacy with multivariate meta-analysis. Compared to TAU, emotion perception was improved by targeted SCT without CRT (d = 0.68) and broad-based SCT without CRT (d = 0.46). Individual treatments worked better for emotion perception. All treatments significantly improved social perception (active control, d = 0.98, targeted SCT with and without CRT, d = 1.38 and d = 1.36, broad-based SCT with and without CRT, d = 1.45 and d = 1.35). Only broad-based SCT (d = 0.42) improved ToM. Broad-based SCT (d = 0.82 without and d = 0.41 with CRT) improved functioning; group treatments worked significantly better. Male gender was negatively related to effects on social functioning and psychiatric symptoms. At follow-up, a moderate effect on social functioning (d = 0.66) was found. No effect was found on attribution, social cognition (miscellaneous), and psychiatric symptoms. While targeted SCT is the most effective for emotion perception and social perception, broad-based SCT produces the best overall outcomes. CRT did not enhance SCT effects.
Text2Connect: a health system approach to engage tobacco users in quitline cessation services via text messaging
Authors: Krebs Paul , Sherman Scott E , Wilson Hannah , El-Shahawy Omar , Abroms Lorien L , Zhao Xiaoquan , Nahvi Shadi , Shelley Donna
Published: February 2020

Mobile technology has created the opportunity for health systems to provide low cost tobacco cessation assistance to patients. The goal of the present study was to examine the feasibility and effectiveness of an intervention (Text2Connect) that uses text messages to offer proactive connection to the New York State Smokers’ Quitline. The electronic health record at two urban health systems was queried for patients who were current smokers and who had an outpatient visit between March 2015 and February 2016. Smokers (N = 4000) were sent an informational letter. Those who did not opt out (N = 3719) were randomized to one of 6 message sequences in order to examine the effect of theoretically informed message frames on response rates. Participants were sent a series of text messages at baseline and at 1 month and were asked to reply in order to be contacted by the state quitline (QL). After removing 1403 nonworking numbers, texts were sent to 2316 patients, and 10.0% (205/2060) responded with a QL request. Almost one quarter (23.6%, 486/2060) replied STOP and 66.4% (1369/2060) never responded. QL request rates were significantly higher when response efficacy messages were not used (p < .001). There were no differences by message framing on STOP requests (p > .05). The Text2Connect intervention was well accepted with a minority opting out. A 10% QL response rate is noteworthy given that only 5–7 brief outreach text messages were used. Results indicate that simple self-efficacy-focused messaging is most effective at supporting response rates.
Spread of Citrus Tristeza Virus in Citrus Orchards in Central California
Authors: Yokomi Raymond K. , Sisterson Mark S. , Hajeri Subhas
Published: February 2020

In California, citrus tristeza virus (CTV) is regulated by a State Interior Quarantine. In CTV abatement districts in central California, trees with CTV that react to MCA13 (MCA13-positive [MCA13+]), a strain-discriminating monoclonal antibody, are rogued to prevent virus spread. The Tulare County Pest Control District, however, does not participate in this abatement program except for a 1.6-km2 zone around the Lindcove Research and Extension Center, Exeter, CA. To quantify CTV spread under these two disparate management programs, CTV surveys were conducted in abatement plots with mandatory aphid control and nonabatement plots. Abatement plot surveys used hierarchical sampling of 25% of trees with samples pooled from four adjacent trees. Detection of MCA13+ CTV in a sample prompted resampling and testing of individual trees. From 2008 to 2018, incidence of CTV increased by an average of 3.9%, with only two MCA13+ samples detected. In contrast, in nonabatement plots, incidence of CTV increased by an average of 4.6% between 2015 and 2018. Increase in MCA13-negative (MCA−) isolates was 11 times greater than that of MCA13+ isolates, with the number of MCA13+ trees increasing by 19 trees between 2015 and 2018. MCA13− isolates were more randomly distributed, suggesting primary spread, whereas MCA13+ CTV isolates were more aggregated, suggesting some secondary spread. These results suggest that spread of MCA13+ isolates was limited by a combination of tree removal and aphid vector suppression. MCA13+ samples were VT isolates with some mixtures with T30 isolates. Despite the presence of VT isolates, all CTV-infected trees were asymptomatic.
Identification of Genetic Loci of Black Point in Chinese Common Wheat by Genome-Wide Association Study and Linkage Mapping
Authors: Lv Guoguo , Dong Zhongdong , Wang Yudan , Geng Junyou , Li Jia , Lv Xialei , Sun Congwei , Ren Yan , Zhang Jianwei , Chen Feng
Published: February 2020

