bluuebunny/crossref_metadata_2025 huggingface dataset:
Pidgins
Authors: Parkvall Mikael
Published: February 2020

This chapter discusses pidgins, what constitutes pidginization, how it can be identified, and presents material from a range of pidgins.
Contact-Induced Language Change in Spanish
Authors: Bouzouita Miriam
Published: February 2020

This chapter offers an overview of the languages with which Spanish has entered into contact in the course of its history. As is to be expected, most contact-induced changes in standard Spanish are found in the lexicon, although some derivational suffixes of foreign origin have also become productive. Spanish also underwent a few contact-induced morphosyntactic changes. Spanish’s sister-languages in the Romance family (including French, Catalan, Portuguese, and Italian), and their shared ancestor Latin, are by some stretch the biggest donors, although English, Basque, Celtic, Germanic and especially Arabic are also notable donors, and some of these loans have replaced previously inherited items of Latin origin.
Contact and the Development of Malayalam
Authors: Sreekumar P.
Published: February 2020

Malayalam is an ideal representative of language contact and convergence in South Asia. This chapter discusses Malayalam’s contact with a dozen languages around the world. The first part of the chapter discusses the historical contexts of these contacts. The results of contact are discussed in the second part of the chapter. The borrowing of phonological, lexical, and grammatical features is discussed, along with supporting evidence. Based on the discussion, it is argued that contact is the major factor of the development of Malayalam and the major “inter-linguistic trigger” that facilitated the development of Malayalam within a short span of time.
Bidirectional Borrowing of Structure and Lexicon
Authors: Næss Åshild
Published: February 2020

This chapter discusses how particular patterns of bilingualism, speaker agency, and L1-L2 interaction can lead to the seemingly contradictory outcome of lexical items and grammatical structure being borrowed in opposite directions between two languages. This can come about when the numerically much smaller language in a contact situation is the intergroup language, leading to a situation where the language has a significantly larger number of L2 speakers than L1 speakers. Over time, this can lead to the L2 variety, which incorporates structural features from the majority language through what van Coetsem calls imposition, becoming the norm, even among the monolingual L1 speakers. This scenario highlights the importance of isolating individual factors that are often bundled together under labels such as “prestige” or “dominance”—in this case, socioeconomic prestige versus demographic dominance—and of examining the interactions between the rise of contact-induced change in the speech of individuals and the mechanisms through which change spreads through a community.
New-Onset Psychosis Associated With a Lesion Localized in the Rostral Tectum: Insights Into Pathway-Specific Connectivity Disrupted in Psychosis
Authors: Koropouli Eleftheria , Melanitis Nikos , Dimitriou Vasileios I , Grigoriou Asimina , Karavasilis Efstratios , Nikita Konstantina S , Tzavellas Elias , Paparrigopoulos Thomas
Published: February 2020

Objective

To investigate pathway-specific connectivity disrupted in psychosis.

Methods

We carried out a case study of a middle-aged patient who presented with new-onset psychosis associated with a space-occupying lesion localized in the right superior colliculus/periaqueductal gray. The study sought to investigate potential connectivity deficits related to the lesion by the use of diffusion tensor imaging and resting-state functional magnetic resonance imaging. To this aim, we generated a functional connectivity map of the patient’s brain, centered on the lesion area, and compared this map with the corresponding map of 10 sex- and age-matched control individuals identified from the Max Planck Institute–Leipzig Mind–Brain–Body database.

Results

Our analysis revealed a discrete area in the right rostral tectum, in the immediate vicinity of the lesion, whose activity is inversely correlated with the activity of left amygdala, whereas left amygdala is functionally associated with select areas of the temporal, parietal, and occipital lobes. Based on a comparative analysis of the patient with 10 control individuals, the lesion has impacted on the connectivity of rostral tectum (superior colliculus/periaqueductal gray) with left amygdala as well as on the connectivity of left amygdala with subcortical and cortical areas.

Conclusions

The superior colliculus/periaqueductal gray might play important roles in the initiation and perpetuation of psychosis, at least partially through dysregulation of left amygdala activity.
Universal loop assembly: open, efficient and cross-kingdom DNA fabrication
Authors: Pollak Bernardo , Matute Tamara , Nuñez Isaac , Cerda Ariel , Lopez Constanza , Vargas Valentina , Kan Anton , Bielinski Vincent , von Dassow Peter , Dupont Chris L , Federici Fernán
Published: February 2020

Standardized type IIS DNA assembly methods are becoming essential for biological engineering and research. These methods are becoming widespread and more accessible due to the proposition of a ‘common syntax’ that enables higher interoperability between DNA libraries. Currently, Golden Gate (GG)-based assembly systems, originally implemented in host-specific vectors, are being made compatible with multiple organisms. We have recently developed the GG-based Loop assembly system for plants, which uses a small library and an intuitive strategy for hierarchical fabrication of large DNA constructs (>30 kb). Here, we describe ‘universal Loop’ (uLoop) assembly, a system based on Loop assembly for use in potentially any organism of choice. This design permits the use of a compact number of plasmids (two sets of four odd and even vectors), which are utilized repeatedly in alternating steps. The elements required for transformation/maintenance in target organisms are also assembled as standardized parts, enabling customization of host-specific plasmids. Decoupling of the Loop assembly logic from the host-specific propagation elements enables universal DNA assembly that retains high efficiency regardless of the final host. As a proof-of-concept, we show the engineering of multigene expression vectors in diatoms, yeast, plants and bacteria. These resources are available through the OpenMTA for unrestricted sharing and open access.
Genome Sequence Resource for Elsinoë ampelina, the Causal Organism of Grapevine Anthracnose
Authors: Li Zhi , Fan Yanchun , Chang Pingping , Gao Linlin , Wang Xiping
Published: February 2020

