bluuebunny/crossref_metadata_2025 huggingface dataset:
Preconcentration of charged molecules on paper pads using greenly synthesized smart nano-composite membranes
Authors: Syed Abeer , Da’na Enshirah , Taha Amel
Published: July 2021

Low concentration of biomarkers (proteins, nucleic acids, metabolites) is a major concern in early disease diagnosis due to the very low concentration of these biomarkers at the early stage of any disease. This challenge can be addressed by preconcentrating the biomarkers to improve the sensitivity of the diagnostic device. This paper describes a novel method to preconcentrate the charged molecules on paper using greenly synthesized iron nanoparticles. The iron nanoparticles were synthesized by utilizing plant extract as stabilizing agent, which both minimizes the cost and protects the environment. Three different samples of the nanoparticles were prepared by changing the charge or attaching a functional group (amine) to the surface. The iron nanoparticles act as a charged nanoporous membrane when deposited on the paper pads inducing electrostatic forces around the membrane leading to the concentration of the charged analytes near the boundary of the membrane. Crystal violet was used as a surrogate for the charged biomolecule. We report ∼24-fold increase in the concentration of crystal violet dye within 120 seconds using the positively charged membrane and the 0.2 mM dye solution. The developed experimental set-up eliminates the need for external pumping device and complex fabrication processes making the proposed method cost-effective, environment-friendly, and simple to use.
A spotlight on prey-induced metabolite dynamics in sundew. A commentary on: ‘Metabolomic analysis reveals reliance on secondary plant metabolites to facilitate carnivory in the Cape sundew,Drosera capensis’
Authors: Mithöfer Axel
Published: July 2021

This article comments on:

Christopher R. Hatcher, Ulf Sommer, Liam M. Heaney and Jonathan Millett, Metabolomic analysis reveals reliance on secondary plant metabolites to facilitate carnivory in the Cape sundew, Drosera capensis, Annals of Botany Volume 128, Issue 3, 26 August 2021, Pages 301–314, https://doi.org/10.1093/aob/mcab065
Improved prediction of conopeptide superfamilies with ConoDictor 2.0
Authors: Koua Dominique , Ebou Anicet , Dutertre Sébastien
Published: July 2021

Motivation

Cone snails are among the richest sources of natural peptides with promising pharmacological and therapeutic applications. With the reduced costs of RNAseq, scientists now heavily rely on venom gland transcriptomes for the mining of novel bioactive conopeptides, but the bioinformatic analyses often hamper the discovery process.

Results

Here, we present ConoDictor 2.0 as a standalone and user-friendly command-line program. We have updated the program originally published as a web server 10 years ago using novel and updated tools and algorithms and improved our classification models with new and higher quality sequences. ConoDictor 2.0 is now more accurate, faster, multiplatform and able to deal with a whole cone snail venom gland transcriptome (raw reads or contigs) in a very short time. The new version of Conodictor also improves the identification and subsequent classification for entirely novel or relatively distant conopeptides. We conducted various tests on known conopeptides from public databases and on the published venom duct transcriptome of Conus geographus, and compared previous results with the output of ConoDictor 2.0, ConoSorter and BLAST. Overall, ConoDictor 2.0 is 4 to 8 times faster for the analysis of a whole transcriptome on a single core computer and performed better at predicting gene superfamily.

Availability and implementation

ConoDictor 2.0 is available as a python 3 git folder at https://github.com/koualab/conodictor.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
Sleep and circadian phenotype in people without cone-mediated vision: a case series of fiveCNGB3and twoCNGA3patients
Authors: Spitschan Manuel , Garbazza Corrado , Kohl Susanne , Cajochen Christian
Published: July 2021

Light exposure entrains the circadian clock through the intrinsically photosensitive retinal ganglion cells, which sense light in addition to the cone and rod photoreceptors. In congenital achromatopsia (prevalence 1:30–50 000), the cone system is non-functional, resulting in severe light avoidance and photophobia at daytime light levels. How this condition affects circadian and neuroendocrine responses to light is not known. In this case series of genetically confirmed congenital achromatopsia patients (n = 7; age 30–72 years; 6 women, 1 male), we examined survey-assessed sleep/circadian phenotype, self-reported visual function, sensitivity to light and use of spectral filters that modify chronic light exposure. In all but one patient, we measured rest-activity cycles using actigraphy over 3 weeks and measured the melatonin phase angle of entrainment using the dim-light melatonin onset. Owing to their light sensitivity, congenital achromatopsia patients used filters to reduce retinal illumination. Thus, congenital achromatopsia patients experienced severely attenuated light exposure. In aggregate, we found a tendency to a late chronotype. We found regular rest-activity patterns in all patients and normal phase angles of entrainment in participants with a measurable dim-light melatonin onset. Our results reveal that a functional cone system and exposure to daytime light intensities are not necessary for regular behavioural and hormonal entrainment, even when survey-assessed sleep and circadian phenotype indicated a tendency for a late chronotype and sleep problems in our congenital achromatopsia cohort.
Single-step genomic BLUP enables joint analysis of disconnected breeding programs: an example with Eucalyptus globulus Labill
Authors: Callister Andrew N , Bradshaw Ben P , Elms Stephen , Gillies Ross A W , Sasse Joanna M , Brawner Jeremy T
Published: July 2021