Black point is a common disease in wheat all over the world. The disease could downgrade wheat quality and cause human health problems. In this study, 406 wheat cultivars were used to investigate black point resistance. In the field tests, 20, 65.5, and 14.5% of the tested cultivars were resistant, moderately resistant, and susceptible, respectively, suggesting that improving black point resistance is necessary in Chinese wheat breeding. A genome-wide association study (GWAS) identified 386 single-nucleotide polymorphisms (SNPs) significantly related to black point resistance in the tested wheat cultivars, and they were located on all chromosomes. Linkage mapping in a biparental population identified three quantitative trait loci (QTL) for black point resistance—QBP.hau-3A, QBP.hau-6D, and QBP.hau-7D—with 6.76, 7.79, and 8.84% phenotypic variation explained, respectively. Based on both the GWAS and linkage analyses, QBP.hau-6D covered six significant SNPs from the GWAS, and the position of these SNPs indicated that this QTL is a new locus for black point resistance. This study provides valuable germplasm for breeding wheat cultivars with resistance to black point and information for further understanding of molecular and genetic basis of black point resistance.
Pediatric non-red cell blood product transfusion practices: what's the evidence to guide transfusion of the ‘yellow’ blood products?
Authors: Steinbicker Andrea U. , Wittenmeier Eva , Goobie Susan M.
Published: February 2020

Purpose of review

Research studies pertaining to the management of pediatric non-red cell blood product transfusion is limited. Clinical practices vary within disciplines and regions. Anesthesiologists need evidence-based guidelines to make appropriate and safe decisions regarding transfusion of the ‘yellow’ blood products for pediatric patients.

Recent findings

This review outlines clinical indications for transfusion of fresh frozen plasma, cryoprecipitate, platelets, and fibrinogen concentrate in pediatrics. Recent studies of non-red blood cell transfusions in critical, but stable situations are highlighted. Recommendations to guide transfusion of the ‘yellow’ blood products in operative and non-operative settings are summarized. Special attention is drawn to guidelines in massive hemorrhage and trauma situations.

Evidence-based guidelines and expert consensus recommendations exist to guide the transfusion of pediatric non-red blood products and should be followed when transfusing the ‘yellow’ blood components. As high-quality studies in neonates, infants and children are limited, future research should broaden our knowledge in this direction with the goal to use restrictive strategies to improve patient outcomes.
Risk Factors of Nonunion After Acute Osteoporotic Vertebral Fractures
Authors: Inose Hiroyuki , Kato Tsuyoshi , Ichimura Shoichi , Nakamura Hiroaki , Hoshino Masatoshi , Togawa Daisuke , Hirano Toru , Tokuhashi Yasuaki , Ohba Tetsuro , Haro Hirotaka , Tsuji Takashi , Sato Kimiaki , Sasao Yutaka , Takahata Masahiko , Otani Koji , Momoshima Suketaka , Yuasa Masato , Hirai Takashi , Yoshii Toshitaka , Okawa Atsushi
Published: February 2020

Study Design.

Prospective cohort study.

Objective.

To characterize a patient population with nonunion after acute osteoporotic vertebral fractures (OVFs) and compare the union and nonunion groups to identify risk factors for nonunion.

Summary of Background Data.

While OVFs are the most common type of osteoporotic fracture, the predictive value of a clinical assessment for nonunion at 48 weeks after OVF has not been extensively studied.

Methods.

This prospective multicenter cohort study included female patients aged 65 to 85 years with acute one-level osteoporotic compression fractures. In the radiographic analysis, the anterior vertebral body compression percentage was measured at 0, 12, and 48 weeks. Magnetic resonance imaging (MRI) was performed at enrollment and at 48 weeks to confirm the diagnosis and union status. The patient-reported outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), a visual analogue scale for low back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at 0, 12, and 48 weeks.

Results.