Elsinoë ampelina is an ascomycetous fungus that causes grape anthracnose, a potentially devastating disease worldwide. Here, we report a 28.29 Mb high-quality genome sequence of E. ampelina YL-1 that encodes 8,057 predicted protein-coding genes and represents the first sequenced genome assembly of E. ampelina. This study adds to the current genomic resources for the genus Elsinoë and paves the way for research on comparative genomic studies, E. ampelina–grape interactions, and improvement of management strategies.
Ensuring the Availability of Clinical Clerkships at U.S. Hospitals: A Tale of 2 States
Authors: Lenhoff Fred , Goldberg Robert B. , Reichgott Michael , Collins Marcia , Jumper Cynthia , Elliott Victoria Stagg
Published: February 2020

U.S. medical schools are facing growing competition for limited clinical training resources, notably slots for the core clerkships that students most often complete in the third year of their undergraduate medical education. In particular, medical schools in the Caribbean (often referred to as offshore medical schools) are buying clerkship slots at U.S. hospitals for their students, most of whom will be U.S. citizen international medical graduates. For hospitals, especially those that are financially stressed, these payments are an attractive source of revenue. Yet, this practice has put pressure on U.S. medical schools to provide similar remuneration for clerkship slots for their students or to find new clinical training sites.

In this Perspective, the authors outline the scope of the challenge facing U.S. medical schools and the U.S. medical education system. They outline legislative strategies implemented in 2 states (New York and Texas) to address this issue and propose the passage of similar legislation in other states to ensure that students at U.S. medical schools can access the clerkships they need to obtain the requisite clinical experience before entering residency. Such legislation would preserve the availability of clerkships for U.S. medical students and the educational quality of these clinical training experiences and, therefore, preserve the quantity and quality of the future physician workforce in the United States.
Machine Learning Prediction of Postoperative Emergency Department Hospital Readmission
Authors: Mišić Velibor V. , Gabel Eilon , Hofer Ira , Rajaram Kumar , Mahajan Aman
Published: February 2020

Background

Although prediction of hospital readmissions has been studied in medical patients, it has received relatively little attention in surgical patient populations. Published predictors require information only available at the moment of discharge. The authors hypothesized that machine learning approaches can be leveraged to accurately predict readmissions in postoperative patients from the emergency department. Further, the authors hypothesize that these approaches can accurately predict the risk of readmission much sooner than hospital discharge.

Methods

Using a cohort of surgical patients at a tertiary care academic medical center, surgical, demographic, lab, medication, care team, and current procedural terminology data were extracted from the electronic health record. The primary outcome was whether there existed a future hospital readmission originating from the emergency department within 30 days of surgery. Secondarily, the time interval from surgery to the prediction was analyzed at 0, 12, 24, 36, 48, and 60 h. Different machine learning models for predicting the primary outcome were evaluated with respect to the area under the receiver-operator characteristic curve metric using different permutations of the available features.

Results

Surgical hospital admissions (N = 34,532) from April 2013 to December 2016 were included in the analysis. Surgical and demographic features led to moderate discrimination for prediction after discharge (area under the curve: 0.74 to 0.76), whereas medication, consulting team, and current procedural terminology features did not improve the discrimination. Lab features improved discrimination, with gradient-boosted trees attaining the best performance (area under the curve: 0.866, SD 0.006). This performance was sustained during temporal validation with 2017 to 2018 data (area under the curve: 0.85 to 0.88). Lastly, the discrimination of the predictions calculated 36 h after surgery (area under the curve: 0.88 to 0.89) nearly matched those from time of discharge.

Conclusions

A machine learning approach to predicting postoperative readmission can produce hospital-specific models for accurately predicting 30-day readmissions via the emergency department. Moreover, these predictions can be confidently calculated at 36 h after surgery without consideration of discharge-level data.

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Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use
Authors: Southren Daniel L. , Moser Stephanie , Abu-Amara Hasan , Lin Paul , Schack Amanda A. , Gunaseelan Vidhya , Waljee Jennifer F. , Brummett Chad M.
Published: February 2020

Background

Zygapophyseal (facet) joint interventions are the second most common interventional procedure in pain medicine. Opioid exposure after surgery is a significant risk factor for chronic opioid use. The aim of this study was to determine the incidence of new persistent use of opioids after lumbar facet radiofrequency ablation and to assess the effect of postprocedural opioid prescribing on the development of new persistent opioid use.