Single-step GBLUP (HBLUP) efficiently combines genomic, pedigree, and phenotypic information for holistic genetic analyses of disjunct breeding populations. We combined data from two independent multigenerational Eucalyptus globulus breeding populations to provide direct comparisons across the programs and indirect predictions in environments where pedigreed families had not been evaluated. Despite few known pedigree connections between the programs, genomic relationships provided the connectivity required to create a unified relationship matrix, H, which was used to compare pedigree-based and HBLUP models. Stem volume data from 48 sites spread across three regions of southern Australia and wood quality data across 20 sites provided comparisons of model accuracy. Genotyping proved valuable for correcting pedigree errors and HBLUP more precisely defines relationships within and among populations, with relationships among the genotyped individuals used to connect the pedigrees of the two programs. Cryptic relationships among the native range populations provided evidence of population structure and evidence of the origin of landrace populations. HBLUP across programs improved the prediction accuracy of parents and genotyped individuals and enabled breeding value predictions to be directly compared and inferred in regions where little to no testing has been undertaken. The impact of incorporating genetic groups in the estimation of H will further align traditional genetic evaluation pipelines with approaches that incorporate marker-derived relationships into prediction models.
Outpatient antibiotic use in British Columbia, Canada: reviewing major trends since 2000
Authors: Saatchi Ariana , Morris Andrew M , Patrick David M , Mccormack James , Reyes Romina C , Morehouse Phillip , Reid Jennifer , Shariff Salimah , Povitz Marcus , Silverman Michael , Marra Fawziah
Published: July 2021

Background

With 90% of all antibiotics in Canada being used in the community setting, tracking outpatient prescribing is integral to mitigate the issue of antimicrobial resistance. In 2005, a provincial programme was launched in British Columbia (BC) to disseminate information regarding the judicious use of antibiotics. These efforts include educational campaigns, updated practitioner guidelines and academic detailing. The impact of provincial stewardship on community prescribing requires ongoing evaluation.

Objectives

This study examines outpatient prescribing to quantify rates of antibiotic use, evaluate major trends over time and identify new targets for stewardship.

Methods

A retrospective cohort design using population-level data.

Results

This study included over 3.5 million unique individuals with a total of 51 367 938 oral antibiotic prescriptions dispensed over a 19 year period (2000–18). Overall antibiotic utilization decreased by 23% over the course of the study period. This trend in the reduction of antibiotic prescription was observed across all major antibiotic classes, apart from the class of other antibacterials, which was mostly related to use of nitrofurantoin. The largest magnitudes of decreased prescribing were observed in the paediatric population. Prescribing across two distinct eras of provincial stewardship reaffirmed preliminary findings of programme efficacy, when compared with pre-stewardship levels of antibiotic use.

Conclusions

Outpatient prescribing in BC is decreasing overall, and this study confirms an association between provincial stewardship interventions and improvements in antibiotic use. Pronounced declines in paediatric populations are promising, and further research is underway to examine prescribing quality.
Peri-operative platelet-rich plasma in arthroscopic femoroacetabular impingement surgery: a randomized controlled trial
Authors: Foo Gen Lin , Knudsen Joshua Sapong , Bacon Catherine Jane , Mei-Dan Omer , McConkey Mark Owen , Brick Matthew John
Published: July 2021

This study aimed to determine whether the addition of platelet-rich plasma (PRP) during hip arthroscopy improves functional outcomes in femoroacetabular impingement (FAI) surgery. This was a prospective randomized single-blinded trial of arthroscopic hip patients aged between 16 and 50 years with a diagnosis of FAI conducted at a single centre. Patients with any previous hip surgery and significant osteoarthritic changes (Tonnis grade > 2) were excluded. Before surgery, patients were randomly assigned to receive either a PRP injection or a saline placebo. Efficacy was evaluated at 6 months, 1 year and 2 years post-surgery using patient-reported outcomes. The short version International Hip Outcome Tool (iHOT12) was the primary outcome. Recruited patients (n = 113) were aged 36.0 ± 10.5 (mean ± standard deviation) years and 56% male. At baseline, iHOT12 scores of the PRP (mean 43.8 ± 22.4) and placebo groups (mean 45.2 ± 21.5) were similar. At a minimum follow-up of 2 years, both groups had improved iHOT12 scores (PRP: mean 83.6 ± 13.4, control: mean 77.1 ± 23.3), with no significant difference in change between the two groups (P = 0.19). There were no significant group differences for the change in Non-Arthritic Hip and Hip Disability and Osteoarthritis Outcome Score—Shortform scores between the two groups (P = 0.22 and 0.46, respectively). The present study does not support the peri-operative use of PRP in arthroscopic surgery for FAI for mid-term improvement. There were no significant differences in outcome between PRP and placebo groups at 2-year minimum follow-up after surgery.
Dosimetric evaluation of ovaries and pelvic bones associated with clinical outcomes in patients receiving total body irradiation with ovarian shielding
Authors: Akahane Keiko , Shirai Katsuyuki , Wakatsuki Masaru , Suzuki Masato , Hatanaka Shogo , Takahashi Yuta , Kawahara Masahiro , Ogawa Kazunari , Takahashi Satoru , Oyama-Manabe Noriko , Ashizawa Masahiro , Kimura Shun-ichi , Kako Shinichi , Kanda Yoshinobu
Published: July 2021