In total, 166 patients completed the 12-month follow-up, 29 of whom had nonunion. Patients with nonunion at 48 weeks after OVF had lower EQ-5D and JOABPEQ walking ability, social life function, mental health, and lumbar function scores than those with union at 48 weeks after injury. The independent risk factors for nonunion after OVF in the acute phase were a diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI. The anterior vertebral body compression percentage and JOABPEQ social life function scores were independent risk factors at 12 weeks.

Conclusion.

A diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI were independent risk factors for nonunion in the acute phase. Patients who have acute OVFs with these risk factors should be carefully monitored for nonunion.

Level of Evidence:2
Distinction and Potential Prediction of Lung Metastasis in Patients with Malignant Primary Osseous Spinal Neoplasms
Authors: Fan Yonggang , Cai Mandi , Xia Lei
Published: February 2020

Study Design.

Retrospective analysis.

Objective.

The aim of this study was to develop and validate a nomogram for the prediction of lung metastasis in patients with malignant primary spinal tumors.

Summary of Background Data.

In patients with malignant primary spinal tumors, lung metastasis is usually found by computed tomography (CT) and is considered to be an essential factor affecting the prognosis and survival.

Methods.

We retrospectively collected 580 malignant primary osseous spinal neoplasms patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic analysis were used to identify independent factors. These prognostic factors were included in the nomograms. The nomograms were validated based on its calibration, discrimination, and clinical utility. The overall survival of the patients was analyzed using the Kaplan–Meier method and the survival differences were tested by the log-rank test.

Results.

We randomly divided all these patients (n = 580) into a training cohort (n = 408) and a validation cohort (n = 172). The results showed that the risk of lung metastasis was independently influenced by histologic type, use of surgery, clinical T stage, clinical N stage, and tumor extension (all P < 0.05). The nomogram consisted of five clinical features and provided good calibration and discrimination in the training and validation cohort, with an area under the curve of 0.858 and 0.811, respectively. Decision curve analysis showed that the nomogram was clinically useful. The Kaplan–Meier curves showed a significant difference between the higher and lower risk of lung metastasis groups (P < 0.001).

Conclusion.

Nomograms were developed to predict the risk of lung metastasis in patients with malignant primary spinal tumors. The nomogram showed favorable discrimination and calibration values, which may help optimize treatment decision-making for patients.

Level of Evidence: 4
Assessment of Sagittal Spinopelvic Balance in a Population of Normal Chinese Children
Authors: Zhou Xiao-Yi , Zhao Jian , Li Bo , Wang Zhi-Bin , Zhang Zi-Cheng , Hu Wen , Cheng Ya-Jun , Li Ming , Wei Xian-Zhao
Published: February 2020

Study Design.

A retrospective study of 257 normal children at a single center from July 2016 to November 2018 was performed.

Objective.

To evaluate the spinopelvic parameters in a population of normal children and adolescents in mainland China.

Summary of Background Data.

Values for sagittal parameters of the spine vary significantly by ages and different population. No study has yet quantified the normal measures for children and adolescents in China, or how these measures compare with other populations.

Methods.

Pelvic incidence (PI), sacral slope, pelvic tilt, thoracic kyphosis (TK, T5-T12), lumbar lordosis (LL, L1-S1), and sagittal vertical axis were measured and evaluated by whole spine AP&lateral X-ray images.

Results.

A total of 257 subjects, including 116 boys (45%) and 141 girls (55%) aged 3 to 12 years, were enrolled. Correlation matrix analysis demonstrated that sagittal balance is strongly correlated with age and Risser sign, including PI, a reported fixed parameter. Further investigation showed that PI could be expressed by the equation PI = 26.243+1.153×age.

Conclusion.

PI was not a fixed but a dynamic parameter in the population under 12-year old. Indeed, PI increases with age and bone maturity in childhood. We also found lower PI, pelvic tilt, and sacral slope compared with published studies of adolescents in other countries. These results may aid in the treatment of patients with spinal deformity, to help them achieve a certain degree of sagittal spinopelvic balance.

Level of Evidence: 2
Retrospective Review of Revision Surgery After Image-guided Instrumented Spinal Surgery Compared With Traditional Instrumented Spinal Surgery
Authors: Towner James E. , Li Yan Icy , Singla Amit , Moquin Ross , Li Yan Michael
Published: February 2020

Study Design:

Retrospective cohort series.