Methods

The authors conducted a retrospective cohort study using claims from the Clinformatics Data Mart Database (OptumInsight, USA) to identify opioid-naïve patients between 18 and 64 yr old who had lumbar radiofrequency ablation. Patients who had either subsequent radiofrequency ablation 15 to 180 days or subsequent surgery within 180 days after the primary procedure were excluded from the analysis. The primary outcome was new persistent opioid use, defined as opioid prescription fulfillment within the 8 to 90 and 91 to 180 day periods after radiofrequency ablation. The authors then assessed patient-level risk factors for new persistent opioid use.

Results

A total of 2,887 patients met the inclusion criteria. Of those patients, 2,277 (78.9%) had radiofrequency ablation without a perioperative opioid fill, and 610 (21.1%) patients had the procedure with a perioperative opioid fill. The unadjusted rate of new persistent opioid use was 5.6% (34 patients) in the group with a perioperative opioid fill versus 2.8% (63 patients) for those without an opioid fill. Periprocedural opioid prescription fill was independently associated with increased odds of new persistent use (adjusted odds ratio, 2.35; 95% CI, 1.51 to 3.66; P < 0.001).

Conclusions

Periprocedural opioid use after lumbar radiofrequency ablation was associated with new persistent use in previously opioid-naïve patients, suggesting that new exposure to opioids is an independent risk factor for persistent use in patients having radiofrequency ablation for chronic back pain. Opioid prescribing after radiofrequency ablation should be reevaluated and likely discontinued in this population.

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Source-level Cortical Power Changes for Xenon and Nitrous Oxide–induced Reductions in Consciousness in Healthy Male Volunteers
Authors: Pelentritou Andria , Kuhlmann Levin , Cormack John , Mcguigan Steven , Woods Will , Muthukumaraswamy Suresh , Liley David
Published: February 2020

Background

Investigations of the electrophysiology of gaseous anesthetics xenon and nitrous oxide are limited revealing inconsistent frequency-dependent alterations in spectral power and functional connectivity. Here, the authors describe the effects of sedative, equivalent, stepwise levels of xenon and nitrous oxide administration on oscillatory source power using a crossover design to investigate shared and disparate mechanisms of gaseous xenon and nitrous oxide anesthesia.

Methods

Twenty-one healthy males underwent simultaneous magnetoencephalography and electroencephalography recordings. In separate sessions, sedative, equivalent subanesthetic doses of gaseous anesthetic agents nitrous oxide and xenon (0.25, 0.50, and 0.75 equivalent minimum alveolar concentration–awake [MACawake]) and 1.30 MACawake xenon (for loss of responsiveness) were administered. Source power in various frequency bands were computed and statistically assessed relative to a conscious/pre-gas baseline.

Results

Observed changes in spectral-band power (P < 0.005) were found to depend not only on the gas delivered, but also on the recording modality. While xenon was found to increase low-frequency band power only at loss of responsiveness in both source-reconstructed magnetoencephalographic (delta, 208.3%, 95% CI [135.7, 281.0%]; theta, 107.4%, 95% CI [63.5, 151.4%]) and electroencephalographic recordings (delta, 260.3%, 95% CI [225.7, 294.9%]; theta, 116.3%, 95% CI [72.6, 160.0%]), nitrous oxide only produced significant magnetoencephalographic high-frequency band increases (low gamma, 46.3%, 95% CI [34.6, 57.9%]; high gamma, 45.7%, 95% CI [34.5, 56.8%]). Nitrous oxide—not xenon—produced consistent topologic (frontal) magnetoencephalographic reductions in alpha power at 0.75 MACawake doses (44.4%; 95% CI [−50.1, −38.6%]), whereas electroencephalographically nitrous oxide produced maximal reductions in alpha power at submaximal levels (0.50 MACawake, −44.0%; 95% CI [−48.1,−40.0%]).

Conclusions

Electromagnetic source-level imaging revealed widespread power changes in xenon and nitrous oxide anesthesia, but failed to reveal clear universal features of action for these two gaseous anesthetics. Magnetoencephalographic and electroencephalographic power changes showed notable differences which will need to be taken into account to ensure the accurate monitoring of brain state during anaesthesia.

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Insights into the Chemical Discovery of Remifentanil
Authors: Feldman Paul L.
Published: February 2020

Design, Synthesis, and Pharmacological Evaluation of Ultrashort- to Long-acting Opioid Analgetics. By Feldman PL, James MK, Brackeen MF, Bilotta JM, Schuster SV, Lahey AP, Lutz MW, Johnson MR, Leighton HJ. J Med Chem 1991; 34:2202-8. Copyright 1991 American Chemical Society. Reprinted with permission.