Total body irradiation (TBI) with ovarian shielding is expected to preserve fertility among hematopoietic stem cell transplant (HSCT) patients with myeloablative TBI-based regimens. However, the radiation dose to the ovaries that preserves ovarian function in TBI remains poorly understood. Furthermore, it is uncertain whether the dose to the shielded organs is associated with relapse risk. Here, we retrospectively evaluated the relationship between fertility and the dose to the ovaries, and between relapse risk and the dose to the pelvic bones. A total of 20 patients (median age, 23 years) with standard-risk hematologic diseases were included. Median follow-up duration was 31.9 months. The TBI prescribed dose was 12 Gy in six fractions for three days. Patients’ ovaries were shielded with cylinder-type lead blocks. The dose–volume parameters (D98% and Dmean) in the ovaries and the pelvic bones were extracted from the dose–volume histogram (DVH). The mean ovary Dmean for all patients was 2.4 Gy, and 18 patients recovered menstruation (90%). The mean ovary Dmean for patients with menstrual recovery and without recovery were 2.4 Gy and 2.4 Gy, respectively, with no significant difference (P = 0.998). Hematological relapse was observed in five patients. The mean pelvis Dmean and pelvis D98% for relapse and non-relapse patients were 11.6 Gy and 11.7 Gy and 5.6 Gy and 5.3 Gy, respectively. Both parameters showed no significant difference (P = 0.827, 0.807). In conclusion, TBI with ovarian shielding reduced the radiation dose to the ovaries to 2.4 Gy, and preserved fertility without increasing the risk of relapse.
Effectiveness of Surgical Decompression in Patients With Degenerative Cervical Myelopathy: Results of the Canadian Prospective Multicenter Study
Authors: Karim S Mohammed , Cadotte David W , Wilson Jefferson R , Kwon Brian K , Jacobs W Bradley , Johnson Michael G , Paquet Jérôme , Bailey Christopher S , Christie Sean D , Nataraj Andrew , Attabib Najmedden , Phan Philippe , McIntosh Greg , Hall Hamilton , Rampersaud Y Raja , Manson Neil , Thomas Kenneth C , Fisher Charles G , Dea Nicolas ,   on behalf of the Canadian Spine Outcomes and Research Network (CSORN)
Published: July 2021

BACKGROUND

Conflicting evidence exists regarding the effectiveness of surgery for degenerative cervical myelopathy (DCM), particularly in mild DCM.

OBJECTIVE

To prospectively evaluate the impact of surgery on patient-reported outcomes in patients with mild (modified Japanese Orthopaedic Association [mJOA] ≥ 15), moderate (mJOA 12-14), and severe (mJOA < 12) DCM.

METHODS

Prospective, multicenter cohort study of patients with DCM who underwent surgery between 2015 and 2019 and completed 1-yr follow-up. Outcome measures (mJOA, Neck Disability Index [NDI], EuroQol-5D [EQ-5D], Short Form [SF-12] Physical Component Score [PCS]/Mental Component Score [MCS], numeric rating scale [NRS] neck, and arm pain) were assessed at 3 and 12 mo postoperatively and compared to baseline, stratified by DCM severity. Changes in outcome measures that were statistically significant (P < .05) and met their respective minimum clinically important differences (MCIDs) were deemed clinically meaningful. Responder analysis was performed to compare the proportion of patients between DCM severity groups who met the MCID for each outcome measure.

RESULTS

The cohort comprised 391 patients: 110 mild, 163 moderate, and 118 severe. At 12 mo after surgery, severe DCM patients experienced significant improvements in all outcome measures; moderate DCM patients improved in mJOA, NDI, EQ-5D, and PCS; mild DCM patients improved in EQ-5D and PCS. There was no significant difference between severity groups in the proportion of patients reaching MCID at 12 mo after surgery for any outcome measure, except NDI.

CONCLUSION

At 12 mo after surgery, patients with mild, moderate, and severe DCM all demonstrated improved outcomes. Severe DCM patients experienced the greatest breadth of improvement, but the proportion of patients in each severity group achieving clinically meaningful changes did not differ significantly across most outcome measures.
Tool for Estimating the Probability of Having COVID-19 With 1 or More Negative RT-PCR Results
Authors: Jara Alejandro , Undurraga Eduardo A , Araos Rafael
Published: July 2021

Early case detection and isolation of infected individuals are critical to controlling coronavirus disease 2019 (COVID-19). Reverse transcription polymerase chain reaction (RT-PCR) is considered the gold standard for the diagnosis of severe acute respiratory syndrome coronavirus 2 infection, but false negatives do occur. We built a user-friendly online tool to estimate the probability of having COVID-19 with negative RT-PCR results and thus avoid preventable transmission.
White Matter Alterations Between Brain Network Hubs Underlie Processing Speed Impairment in Patients With Schizophrenia
Authors: Klauser Paul , Cropley Vanessa L , Baumann Philipp S , Lv Jinglei , Steullet Pascal , Dwir Daniella , Alemán-Gómez Yasser , Bach Cuadra Meritxell , Cuenod Michel , Do Kim Q , Conus Philippe , Pantelis Christos , Fornito Alex , Van Rheenen Tamsyn E , Zalesky Andrew
Published: July 2021

