bluuebunny/crossref_metadata_2025 huggingface dataset:
Indigenous Youth Mentorship Program: key implementation characteristics of a school peer mentorship program in Canada
Authors: Lopresti Sabrina , Willows Noreen D , Storey Kate E , McHugh Tara-Leigh F
Published: August 2020

The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program developed for elementary school students in Indigenous school communities in Canada. A local young adult health leader (YAHL) and high school mentors offer students healthy snacks, physical activity games, relationship building activities and cultural teachings. IYMP aims to improve children’s health and wellbeing and empower Indigenous youth and communities. The purpose of this focused ethnography was to describe the key characteristics of successful IYMP delivery. Two focus groups were conducted with 16 participants (8 YAHLS and 8 youth mentors) from 7 schools followed by 4 individual interviews (3 YAHLs, 1 youth peer mentor). Transcripts were analyzed using content analysis. Findings were triangulated with IYMP program field observations and notes from IYMP national team meetings. The five characteristics identified as important for IYMP delivery were a sense of ownership by those delivering the program, inclusion of Indigenous Elders/knowledge keepers, establishing trusting relationships, open communication among all stakeholder groups, including community and academic partners, and adequate program supports in the form of program funding, manuals that described program activities, and local and national gatherings between academic and community partners for sharing ideas about the program and its components. This study indicates the importance of respectful partnerships between community and academic leads for program success and sustainability. As IYMP is implemented in more communities and becomes community autonomous, program sustainability may be ensured and implementation challenges mitigated by embedding the identified five essential characteristics within the fabric of IYMP.
A Low-Powered and Highly Selective Trap for Male Aedes (Diptera: Culicidae) Surveillance: The Male Aedes Sound Trap
Authors: Staunton Kyran M , Crawford Jacob E , Liu Jianyi , Townsend Michael , Han Yu , Desnoyer Mark , Howell Paul , Xiang Wei , Burkot Thomas R , Snoad Nigel , Ritchie Scott A
Published: August 2020

As Aedes aegypti (Linnaeus, Diptera: Culicidae) expands its global distribution and vectors a range of debilitating arboviruses there is an increased need for enhanced mosquito surveillance. Consequently, we developed a Male Aedes Sound Trap (MAST) that requires minimal power and is highly species-specific. Two different versions of the MAST were developed, one that uses synthetic pyrethroid to kill captured mosquitoes (MAST Spray) and another which has an internal divider to create a killing chamber in which a sticky panel can be placed to capture mosquitoes (MAST Sticky). We compared weekly capture rates of male Ae. aegypti and bycatch from the two MAST versions to those from BG-Sentinel (BGS) traps and Sound-producing BG-Gravid Aedes Traps (SGATs) throughout Cairns, northern Australia. Weekly mean male Ae. aegypti catches did not significantly differ between trap types. However, the rate of positive weekly detections of male Ae. aegypti was lower for the MAST Sticky than the other three trap types. The MASTs sampled significantly fewer mosquitoes other than male Ae. aegypti, than either the BGS trap or the SGAT. Also, the MASTs and SGATs all caught significantly less non-Culicidae bycatch than the BGS traps. Consequently, we have developed a versatile male Ae. aegypti trap which is potentially of great benefit to Ae. aegypti surveillance programs.
A Survey of Chemoreceptive Responses on Different Mosquito Appendages
Authors: Yang Liu , Agramonte Natasha , Linthicum Kenneth J , Bloomquist Jeffrey R
Published: August 2020

Research on the functions of insect chemoreceptors have primarily focused on antennae (olfactory receptors) and mouthparts (gustatory receptors). However, chemoreceptive sensilla are also present on other appendages, such as the leg tarsi and the anterior wing margin, and their specific roles in chemoreception and mosquito behavior remain largely unknown. In this study, electrophysiological analyses in an electroantennogram recording format were performed on Aedes aegypti (L., Diptera: Culicidae) antennae, mouthparts, tarsi, and wings during exposure to a variety of insect repellent and attractant compounds. The results provide evidence that the tarsi and wings can sense chemicals in a gaseous form, and that the odors produce differing responses on different appendages. The most consistent and strongest response occurred when exposed to triethylamine (TEA). Antennae and mouthparts showed nearly identical responses pattern to all tested compounds, and their rank orders of effectiveness were similar to those of fore- and mid-leg tarsi. Hindleg tarsi only responded to TEA, indicating that the hind legs are not as chemoreceptive. Wings responded to a range of odorants, but with a different rank order and voltage amplitude. Insights gleaned into the function of these appendages in insect chemoreception are discussed.
Morphological and Molecular Identification of Tropical Bed Bugs From Two Cities of the Pearl River Delta in China
Authors: Zhang Jingsheng , Xia Yanwei , Wang Changlu , Han Dongliang , Ren Dongsheng , Zheng Jun , Xu Xu , He Yurong , Wang Desen
Published: August 2020