In an effort to discover a potent ultrashort-acting µ-opioid analgetic that is capable of metabolizing to an inactive species independent of hepatic function, several classes of 4-anilidopiperidine analgetics were synthesized and evaluated. One series of compounds displayed potent µ-opioid agonist activity with a high degree of analgesic efficacy and an ultrashort to long duration of action. These analgetics, 4-(methoxycarbonyl)-4-[1-oxopropyl)phenylamino]-1-piperidinepropanoic acid alkyl esters, were evaluated in vitro in the guinea pig ileum for µ-opioid activity, in vivo in the rat tail withdrawal assay for analgesic efficacy and duration of action, and in vitro in human whole blood for their ability to be metabolized in blood. Compounds in this series were all shown to be potent µ agonists in vitro, but depending upon the alkyl ester substitution, the potency and duration of action in vivo varied substantially. The discrepancies between the in vitro and in vivo activities and variations in duration of action are probably due to different rates of ester hydrolysis by blood esterase(s). The [structure–activity relationships] with respect to analgesic activity and duration of action as a function of the various esters synthesized is discussed. It was also demonstrated that the duration of action for the ultrashort-acting analgetic, 8, does not change upon prolonged infusion or administration of multiple bolus injections.
Preoperative Cognitive Abnormality, Intraoperative Electroencephalogram Suppression, and Postoperative Delirium
Authors: Fritz Bradley A. , King Christopher R. , Ben Abdallah Arbi , Lin Nan , Mickle Angela M. , Budelier Thaddeus P. , Oberhaus Jordan , Park Daniel , Maybrier Hannah R. , Wildes Troy S. , Avidan Michael S. ,   for the ENGAGES Research Group*
Published: February 2020

Background

Postoperative delirium is a common complication that hinders recovery after surgery. Intraoperative electroencephalogram suppression has been linked to postoperative delirium, but it is unknown if this relationship is causal or if electroencephalogram suppression is merely a marker of underlying cognitive abnormalities. The hypothesis of this study was that intraoperative electroencephalogram suppression mediates a nonzero portion of the effect between preoperative abnormal cognition and postoperative delirium.

Methods

This is a prespecified secondary analysis of the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) randomized trial, which enrolled patients age 60 yr or older undergoing surgery with general anesthesia at a single academic medical center between January 2015 and May 2018. Patients were randomized to electroencephalogram-guided anesthesia or usual care. Preoperative abnormal cognition was defined as a composite of previous delirium, Short Blessed Test cognitive score greater than 4 points, or Eight Item Interview to Differentiate Aging and Dementia score greater than 1 point. Duration of intraoperative electroencephalogram suppression was defined as number of minutes with suppression ratio greater than 1%. Postoperative delirium was detected via Confusion Assessment Method or chart review on postoperative days 1 to 5.

Results

Among 1,113 patients, 430 patients showed evidence of preoperative abnormal cognition. These patients had an increased incidence of postoperative delirium (151 of 430 [35%] vs.123 of 683 [18%], P < 0.001). Of this 17.2% total effect size (99.5% CI, 9.3 to 25.1%), an absolute 2.4% (99.5% CI, 0.6 to 4.8%) was an indirect effect mediated by electroencephalogram suppression, while an absolute 14.8% (99.5% CI, 7.2 to 22.5%) was a direct effect of preoperative abnormal cognition. Randomization to electroencephalogram-guided anesthesia did not change the mediated effect size (P = 0.078 for moderation).

Conclusions

A small portion of the total effect of preoperative abnormal cognition on postoperative delirium was mediated by electroencephalogram suppression. Study precision was too low to determine if the intervention changed the mediated effect.

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Single-Center Outcome of Fetoscopic Tracheal Balloon Occlusion for Severe Congenital Diaphragmatic Hernia
Authors: Baschat Ahmet A. , Rosner Mara , Millard Sarah E. , Murphy Jamie D. , Blakemore Karin J. , Keiser Amaris M. , Kearney Jennifer , Bullard Janine , Nogee Lawrence M. , Bembea Melania , Jelin Eric B. , Miller Jena L.
Published: February 2020

OBJECTIVE:

To assess feasibility and maternal and infant outcome after fetoscopic tracheal balloon occlusion in patients with severe congenital diaphragmatic hernia.

METHODS:

We conducted a prospective cohort study of fetuses with congenital diaphragmatic hernia and observed/expected lung/head ratio less than 30%. Eligible women had planned fetoscopic tracheal balloon occlusion at 26 0/7–29 6/7 weeks of gestation and balloon removal 4–6 weeks later. Standardized prenatal and postnatal care was at a single institution. Fetoscopic tracheal balloon occlusion details, lung growth, obstetric complications, birth outcome, and infant outcome details until discharge were evaluated.

RESULTS:

Of 57 women screened, 14 (25%) were enrolled between 2015 and 2019. The congenital diaphragmatic hernia was left in 12 (86%); the pre–fetoscopic tracheal balloon occlusion observed/expected lung/head ratio was 23.2% (range 15.8–29.0%). At a median gestational age of 28 5/7 weeks (range 27 3/7–29 6/7), fetoscopic tracheal balloon occlusion was successful in all cases, and balloons remained in situ. Removal was elective in 10 (71%) patients, by ultrasound-guided needle puncture in eight (57%), and occurred at a median of 33 4/7 weeks of gestation (range 32 1/7–34 4/7; median occlusion 34 days, range 17–44). The post–fetoscopic tracheal balloon occlusion observed/expected lung/head ratio increased to a median of 62.8% (44.0–108) and fell to a median of 46.6% (range 30–92) after balloon removal (all Mann Whitney U, P<.003). For prevention of preterm birth, all patients received vaginal progesterone; 11 (79%) required additional tocolytics, three (21%) had vaginal pessary placement for cervical shortening, and five (36%) had amnioreduction for polyhydramnios. Median gestational age at birth was 39 2/7 weeks (range 33 6/7–39 4/7), with term birth in eight (57%) patients. Twelve (86%) neonates required high-frequency ventilation, and seven (50%) required extracorporeal membrane oxygenation for a median of 7 days (range 3–19). All neonates needed patch repair. Neonatal survival was 93% (n=13, 95% CI 49–100%), and survival to hospital discharge was 86% (n=12, 95% CI 44–100%).