Objective:

The objective of this study was to determine if the use of image-guided navigation offers a clinically significant advantage over fluoroscopy-assisted pedicle screw and non-navigated screw placement in reducing the risk of revision surgery for malpositioned screws in instrumented spinal surgery.

Summary of Background Data:

Use image-guided navigation has become increasingly commonplace in instrumented spine surgery, but there is a lack of information regarding differences in the rates of clinically relevant screw malposition with image-guided compared with non-navigated screw placement.

Materials and Methods:

This is a retrospective cohort series of consecutive patients who underwent instrumented spinal surgery by the senior authors at 2 academic tertiary care centers in New York.

Results:

A total of 663 instrumented spinal surgeries were analyzed, including 271 instances with image-guided navigation. For the image-guided navigation cohort, 110 of the patients underwent screw placement using O-Arm image-guidance, yielding data on 1115 screws. The remaining 161 surgeries utilizing image-guided screw placement were performed using Brainlab Spine Navigation, for a total of 1001 screws. A fluoroscopy-assisted technique or freehand technique was used in 419 instances, with a total of 3689 screws. Of the non-navigated cohort, 10 patients required a surgical revision of screw placement, for a total of 15 malpositioned screws. Amongst the image-guided navigation cohort, 1 patient in the O-Arm group and 2 in the Brainlab group required revision surgery, with 3 malpositioned screws in total. The rate of revision surgery for a malpositioned screw placed via non-navigated techniques was 2.39%. This risk was decreased to 1.11% with the use of the intraoperative image-guided navigation. However, no comparisons between non-navigated and image-guided screw placement reached statistical significance.

Conclusion:

Although not reaching statistical significance, these data suggest there may be an advantage offered by image-guided screw placement in instrumented spinal surgery.
Risk factors of interstitial lung diseases in clinically amyopathic dermatomyositis
Authors: Gan Yu-Zhou , Zhang Li-Hua , Ma Lin , Sun Feng , Li Yu-Hui , An Yuan , Li Zhan-Guo , Ye Hua
Published: February 2020

Background

Clinically amyopathic dermatomyositis (CADM) is a unique sub-type of idiopathic inflammatory myopathies with a high prevalence of interstitial lung disease (ILD). Poor prognosis of the patients was strongly associated with rapid progressive ILD. The aim of this study was to identify risk factors for prediction of different types of ILD in CADM.

Methods

In this study, data of 108 inpatients with CADM were collected, including 87 with ILD. The baseline clinical data and laboratory parameters, including myositis-specific and associated antibodies and tumor-associated antigens were analyzed to identify risk factors for acute or subacute interstitial pneumonitis (A/SIP) and chronic interstitial pneumonitis (CIP).

Results

In 87 patients with CADM-ILD, 39 (36.1%) were A/SIP, and 48 (44.4%) were CIP. There were 22 (20.4%) patients with asymptomatic ILD who were detected by routine high resolution computed tomography. Cytokeratin-19 fragment (CYFRA21-1) was significantly higher in CADM-ILD than that in CADM patients without ILD; carcinoembryonic antigen and neuron-specific enolase were significantly elevated in A/SIP than that in CIP. Patients with A/SIP had a higher positive rate of anti-melanoma differentiation-associated gene 5 (MDA5), while patients with CIP had a higher positive rate of anti PL-12 and anti-Ro-52. Logistic regression analysis indicated that elevation of CYFRA21-1 was a risk factor for ILD, higher titer of anti-MDA5 indicated increased likelihood for A/SIP, and higher titer of anti-Ro-52 was also clearly associated with CIP.

Conclusions

This study indicated that the prevalence of ILD was high in CADM. Asymptomatic ILD has been previously underestimated. Anti-MDA5 was a risk factor for the presence of A/SIP, and CYFRA21-1 was a risk factor for ILD.
Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province
Authors: Liu Kui , Fang Yuan-Yuan , Deng Yan , Liu Wei , Wang Mei-Fang , Ma Jing-Ping , Xiao Wei , Wang Ying-Nan , Zhong Min-Hua , Li Cheng-Hong , Li Guang-Cai , Liu Hui-Guo
Published: February 2020

Background

The 2019 novel coronavirus (2019-nCoV) causing an outbreak of pneumonia in Wuhan, Hubei province of China was isolated in January 2020. This study aims to investigate its epidemiologic history, and analyze the clinical characteristics, treatment regimens, and prognosis of patients infected with 2019-nCoV during this outbreak.