Processing speed (PS) impairment is one of the most severe and common cognitive deficits in schizophrenia. Previous studies have reported correlations between PS and white matter diffusion properties, including fractional anisotropy (FA), in several fiber bundles in schizophrenia, suggesting that white matter alterations could underpin decreased PS. In schizophrenia, white matter alterations are most prevalent within inter-hub connections of the rich club. However, the spatial and topological characteristics of this association between PS and FA have not been investigated in patients. In this context, we tested whether structural connections comprising the rich club network would underlie PS impairment in 298 patients with schizophrenia or schizoaffective disorder and 190 healthy controls from the Australian Schizophrenia Research Bank. PS, measured using the digit symbol coding task, was largely (Cohen’s d = 1.33) and significantly (P < .001) reduced in the patient group when compared with healthy controls. Significant associations between PS and FA were widespread in the patient group, involving all cerebral lobes. FA was not associated with other cognitive measures of phonological fluency and verbal working memory in patients, suggesting specificity to PS. A topological analysis revealed that despite being spatially widespread, associations between PS and FA were over-represented among connections forming the rich club network. These findings highlight the need to consider brain network topology when investigating high-order cognitive functions that may be spatially distributed among several brain regions. They also reinforce the evidence that brain hubs and their interconnections may be particularly vulnerable parts of the brain in schizophrenia.
Phosphonate Treatment Effects on Phytophthora Root Rot Control, Phosphite Residues and Phytophthora cactorum Inoculum in Young Apple Orchards
Authors: Nyoni M. , Mazzola M. , Wessels J. P. B. , McLeod A.
Published: July 2021

Phytophthora root rot, caused by Phytophthora cactorum, is an economically important disease on young apple trees. Limited information is available on the effect of different phosphonate application methods and dosages on disease control, fruit and root phosphite concentrations, and soil and root pathogen inoculum levels. Evaluation of phosphonate treatments in three apple orchard trials (two in the Grabouw and one in the Koue Bokkeveld region) showed that foliar sprays (ammonium or potassium phosphonate), trunk sprays and trunk paints, were equally effective at increasing trunk diameter in one trial and yield in a second trial over a 25-month period. Foliar ammonium and potassium phosphonate sprays (12 g of phosphorous acid/tree), and two different dosages of the ammonium phosphonate sprays (∼4.8 g or 12 g of phosphorous acid/tree) were all equally effective at improving tree growth. The addition of a bark penetrant (polyether-polymethylsiloxane-copolymer) to trunk sprays did not improve the activity of trunk sprays. The low dosage ammonium phosphonate foliar spray (∼4.8 g a.i./tree) was the only treatment that, in general, yielded significantly lower root phosphite concentrations than the other phosphonate treatments. Root phosphite concentrations were significantly positively correlated (P < 0.0001) with an increase in trunk diameter and negatively (P < 0.0001) with P. cactorum root DNA quantities. Phosphite fruit residues were <31 ppm for all treatments, with the trunk paint treatment (80 g of phosphorous acid/tree applied annually) yielding significantly lower residues than the higher dosage foliar sprays (∼12 g a.i./tree). Twenty-one months posttreatment, most of the phosphonate treatments in all of the trials similarly significantly reduced P. cactorum DNA quantities estimated directly from roots, but not from soil based on soil baiting DNA analysis. Pathogen quantities in fine feeder roots did not differ significantly from those in higher-order roots (<5 mm diameter). P. cactorum DNA quantities estimated using DNA quantification directly from roots were significantly correlated (P < 0.0001) with those obtained through root leaf baiting DNA analysis and, to a lesser extent, with soil leaf baiting DNA quantities (P = 0.025).
First Report of Powdery Mildew Caused by Podosphaera macularis on Hemp in Oregon
Authors: Bates Taylor A. , Block Mary H. , Wiseman Michele S. , Garfinkel Andrea R. , Gent David H. , Ocamb Cynthia M.
Published: July 2021

In Oregon, hemp (Cannabis sativa) production has increased substantially after cultivation was legalized in the 2014 and 2018 Farm Bills. Typically, hemp species are affected by powdery mildew caused by Golovinomyces species. This paper reports on hop powdery mildew caused by Podosphaera macularis, found colonizing hemp in natural conditions. The occurrence of the hop powdery mildew fungus on hemp may have management implications for both the hemp and hop industry.
First Report of Macrophomina phaseolina, Fusarium brachygibbosum, and Lasiodiplodia theobromae Causing Fungal Watermelon Vine Decline in Southwest and West-Central Florida
Authors: Pisani Cristina , Adkins Scott , Turechek William W. , Patel Pragna C. , Rosskopf Erin N.
Published: July 2021