CONCLUSION:

Fetoscopic tracheal balloon occlusion for severe congenital diaphragmatic hernia was feasible in our single-center setting, with few obstetric complications and favorable infant outcome.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02710968.
Surrogacy Laws in the United States
Authors: Tsai Shelun , Shaia Kathryn , Woodward Julia T. , Sun Michael Y. , Muasher Suheil J.
Published: February 2020

The first child carried by a surrogate after in vitro fertilization in the United States was born in 1985. Since then, the number of such births has steadily grown. According to the Centers for Disease Control and Prevention, the number of gestational carrier cycles increased from 727 in 1999 to 3,432 in 2013, encompassing more than 18,000 children born over this period. Surrogacy offers an alternative to adoption. However, it also disrupts traditional notions of parentage and gestation and complicates the role of obstetrician–gynecologists (ob-gyns) in helping their patients navigate difficult ethical issues. Surrogacy legislation falls under the jurisdiction of each individual state, which results in a variety of approaches. In this article, we review the legal aspects of surrogacy important for specialist ob-gyns, including select landmark court cases, states' approaches to surrogacy legislation, and unique components of informed consent. We also provide clinical recommendations specific to the United States for working with gestational surrogates and intended parents, spanning preconception, prenatal care, and delivery.
Gestation-Specific Vital Sign Reference Ranges in Pregnancy
Authors: Green Lauren J. , Mackillop Lucy H. , Salvi Dario , Pullon Rebecca , Loerup Lise , Tarassenko Lionel , Mossop Jude , Edwards Clare , Gerry Stephen , Birks Jacqueline , Gauntlett Rupert , Harding Kate , Chappell Lucy C. , Watkinson Peter J.
Published: February 2020

OBJECTIVE:

To estimate normal ranges for maternal vital signs throughout pregnancy, which have not been well defined in a large contemporary population.

METHODS:

We conducted a three-center, prospective, longitudinal cohort study in the United Kingdom from August 2012 to September 2017. We recruited women at less than 20 weeks of gestation without significant comorbidities with accurately dated singleton pregnancies. We measured participants' blood pressure (BP), heart rate, respiratory rate, oxygen saturation and temperature following standardized operating procedures at 4–6 weekly intervals throughout pregnancy.

RESULTS:

We screened 4,279 pregnant women, 1,041 met eligibility criteria and chose to take part. Systolic and diastolic BP decreased slightly from 12 weeks of gestation: median or 50th centile (3rd–97th centile) 114 (95–138); 70 (56–87) mm Hg to reach minimums of 113 (95–136); 69 (55–86) mm Hg at 18.6 and 19.2 weeks of gestation, respectively, a change (95% CI) of −1.0 (−2 to 0); −1 (−2 to −1) mm Hg. Systolic and diastolic BP then rose to a maximum median (3rd–97th centile) of 121 (102–144); 78 (62–95) mm Hg at 40 weeks of gestation, a difference (95% CI) of 7 (6–9) and9 (8–10) mm Hg, respectively. The median (3rd–97th centile) heart rate was lowest at 12 weeks of gestation: 82 (63–105) beats per minute (bpm), rising progressively to a maximum of 91 (68–115) bpm at 34.1 weeks. SpO2 decreased from 12 weeks of gestation: median (3rd–97th centile) 98% (94–99%) to 97% (93–99%) at 40 weeks. The median (3rd–97th centile) respiratory rate at 12 weeks of gestation was 15 (9–22), which did not change with gestation. The median (3rd–97th centile) temperature at 12 weeks of gestation was 36.7 (35.6–37.5)°C, decreasing to a minimum of 36.5 (35.3–37.3)°C at 33.4 weeks.

CONCLUSION:

We present widely relevant, gestation-specific reference ranges for detecting abnormal BP, heart rate, respiratory rate, oxygen saturation and temperature during pregnancy. Our findings refute the existence of a clinically significant BP drop from 12 weeks of gestation.

CLINICAL TRIAL REGISTRATION:

ISRCTN, ISRCTN10838017.
Cervical stand-alone PEEK cage versus anchored cage with screws in single-level anterior cervical discectomy and fusion: A prospective cohort study
Authors: Khattab Mohamed Fawzy , Kotb Ahmed
Published: February 2020

Background:

Anterior cervical discectomy and fusion (ACDF) is a gold standard procedure for surgical management of symptomatic cervical degenerative disc disease. Traditionally, iliac crest bone graft was used as a strut graft to fill the disc space after discectomy. However, several complications have been observed, including donor site hematoma, infection, and pain. A cage can be used as an alternative, but cage dislodgement can be a devastating complication. Some surgeons advocate plate application to augment the cage construct, but the incidence of dysphagia is much higher with longer operative times. An anchored cage with screws could reduce postoperative dysphagia and simultaneously fix the cage. This study compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage with the anchored cage with screws for single-level ACDF.