Methods

Clinical data from 137 2019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30, 2019 to January 24, 2020 were retrospectively collected, including general status, clinical manifestations, laboratory test results, imaging characteristics, and treatment regimens.

Results

None of the 137 patients (61 males, 76 females, aged 20–83 years, median age 57 years) had a definite history of exposure to Huanan Seafood Wholesale Market. Major initial symptoms included fever (112/137, 81.8%), coughing (66/137, 48.2%), and muscle pain or fatigue (44/137, 32.1%), with other, less typical initial symptoms observed at low frequency, including heart palpitations, diarrhea, and headache. Nearly 80% of the patients had normal or decreased white blood cell counts, and 72.3% (99/137) had lymphocytopenia. Lung involvement was present in all cases, with most chest computed tomography scans showing lesions in multiple lung lobes, some of which were dense; ground-glass opacity co-existed with consolidation shadows or cord-like shadows. Given the lack of effective drugs, treatment focused on symptomatic and respiratory support. Immunoglobulin G was delivered to some critically ill patients according to their conditions. Systemic corticosteroid treatment did not show significant benefits. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea.

Conclusions

The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom, and most of them still showed typical manifestations of viral pneumonia on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.
Does vitamin D status influence lumbar disc degeneration and low back pain in postmenopausal women? A retrospective single-center study
Authors: Xu Hao-Wei , Yi Yu-Yang , Zhang Shu-Bao , Hu Tao , Wang Shan-Jin , Zhao Wei-Dong , Wu De-Sheng
Published: February 2020

Objective:

To investigate the relationship between serum vitamin D concentration and lumbar disc degeneration (LDD) in postmenopausal women and the epidemiologic factors affecting low back pain (LBP).

Methods:

Between July 2017 and December 2018, 232 participants were retrospectively enrolled. Serum concentrations of bone turnover markers were measured using electrochemiluminescence assays. Disc degeneration was evaluated using the Pfirrmann grading system. Other variables were assessed using relevant questionnaires.

Results:

The mean age of the women was 65.6 ± 10.1 and their serum 25(OH)D concentrations were 19.38 ± 9.21 ng/mL. The prevalences of severe vitamin D deficiency (<10 ng/mL) and normal status (>30 ng/mL) were 12.9% and 12.5%, respectively. The severely deficient group had higher visual analog scale (VAS) scores for LBP (P = 0.002) and lower bone mineral density T scores (P = 0.004) than the other groups. Lower 25(OH)D concentration (<10 ng/mL) was significantly associated with more severe LDD in the lumbosacral region (L4-S1, L1-S1, P < 0.05), but less so in the upper lumbar region. There was an inverse relationship between vitamin D concentration and the severity of disc degeneration (L2-L3, L4-S1, L1-S1, P < 0.05). After adjustment for confounding factors, smoking, vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and low bone mineral density T score were associated with higher incidence of moderate-to-severe pain in postmenopausal women (P < 0.05).

Conclusions:

Vitamin D deficiency is associated with LDD and LBP in postmenopausal women. Specifically, a serum vitamin D concentration < 10 ng/mL is a marker of severe LDD and LBP. Smoking, severe vitamin D deficiency, lack of vitamin D supplementation, high body mass index, and osteoporosis are associated with a higher prevalence of moderate-to-severe pain.
Bacteriological pattern and their correlation with complications in culture positive cases of acute bacterial conjunctivitis in a tertiary care hospital of upper Assam
Authors: Bhattacharyya Anusuya , Sarma Phulen , Sarma Bhaswati , Kumar Subodh , Gogoi Tapan , Kaur Hardeep , Prajapat Manisha
Published: February 2020

Acute conjunctivitis is inflammation of conjunctiva of less than 3 to 4 weeks duration, characterized by cellular infiltration and exudation. It may also result into corneal, lid or orbital involvement which may lead to various complications.

A hospital based prospective study was conducted in Assam Medical College and Hospital with 110 culture proven acute bacterial conjunctivitis cases. Primary objective was to evaluate the bacteriological pattern and secondary objectives were to evaluate seasonal variation, association of different organisms with various complications and antibiotic sensitivity pattern of the isolates.