Wilt and vine decline symptoms were observed on watermelon plants in Glades and Hardee Counties in Florida in spring 2017 that resembled viral watermelon vine decline caused by squash vein yellowing virus (SqVYV). When no SqVYV was detected, greenhouse studies and morphological and molecular analyses revealed three fungal pathogens, Macrophomina phaseolina, Fusarium brachygibbosum, and Lasiodiplodia theobromae, that were not previously reported on watermelon in Florida. A previously reported oomycete, Pythium spinosum, was also detected in some, but not all, isolations and when applied independently resulted in disease incidence that was comparable to the untreated check, ruling it out as a primary causal agent of the symptoms observed in the field. In one of three experiments, seedlings inoculated with a combination of M. phaseolina, F. brachygibbosum, and P. spinosum suffered the highest disease severity based on AUDPC values. In another experiment, seedlings inoculated with F. brachygibbosum exhibited the most severe symptoms and rapid disease development following inoculation. When seeds were inoculated with either a single or a combination of the isolated fungi, those inoculated with L. theobromae resulted in seedlings with the greatest disease severity. This is the first report of these three fungal pathogens on watermelon in Florida.
Postoperative innovative technology for ambulatory anesthesia and surgery
Authors: Coppens Marc , Van Caelenberg Els , De Regge Melissa
Published: July 2021

Purpose of review

To give an overview of the impact of different forms of telehealth that are currently used in ambulatory anesthesia and surgery. Telehealth is applicable during the early recovery and intermediate recovery period (e.g. monitoring of quality of recovery), and as a tool for postoperative check-up during the late recovery phase.

Recent findings

Postoperative follow-up after ambulatory surgery is still crucial to maintain quality of care as pain and postoperative nausea and vomiting remain common adverse events. There is a surge of telehealth applications from procedure-specific commercial smartphone apps (mHealth) to complete digital patient platforms instituted by the government. However, patient and healthcare provider engagement is not universal. Usability of these applications is mandatory as well as identifying and overcoming the barriers to its use.

Telehealth gives many opportunities for postoperative follow-up of ambulatory surgery patients. Clear evidence on the benefits of telehealth in ambulatory surgery is however still sparse. Future research should focus on telehealth for improving quality and safety of postoperative recovery, convincing policymakers for reimbursement encouraging healthcare providers and patients to engage in telehealth.
Narratives as Borders
Authors: Hoffman Sarah J. , Vukovich Maria M. , Peden-McAlpine Cynthia , Robertson Cheryl L. , Wilk Kristin , Wiebe Grey , Gaugler Joseph E.
Published: July 2021

The refugee narrative spans time, geography, and generations, enfolding the complexity of constructing identities through displacement and migration. Through adapted narrative analysis, we examined the physical narratives of war trauma which a sample of Karen refugee women constructed, as they claimed their experiences of war trauma and torture in interview discussions. We employed an adapted narrative method relevant to the analysis of field texts to interpret the remembering and retelling of trauma narratives. This method helped to elicit positional identities and physical/sensory memories that were prominent in women's experiences and to contextualized concurrently collected quantitative data. Accounts revealed key constructs relevant to the narrative function and orientation of the narratives: remembering childhood, being a mother, embodiment of trauma.
Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on AP Hip Radiographs
Authors: Furdock Ryan J. , Benedick Alexander J. , Nelson Grant , Li Don , Cooperman Daniel R. , Sanders James O. , Liu Raymond W.
Published: July 2021

Background:

The ability to estimate skeletal maturity using a hip radiograph does not yet exist, but may have utility in the treatment of scoliosis, slipped capital femoral epiphysis, and lower limb deformity. We sought to develop a fast, accurate, and reproducible method.

Methods:

Fourteen hip radiologic parameters were evaluated on serial anteroposterior hip radiographs from 3 years before to 2 years after the skeletal age associated with 90% of final height, a validated skeletal maturity definition which correlates with the timing of peak height velocity. The Greulich and Pyle (GP) left hand bone age was obtained for comparison. Stepwise linear regression and generalized estimating equation analyses were used to isolate key hip and demographic parameters, creating the “optimized Oxford” skeletal maturity system. The accuracy of the optimized Oxford system in predicting years from 90% of final height was evaluated and compared with systems of demographics only, the modified Oxford, demographics+modified Oxford, and demographics+GP.

Results:

A total of 284 hip radiographs from 41 girls (range: 7 to 15 y) and 38 boys (range: 9 to 17 y) were included. Following multivariate analyses, 5 of the original 14 hip radiographic parameters remained significant. The predictions made by the optimized Oxford model had greater accuracy and fewer outlier predictions (predictions >1 y off from actual years from 90% of final height) than the demographics only and modified Oxford only models (P<0.05 for all). The optimized Oxford model had greater prediction accuracy than the demographics+modified Oxford model, but similar rates of outlier predictions (P=0.903). No differences in mean prediction accuracy or rate of outlier predictions were observed between the optimized Oxford and the demographics+GP model (P>0.05).

Conclusion:

High precision in skeletal maturity estimation can be achieved by using chronological age, sex, and 5 hip radiographic parameters.