Methods:

This prospective study was conducted in 50 patients who underwent single-level ACDF for cervical degeneration, with radiculopathy or myelopathy, from January, 2012, to January, 2014, at a single institution. Follow-up was 2 yr. Twenty-one patients were allocated to the stand-alone cage group (group 1) and 29 to the anchored cage with screws group (group 2). The Neck Disability Index (NDI), Visual Analogue Scale (VAS) of the arm and neck, radiographic segmental cervical angle (CA), and disc height assessments were done preoperatively, at 6 mo, and at 2 yr postoperatively.

Results:

Clinical outcomes showed improvement in both groups. The change between final follow-up (24 mo) and 6 mo postoperative CA (P=0.01) and disc height (P=0.02) showed statistically better outcomes for the anchored cage group (group 2) than the stand-alone cage group (group 1). The VAS showed significant pain improvement in the stand-alone group (group 1) than in the anchored cage with screws group (group 2) at 2 yr. The NDI difference was highly significant (P=0.001) preoperatively and at 6 mo postoperatively in favor of group 2, but this did not persist at 2-year follow-up.

Conclusions:

For one-level ACDF, the anchored cage with screws has some advantage compared to the stand-alone PEEK cage in avoiding dysphagia and restoring disc space height and cervical lordosis. We suggest the anchored spacer may be a good substitute for the stand-alone cage in one-level ACDF.

Level of Evidence:

Level II
Improving Quality in the Treatment of Pediatric Forearm Fractures: Minimizing the Need for Repeat Intervention With Long-arm Extension Casting
Authors: Neal Kevin M. , Osterbur Todd A. , Kiebzak Gary M.
Published: February 2020

Purpose:

Repeat intervention for pediatric forearm fractures after closed manipulation is as high as 46% with flexed elbow (FE) long-arm casts. Casting with the elbow extended (EE) has been advocated as an alternative technique. We documented outcomes of patients treated with closed manipulation and casting with EE long-arm casts for displaced, diaphyseal both-bone forearm fractures.

Methods:

We retrospectively reviewed charts for patients who had sedated manipulations and casting for closed, diaphyseal forearm fractures. Open fractures, immediate surgical intervention, metabolic bone disease, recurrent fractures, and Monteggia injuries were excluded. Closed manipulations were performed by orthopaedic residents assisted by cast technicians, with sedation provided by emergency department physicians. Radiographic angulation and displacement of the radius and ulna on immediate postreduction radiographs and all follow-up radiographs were recorded. Patients requiring repeat intervention were compared with those who did not by using the Mann-Whitney U and Fisher exact tests.

Results:

Of 86 patients (7.2±2.8 y) available for analysis, 82 (95.3%) completed treatment after a single-sedated manipulation and placement of an EE long-arm cast. There were no malunions or nonunions. The average follow-up was 50 days. Four (4.7%) patients required repeat interventions (2 had surgery, 1 had a repeat sedated manipulation, and 1 had a nonsedated manipulation). There were no statistically significant differences in age, sex, laterality, fracture position in the diaphysis, or immediate postreduction angulation of the radius or ulna. A literature review showed average repeat intervention rates of 14.9% (range, 0% to 45.9%) for FE casts and 3.3% (range, 0% to 15%) for EE casts.

Conclusions:

There was a low rate of repeat interventions (4.7%) in patients with EE casts compared with historical rates for FE casts. Improving the quality of health care involves identifying and implementing practices that provide the best outcomes at the lowest costs. The use of EE long-arm casts following closed manipulation of pediatric forearm fractures may decrease the rate of repeat manipulation or surgery compared with conventional FE casts.

Level of Evidence:

Level IV—case series.
Chronic Opioid Use Is Associated With Surgical Site Infection After Lumbar Fusion
Authors: Pirkle Sean , Reddy Srikanth , Bhattacharjee Sarah , Shi Lewis L. , Lee Michael J.
Published: February 2020

Study Design.

Retrospective, database review.

Objective.

The purpose of this study was to explore the association between preoperative opioid use and postoperative infection requiring operative wound washout in elective lumbar fusion patients.

Summary of Background Data.

Numerous peer-reviewed publications have conducted multivariate analyses of risk factors for surgical site infection. However, few have explored preoperative opioid use. Opioids have been widely prescribed preoperatively for pain management, but their effect on postsurgical infection is currently inconclusive.

Methods.

We retrospectively queried the PearlDiver national insurance claims database and included patients from 2007 to 2017 with a history of lumbar fusion. Any interbody fusion history designated exclusion. We stratified patients by single or multilevel procedures and conducted univariate analyses of previously documented infection risk factors, as well as our variable of interest, chronic preoperative opioid use. Variables associated (P < 0.100) with the outcome measure of 90-day postoperative infection treated with operative irrigation and wound debridement were included in a multivariate analysis.

Results.

A total of 12,519 patients matched our inclusion criteria. Among the single-level cohort, only diabetes was observed to be associated with infection requiring operative wound washout and thus no subsequent regression was performed. For the cohort of patients who underwent multilevel fusion, chronic opioid use, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and hypertension trended toward significance in the univariate analysis and were included in a logistic regression model. In the multivariate analysis, chronic opioid use (odds ratio [OR] = 1.435, P = 0.025), diabetes (OR = 1.591 P = 0.003), and congestive heart failure (OR = 1.929, P = 0.003) were identified as independent risk factors for infection requiring operative wound washout.