Maximum frequency of bacterial conjunctivitis observed from May to September. SA was the predominant organism isolated throughout the year (32.1%). Commonest single organism isolates were SE (26.1%) and SA (21.6%). True membrane formation was significantly associated with CD (P < .05), whereas pseudo-membrane formation was associated with SA and STBH isolation (P < .05). Isolation of SE, SA, and PA was associated with corneal involvement (P < .05). Lid involvement was seen with SA and Diphtheroid, whereas SP isolation was associated with concomitant dacryocystitis (P < .05). All the major organisms were (SE, SA, D, STBH, SP) highly sensitive to amino-glycosides, cephalosporins, chloromphenicol, vancomycin and linezolid, whereas high level of resistance was seen towards fluroquinolones (ciprofloxacin and moxifloxacin).

All acute bacterial conjunctivitis cases don’t require antibiotic therapy. In case if required, periodical culture and sensitivity may guide initial pre-emptive antibiotic therapy. Further choice of antibiotic should be govern by culture and sensitivity status.
Diode laser transscleral cyclophotocoagulation for uveitis-glaucoma-hyphema syndrome
Authors: Liu Zhengfeng , Zhang Feng , Wen Ying , Du Xiujuan , Pan Xuemei , Bi Hongsheng
Published: February 2020

Rationale:

To report a case of diode laser transscleral cyclophotocoagulation (DLTSC) for uveitis-glaucoma-hyphema syndrome (UGH).

Patient concerns:

The patient developed UGH on the right eye (OD) after vitrectomy and intraocular lens (IOL) implantation.

Diagnoses:

Best corrected visual acuity (BCVA) was HM/50 cm, intraocular pressure (IOP) was 51.3 mm Hg on the OD. He was found to have 3+ anterior chamber cells. A B-scan ultrasound showed vitreous opacity. Ultrasound biomicroscopy (UBM) showed the chafing between the IOL and the posterior surface of the iris. Thus, he was diagnosed as UGH on the OD.

Interventions:

The patient was worried about the complications for removal of the IOL, a DLTSC approach was performed.

Outcomes:

BCVA was 20/40 on the OD, IOP was 12 mm Hg on the OD. There were no anterior chamber inflammation and no vitreous opacity. UBM showed there was no contact between IOL and the posterior surface of the iris, the fundus of the eye was clearly visible.

Lessons:

UGH syndrome is a severe complication of cataract extraction. IOL extraction has been the traditional approach to treatment. DLTSC can be an option when the IOL is slightly tilted.
Ursodeoxycholic acid use is associated with significant risk of morbidity and mortality in infants with cholestasis
Authors: Kotb Magd Ahmed , Mosallam Dalia , Basanti Christine William Shaker , El Sorogy Sally Talaat Mostafa , Badr Ahmed M. , Abd El Baky Hend El Hosainy , Draz Iman Hassan
Published: February 2020

The off-label use of medications is a “right” for pediatricians, owing to lack of enough safety and effectiveness drug trials in pediatric age group. Pediatricians have to rely on their personal judicial use of medications in children.

We studied off-label use of ursodeoxycholic acid (UDCA) retrospectively during 2005 to 2015 among those who attended the Pediatic Hepatology Unit, Cairo University.

We analyzed data of 779 neonates and infants with cholestasis. 15% dropped out. Males comprised 374 (56.5%). Cholestasis was due to surgical causes in 129 (19.5%), neonatal hepatitis in 445 (67.2%), and paucity of intrahepatic bile ducts in 88 (13.3%). Three hundred sixty (54.4%) received UDCA (15–30 mg/kg/d), and 302 (45.6%) did not. Both groups were matched as regards causes and severity of cholestasis. Those who received UDCA had worse outcome (P < .001), and more complications (P < .001). A total of 73.1% (221) achieved cure without UDCA compared to only 45.8% (165) of those on UDCA (P < .001).

UDCA is not effective and not safe in Egyptian neonates and infants with cholestasis. UDCA use compromises chance of cure, and is associated with serious morbidity, progression of disease, and death. UDCA off-label use mortality was absolutely preventable. Off- label use of UDCA in neonates and children should be utterly prohibited. Information of use of off-label medications, effectiveness, and safety, should be recorded, analyzed, and made available within context of Off-label Use Registry Studies with informed consent of parents.