Clinical Relevance:

We have developed a skeletal maturity system that utilizes anteroposterior hip radiographs and performs as accurately as GP.
Interlocking Fixation in Fassier-Duval Rods: Performance and Success Factors
Authors: Suresh Krishna V. , Vankara Ashish , Lentz Jonathon M. , Sponseller Paul D.
Published: July 2021

Introduction:

Pediatric patients with osteogenesis imperfecta (OI) can be treated with intramedullary Fassier-Duval rod (FDR) systems for limb deformity or recurrent fractures. Single-interlocking pins can improve epiphyseal fixation, but there is a paucity of literature examining incidence of rod migration or pin backout long-term. The purpose of this study is to quantify rates of rod migration and pin backout in OI patients treated with single-interlocking FDRs.

Methods:

A retrospective chart review was performed on pediatric patients treated at a tertiary care center across a 15-year period. Inclusion criteria to select patients was: (1) Pediatric patients (below 18 y of age); (2) Patients with confirmed OI; and (3) Patients with lower extremity fractures or deformity treated with FDRs with distal interlocking pins. Age at time of surgery, rates of obturator migration and pin backout and prominence were collected. We recorded if pin tips were bent by the surgeon during the procedure. Bivariate statistics were used to analyze risk factors for pin backout and prominence.

Results:

Twenty-four single-interlocking pin FDRs (21 tibia, 3 femur) were identified. The mean age at index surgery was 5.7±3.4 years, with the mean follow-up time of 7.2±4.7 years. Fourteen (58%) rods underwent revision surgery. Obturator proximal migration was observed in 3/24 rods (13%). No cases of obturator distal migration were observed (0/24, 0%). Mean proximal obturator migration was 2.16±1.8 cm. Revision for pin backout was observed in 10 (42%) rods and pin prominence in 11 (46%) extremities. Bending interlocking pins on at least 1 end was associated with decreased pin backout (P=0.01) and prominence (P=0.04).

Conclusions:

Even with distal interlocking pins, the obturator of FDRs can still migrate over time. Pin backout is a common indication for revision surgery. Bending interlocking pins can decrease rates of pin backout and prominence.

Level of Evidence:

Level III.
Symptomatic Discoid Meniscus in Children and Adolescents: A Review of 470 Cases
Authors: Logan Catherine A. , Tepolt Frances A. , Kocher Sophia D. , Feroe Aliya G. , Micheli Lyle J. , Kocher Mininder S.
Published: July 2021

Background:

Discoid meniscus is a congenital variant, typically involving the lateral meniscus, that comprises a spectrum of meniscal shapes and degrees of instability in an estimated 1% to 15% of the population. The purpose of this study was to describe the clinical and operative course of a large cohort of children and adolescents patients with symptomatic lateral discoid meniscus.

Methods:

Medical records of 470 knees with symptomatic lateral discoid meniscus in 401 patients ages 18 years or younger diagnosed at a single institution between 1991 and 2016 were reviewed retrospectively for patient characteristics, treatment course (nonoperative and/or operative), and complications. Surgical reports were reviewed in the operative group.

Results:

The series included 401 patients of mean age 11.6 years (range: 1 mo–18.9 y), of which 222 (55%) were female, and 69 (17%) had bilateral involvement. Of 470 knees, 83 (18%) were initially managed nonoperatively. Of these, 32 knees (39%) failed nonoperative management and were converted to surgical treatment at a median of 7.9 months (interquartile range: 4.0-15.1). In total, 419 knees were managed surgically with saucerization (partial meniscectomy) with or without meniscal repair/stabilization; 84 knees (20%) required at least one concurrent nonmeniscal procedure. Discoid meniscus tears were reported in 264/419 knees (63%) intraoperatively; horizontal cleavage tears were most common. Reoperation was required for 66/379 cases (17%) with clinical follow-up, at a median of 19.6 months (range: 9.2-34.9) after index saucerization; 60/379 cases (16%) had ongoing pain and/or mechanical symptoms at final follow-up.

Conclusion:

With a failure rate of 39% (32/83 knees), nonoperative management for discoid lateral meniscus frequently convert to surgical treatment. During surgery, meniscus tearing and instability are common and should be anticipated. Postoperatively, 33% (126/379) of knees with clinical follow-up underwent either reoperation, or had ongoing symptoms of the knee at final follow-up. Discoid mensical retear is the most common complication (94%, 62/66) prompting repeat surgery, and should be discussed with families before the index operation.

Level of Evidence:

Level IV—descriptive case series.
The Association Between Different Trajectories of Low Back Pain and Degenerative Imaging Findings in Young Adult Participants Within The Raine Study
Authors: Smith Anne , Hancock Mark , O’Hanlon Susan , Krieser Michael , O'Sullivan Peter , Cicuttini Flavia , Straker Leon , Adler Brendan , Wang YuanYuan , Karppinen Jaro , Samartzis Dino , Beales Darren , Coenen Pieter , Kent Peter
Published: July 2021

Study Design.

Case-control study.

Objective.

Investigate the association between lumbar spine magnetic resonance imaging (MRI) findings and 5-year trajectories of low back pain (LBP) in young Australian adults.

Summary of Background Data.

The association between lumbar spine imaging findings and LBP remains unclear due to important limitations of previous research, such as a lack of clearly defined LBP phenotypes and inadequate controlling for age, which may substantially affect the association.

Methods.