Conclusion.

In this analysis, preoperative opioid use was significantly associated with infection requiring operative wound washout in multilevel lumbar fusion patients. Limiting opioid consumption may have the benefit of reducing the risk of infection following spine surgery.

Level of Evidence: 3
A Positive (+ve) Postoperative Upper Instrumented Vertebra Tilt Angle (≥0°) Significantly Increases the Risk of Medial Shoulder and Neck Imbalance in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients
Authors: Kwan Mun Keong , Lee Sin Ying , Ch’ng Pei Ying , Chung Weng Hong , Chiu Chee Kidd , Chan Chris Yin Wei
Published: February 2020

Study Design.

Retrospective study.

Objective.

To investigate the relationship between a +ve postoperative Upper Instrumented Vertebra (UIV) (≥0°) tilt angle and the risk of medial shoulder/neck and lateral shoulder imbalance among Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) patients following Posterior Spinal Fusion.

Summary of Background Data.

Current UIV selection strategy has poor correlation with postoperative shoulder balance. The relationship between a +ve postoperative UIV tilt angle and the risk of postoperative shoulder and neck imbalance was unknown.

Methods.

One hundred thirty-six Lenke 1 and 2 AIS patients with minimum 2 years follow-up were recruited. For medial shoulder and neck balance, patients were categorized into positive (+ve) imbalance (≥+4°), balanced, or negative (−ve) imbalance (≤−4°) groups based on T1 tilt angle/Cervical Axis measurement. For lateral shoulder balance, patients were classified into +ve imbalance (≥+3°) balanced, and −ve imbalance (≤−3°) groups based on Clavicle Angle (Cla-A) measurement. Linear regression analysis identified the predictive factors for shoulder/neck imbalance. Logistic regression analysis calculated the odds ratio of shoulder/neck imbalance for patients with +ve postoperative UIV tilt angle.

Results.

Postoperative UIV tilt angle and preoperative T1 tilt angle were predictive of +ve medial shoulder imbalance. Postoperative UIV tilt angle and postoperative PT correction were predictive of +ve neck imbalance. Approximately 51.6% of patients with +ve medial shoulder imbalance had +ve postoperative UIV tilt angle. Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance and 3.3 times increased odds of developing +ve neck imbalance. Postoperative UIV tilt angle did not predict lateral shoulder imbalance.

Conclusion.

Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance (T1 tilt angle ≥+4°) and 3.3 times increased odds of developing +ve neck imbalance (cervical axis ≥+4°).

Level of Evidence: 4
Risk Factors and Assessment Using an Endoscopic Scoring System for Early and Persistent Dysphagia After Anterior Cervical Decompression and Fusion Surgery
Authors: Ohba Tetsuro , Hatsushika Kyousuke , Ebata Shigeto , Koyama Kensuke , Akaike Hiroshi , Yokomichi Hiroshi , Masuyama Keisuke , Haro Hirotaka
Published: February 2020

Study Design:

Prospective study.

Objectives:

Preoperative and postoperative dysphagia was evaluated by an otolaryngology doctor and a speech-language-hearing therapist using the eating assessment tool (EAT-10) and Hyodo-Komagane scores. The objective was to achieve a more precise evaluation of the incidence and risk factors of early and persistent dysphagia after anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

Although numerous reports have explored the risk factors for dysphagia after ACDF, these factors remain controversial. The main reason for this situation is that the methods for evaluating dysphagia are not adequate or uniform.

Materials and Methods:

This study involved a retrospective 47 consecutive patients who had undergone ACDF and been followed up for at least 1 year. Sagittal alignment of the cervical spine was evaluated by a preoperative x-ray. Univariate and multivariate logistic regression analyses were performed to determine risk factors for transient or persistent dysphagia.

Results:

The study showed that 34% of patients developed dysphagia in the early postoperative period and that 25.5% of patients still had persistent dysphagia 1 year postoperatively. 8.5% of patients had already developed dysphagia preoperatively, with a significant positive correlation observed between preoperative and postoperative dysphagia.

Aging and smoking were significant risk factors for transient dysphagia. A preoperative cervical kyphotic angle at the C3/C4, C4/C5 disk-level and change in the kyphotic angle at C4/C5 during surgery were significant risk factors of persistent dysphagia 1 year after surgery.

Conclusions:

This is the first study to show dysphagia after anterior cervical spine surgery using the EAT-10 score and Hyodo-Komagane score with endoscopic evaluation. Aging and smoking were significant risk factors for transient dysphagia, while preoperative local kyphosis angles of C3–C4 and C4–C5 and change in the kyphotic angle at C4/C5 during surgery may be a key alignment of risk factors for postoperative persistent dysphagia.

Level of Evidence:

Level: III.
The role of long noncoding RNAs in regulating invasion and metastasis of malignant tumors
Authors: Tang Xianglian , Li Yong , Li Ming , Zhou Yuxiang , Wen Jiabing , Huang Zhao , Xiao Yaling
Published: February 2020

Long noncoding RNAs (lncRNAs) are a group of non–protein-coding transcripts exceeding 200 nucleotides in length, which are emerging as key players in various fundamental biological processes. Furthermore, it is increasingly recognized that mutation and dysregulation of lncRNAs contribute importantly to a variety of human diseases, particularly human cancers. Previous studies have revealed that altered lncRNAs have a close association with tumorigenesis, metastasis, prognosis and diagnosis of cancers. The present review aims to exhibit a brief overview of the associated reports of lncRNAs in cancers, including colorectal cancer, gastric cancer, lung adenocarcinoma, nasopharyngeal carcinoma, cervical cancer and esophageal cancer. Altogether, we argue that lncRNAs have potential as new biomarkers in cancer prognosis and diagnosis, and as promising therapeutic targets for the prevention and treatment of human cancers.
Dissecting the spatial bone marrow microenvironment of hematopoietic stem cells
Authors: Kokkaliaris Konstantinos D.
Published: February 2020

Purpose of review

Hematopoietic stem cells (HSCs) reside in specialized anatomical microenvironments within the bone marrow space, termed HSC niches. Different bone marrow imaging modalities have been utilized to visualize HSCs in situ, and unravel the cellular identity of bone marrow cell types located in their immediate proximity. However, despite extensive research, the exact identity of bone marrow populations that physically associate with HSCs remains controversial.

Recent findings

Recent advances in volumetric imaging enable precise identification of bone marrow populations and their spatial distribution both at tissue-wide scale and single-cell resolution. In addition, single-cell RNA sequencing and mass-cytometry-based approaches dissect the complexity of the bone marrow microenvironment with unprecedented resolution. Here, we review current concepts regarding bone marrow populations that physically associate with HSCs and recent efforts to localize HSCs and their niche populations.

Defining the bone marrow cell types in the immediate proximity of HSCs in homeostasis and stress is key to determine the cellular and molecular cues driving HSC maintenance and regeneration.
Enhanced recovery after cesarean delivery: a challenge for anesthesiologists
Authors: Liu Zhi-Qiang , Du Wei-Jia , Yao Shang-Long
Published: February 2020

Enhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.
ACR–ASTRO Practice Parameter for the Performance of Proton Beam Radiation Therapy
Authors: Shih Helen A. , Rengan Ramesh , Apisarnthanarax Smith , Cheng Chee-Wai , Daartz Juliane , DeLaney Thomas F. , Hartsell William F. , Indelicato Daniel J. , Keole Sameer R. , Rosenthal Seth , Hartford Alan C.
Published: February 2020

Aim/Objectives/Background:

The American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for proton beam radiation therapy. Proton radiotherapy is the application of a high-energy proton beam to a patient in a clinical setting with therapeutic intent. Proton radiotherapy may permit improved therapeutic ratios with lower doses to sensitive normal structures and greater dose to target tumor tissues.

Methods:

A literature search was performed to identify published articles regarding clinical outcomes, reviews, quality assurance methodologies, and guidelines and standards for proton radiation therapy. Selected articles are referenced in the text. The following recommendations are based on firsthand experiences of multiple clinical authorities who employ proton therapy and have been peer reviewed by experts at different practicing institutions.

Results:

This practice parameter is developed to serve as a tool in the appropriate application of this evolving technology in the care of cancer patients or other patients with conditions where radiation therapy is indicated. It addresses clinical implementation of proton radiation therapy, including personnel qualifications, quality assurance standards, indications, and suggested documentation.

Conclusions:

This practice parameter is a tool to guide technical use of proton therapy and does not assess the relative clinical indication of proton radiotherapy when compared with other forms of radiotherapy, but to focus on the best practices required to deliver proton therapy safely and effectively, when clinically indicated. Costs of proton treatments are high, and the economic costs of proton radiotherapy may also need to be considered.
A Split-Scar Study Investigating the Effectiveness of Early Intervention With Electroabrasion on Improving the Cosmetic Appearance of Postsurgical Scars
Authors: Kannan Swati , de Golian Emily , Lee Nayoung , Smith Jonathan , Brian Jiang Shang I.
Published: February 2020

BACKGROUND

Electroabrasion, which uses an in-office electrosurgical device, is a method of surgical planning that ablates the skin to the papillary dermis. Several reports demonstrate that intraoperative ablative interventions with lasers or dermabrasion can modulate scar formation more effectively. This investigation uses electroabrasion intraoperatively to mitigate scar formation.

OBJECTIVE

To evaluate the effectiveness of intraoperative electroabrasion for scar revision.

MATERIALS AND METHODS

This was a prospective, randomized, observer-blinded, split-scar study with 24 linear scar segments resulting from primary closures in patients undergoing Mohs micrographic surgery. After placement of dermal sutures, half of the wound was randomly treated with electroabrasion. The other half was used as the control. Scar appearance was assessed by a blinded observer and by the patient using the Patient and Observer Scar Assessment Scale at 1 to 2 weeks, 1 month, and 3 months after surgery.

RESULTS

At the 3-month follow-up, both patient and observer variables measuring scar contour improved on the treated side, whereas erythema was worse. Overall, no difference was seen in total scores between the 2 sides.

CONCLUSION

Based on this pilot study, scars treated with electroabrasion revealed improved surface topography but worsened erythema. Future studies with more refined electrosurgical settings are needed for further evaluation.