Seventy-eight “case” participants with a previously identified “consistent high disabling LBP” trajectory from age 17 to 22 years and 78 “control” participants from a trajectory with consistently low LBP over the same time period, matched for sex, body mass index, physical activity levels, and work physical demands, were identified from Gen2 Raine Study participants. At age 27, participants underwent a standardized lumbar MRI scan, from which 14 specific MRI phenotypes were identified. Primary analyses used unconditional logistic regression, adjusting for covariates used in the matching process, to investigate the relationship between presence of each imaging finding and being a case or control. Secondary analyses explored those relationships based on the number of spinal levels with each MRI finding.

Results.

The odds for being a case compared with a control were higher in those with disc degeneration (Pfirrmann grade ≥ 3; OR = 3.21, 95% CI: 1.60–6.44; P = 0.001) or those with a herniation (OR = 1.90, 95% CI: 0.96–3.74; P – 0.065). We also found that the association became substantially stronger when either disc degeneration or herniation was present at two or more spinal levels (OR = 5.56, 95% CI: 1.97–15.70; P = 0.001, and OR = 5.85, 95% CI: 1.54–22.25; P = 0.009, respectively). The other investigated MRI findings were not associated with greater odds of being a case.

Conclusion.

Lumbar disc degeneration and herniation may be important contributors to disabling LBP in young adults. Further investigation of their potential prognostic and causal roles is indicated.

Level of Evidence: 4
Prognostic Value of Nucleated RBCs for Patients With Suspected Sepsis in the Emergency Department: A Single-Center Prospective Cohort Study
Authors: Amundsen Erik K. , Binde Christina , Christensen Erik E. , Klingenberg Olav , Kvale Dag , Holten Aleksander R.
Published: July 2021

OBJECTIVES:

Increase of nucleated RBCs in peripheral blood has been shown to be predictive of mortality in ICU patients. The aim of this study was to explore the prognostic value of nucleated RBCs in the first blood sample taken at admission to the emergency department from patients with suspected sepsis.

DESIGN:

Single-center prospective cohort study.

SETTING:

Emergency department.

PATIENTS:

One-thousand two-hundred thirty-one consecutive adult patients with suspected sepsis were included in a prospective quality register-based cohort study. Inclusion criteria were as follows: patients received in rapid response team with blood cultures taken and immediate antibiotics given in the emergency department.

Intervention:

Not applicable.

MEASUREMENT AND MAIN RESULTS:

Nucleated RBCs, Sequential Organ Failure Assessment score, Quick Sequential Organ Failure Assessment, Charlson Comorbidity Index, and commonly used laboratory tests measured in the emergency department were compared with 30-day mortality. Nvaucleated RBC counts were divided into five groups, called “Nucleated RBC score,” according to nucleated RBC count levels and analyzed with logistic regression together with the Sequential Organ Failure Assessment score and Charlson Comorbidity Index. Of the 262 patients with nucleated RBCs equal to or higher than the detection limit (0.01 × 109/L), 26% died within 30 days, compared with 12% of the 969 patients with nucleated RBCs below the detection limit (p < 0.0001). Mortality was significantly higher for each increase in Nucleated RBC score, except from score 2 to 3, and was 62% in the highest group. In multivariate logistic regression, odds ratios for 30-day mortality were as follows: Nucleated RBC score: 1.33 (95% CI, 1.13–1.56), Sequential Organ Failure Assessment score: 1.32 (1.29–1.56), and Charlson Comorbidity Index: 1.17 (1.09–1.25).

CONCLUSIONS:

Most patients with suspected sepsis in emergency department had undetectable nucleated RBCs at admission to the emergency department. However, increased nucleated RBCs significantly predicted 30-day mortality. Nucleated RBCs may provide additional prognostic information to Sequential Organ Failure Assessment score and other laboratory tests.
Safety of early surgery for geriatric hip fracture patients taking clopidogrel: a retrospective case-control study of 120 patients in China
Authors: Yang Ming-Hui , Li Bo , Yao Dong-Chen , Zhou Yan , Zhang Wen-Chao , Wang Geng , Zhang Ping , Zhu Shi-Wen , Wu Xin-Bao
Published: July 2021

Background:

Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.

Methods:

Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student's t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.

Results:

Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0–120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.

Conclusions:

Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.
The rule of 3
Authors: Strand Niels August Willer , Vinther Siri , Horwitz Henrik
Published: July 2021

In this paper, we critically review the information distributed to patients and doctors regarding adverse drug reactions. One major concern is that frequencies reported in the summary of product characteristics are not adjusted for the nocebo effect, leading to an exaggerated concern of adverse drug reactions. Previous research has found that the understanding of health hazards related to pharmacotherapy can be significantly improved by providing information on the frequencies of adverse drug reactions in both the active- and placebo-treated group.
Acute Calcific Band Keratopathy as an Adverse Effect of Recombinant Human Nerve Growth Factor (Cenegermin): A Multicenter Case Series
Authors: Qureshi Sana , Ferguson Tanner J. , Lim Mira , You Jae Young , Goshe Jeffrey M. , Hood Christopher T.
Published: July 2021

Purpose:

Cenegermin, (OXERVATE) a recently Food and Drug Administration-approved topical formulation of recombinant human nerve growth factor, has been used for the treatment of neurotrophic keratopathy (NK). Corneal deposits have been previously reported as a potential adverse effect; however, the clinical characteristics, visual significance, and treatment options have not been fully described. The purpose of this article is to better characterize corneal deposits occurring during treatment with cenegermin for neurotrophic keratopathy.

Methods:

This was a retrospective, multicenter consecutive case series.

Results:

We identified 5 patients from 3 institutions who developed a white opacity in varying layers of the cornea, consistent with calcium deposition, during treatment with cenegermin. In all cases, the opacity occurred rapidly over the course of a few weeks after initiation of treatment. Histopathologic examination of the cornea from one corneal patient demonstrated extensive calcification of the stroma extending to 90% depth. Before treatment, all patients had stage 2 or 3 NK (Mackie classification). The deposits were visually significant in all patients and did not resolve after cessation of cenegermin. There were no differences in age, sex, etiology of the NK, corneal transplant status, or concurrent medications between the patients who developed a deposit and 15 other patients with stage 2 or 3 NK who did not. One patient was successfully treated with superficial keratectomy with ethylenediaminetetraacetic acid chelation, one patient underwent penetrating keratoplasty, and one patient received a Boston keratoprosthesis.

Conclusions:

We report the rapid onset of a corneal opacity after initiation of treatment with cenegermin in patients with stage 2 or 3 NK, consistent with acute calcific band keratopathy. This visually significant adverse finding has not previously been described. We could not identify any risk factors for development. We recommend close monitoring of patients receiving cenegermin therapy because the opacity may be irreversible and may require keratoplasty for visual rehabilitation.
Symptom-based Screening Versus Chest Radiography for TB Child Contacts: A Systematic Review and Meta-analysis
Authors: Vasiliu Anca , Abelman Rebecca A. , Casenghi Martina , Cohn Jennifer , Bonnet Maryline
Published: July 2021

Background:

Accessibility to chest radiography remains a major challenge in high burden and low-income countries. The World Health Organization (WHO) guidelines acknowledge that for child contacts under 5 years, a negative symptom-based screening is sufficient to exclude active tuberculosis (TB), but in child contacts older than 5 years, a chest radiograph should be considered. We performed a systematic review and meta-analysis to assess the performance of symptom-based screening compared with chest radiography in household contacts under 15 years in low-income and middle-income countries.

Methods:

Screening articles published prior 1 October 2020 and data extraction were performed by 2 independent reviewers. The primary outcome was the concordance between symptom screening and chest radiography using the prevalence adjusted bias adjusted kappa coefficient (PABAK) and the proportion of asymptomatic children with negative chest radiography. The analysis was stratified by age group.

Results:

Of 639 identified articles, 10 were included. PABAK varied between 0.09 and 0.97 and between 0.22 and 0.98, in children less than 5 years and 5–14 years, respectively. The pooled proportion of children with both non-TB suggestive symptoms and chest radiography findings was 98.7% (96.9–99.8) in children less than 5 years and 98.1% (93.8–100) in children of age 5–14 years.

Conclusions:

Despite low concordance between symptom-based screening and chest radiography, most children without TB suggestive symptoms did not have chest radiography findings suggestive of TB. These results suggest that a negative symptom screening is sufficient to rule out active TB, supporting the WHO recommendation to use symptom-based screening alone when chest radiography is not available.
Short- and Long-term Patient Satisfaction and Complications in 650 Endoscopic Forehead Lift Procedures
Authors: Kashkouli Mohsen Bahmani , Abdolalizadeh Parya , Mansour Saina , Hamami Parisa , Karimi Nasser , Khademi Behzad
Published: July 2021

Purpose:

The aims are to compare short- versus long-term patient satisfaction and report temporary versus permanent complications in 650 patients with endoscopic forehead lift procedure (EFL).

Methods:

This is a retrospective study on all of the consecutive patients with EFL. Patients with previous trauma and surgery and less than 2 years follow up were excluded. Short- (6 months) and long-term (≥2 years) patient satisfaction (visual analog score [VAS], 0–100) were recorded. Patients’ perspectives on temporary versus permanent complications were also documented.

Results:

Mean age and follow up were 46.4 and 7.1 (2–13) years, respectively. Long-term satisfaction (79.9) was significantly lower than the short term (96.6). The long-term satisfaction decreased in 95.7%, increased in 2.7%, and remained the same in 1.6% of the patients. Intraoperative skin laceration occurred in 3 patients (0.5%). Mean time of forehead numbness recovery was 2.3 months. Temporary complications were itching (13.7%), headache (6.3%), unilateral facial nerve palsy (5.8%), acne (3.2%), and remained staples (1.7%). Permanent complications included undercorrection (7.1%), alopecia (4.2%), forehead irregularities (2.3%), surprised look (2.2%), incision site complications (2%), and glabellar depression (0.9%). Reoperation (1.2%) was performed for undercorrection and alopecia. While short-term satisfaction was significantly lower in patients with temporary facial nerve paresis, long-term satisfaction was lower in patients with undercorrection and reoperation.

Conclusion:

A high satisfaction scores of 96.6 and 80 were observed in the short- and long-term follow up after the EFL. Frequency of temporary and permanent postoperative complications was 30.3% and 15.8%. Reoperation rate was 1.2%.