From the 1960s to the 1980s, with the implementation of nationwide ‘Four-Pest Elimination’ campaigns (bed bugs, Cimex lectularius L. and Cimex hemipterus (F.) (Hemiptera: Cimicidae), were listed as one of the targeted pests), bed bug infestations were gradually eliminated in most provinces in China. However, during the last two decades, reports of bed bug infestations in the Pearl River Delta of China have shown an upward trend. Up to now, the bed bug species occurring in this area was much less frequently reported. In this study, we used both morphological and molecular methods to accurately identify the species of bed bugs collected from the cities of Guangzhou and Foshan, China. Results indicated that no significant difference was observed in the mean pronotum width-to-length ratio of Guangzhou (2.6) and Foshan (2.4) specimens; however, both were significantly lower than that of a laboratory strain C. lectularius (3.1). The genetic distances of our specimens with C. hemipterus and C. lectularius were 0–0.2% and 22.2–22.6%, respectively. On the basis of the morphological characteristics and mitochondrial DNA sequence data, it can be affirmed that bed bugs collected from Guangzhou and Foshan were C. hemipterus.
Longitudinal Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging in Sheep (Ovis aries) With Quinolinic Acid Lesions of the Striatum: Time-Dependent Recovery of N-Acetylaspartate and Fractional Anisotropy
Authors: O’Connell Adam B , Kuchel Timothy R , Perumal Sunthara R , Sherwood Victoria , Neumann Daniel , Finnie John W , Hemsley Kim M , Morton A Jennifer
Published: August 2020

We created an excitotoxic striatal lesion model of Huntington disease (HD) in sheep, using the N-methyl-d-aspartate receptor agonist, quinolinic acid (QA). Sixteen sheep received a bolus infusion of QA (75 µL, 180 mM) or saline, first into the left and then (4 weeks later) into the right striatum. Magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) of the striata were performed. Metabolite concentrations and fractional anisotropy (FA) were measured at baseline, acutely (1 week after each surgery) and chronically (5 weeks or greater after the surgeries). There was a significant decrease in the neuronal marker N-acetylaspartate (NAA) and in FA in acutely lesioned striata of the QA-lesioned sheep, followed by a recovery of NAA and FA in the chronically lesioned striata. NAA level changes indicate acute death and/or impairment of neurons immediately after surgery, with recovery of reversibly impaired neurons over time. The change in FA values of the QA-lesioned striata is consistent with acute structural disruption, followed by re-organization and glial cell infiltration with time. Our study demonstrates that MRS and DTI changes in QA-sheep are consistent with HD-like pathology shown in other model species and that the MR investigations can be performed in sheep using a clinically relevant human 3T MRI scanner.
Hunting monolignol transporters: membrane proteomics and biochemical transport assays with membrane vesicles of Norway spruce
Authors: Väisänen Enni , Takahashi Junko , Obudulu Ogonna , Bygdell Joakim , Karhunen Pirkko , Blokhina Olga , Laitinen Teresa , Teeri Teemu H , Wingsle Gunnar , Fagerstedt Kurt V , Kärkönen Anna
Published: August 2020

Both the mechanisms of monolignol transport and the transported form of monolignols in developing xylem of trees are unknown. We tested the hypothesis of an active, plasma membrane-localized transport of monolignol monomers, dimers, and/or glucosidic forms with membrane vesicles prepared from developing xylem and lignin-forming tissue-cultured cells of Norway spruce (Picea abies L. Karst.), as well as from control materials, comprising non-lignifying Norway spruce phloem and tobacco (Nicotiana tabacum L.) BY-2 cells. Xylem and BY-2 vesicles transported both coniferin and p-coumaryl alcohol glucoside, but inhibitor assays suggested that this transport was through the tonoplast. Membrane vesicles prepared from lignin-forming spruce cells showed coniferin transport, but the Km value for coniferin was much higher than those of xylem and BY-2 cells. Liquid chromatography-mass spectrometry analysis of membrane proteins isolated from spruce developing xylem, phloem, and lignin-forming cultured cells revealed multiple transporters. These were compared with a transporter gene set obtained by a correlation analysis with a selected set of spruce monolignol biosynthesis genes. Biochemical membrane vesicle assays showed no support for ABC-transporter-mediated monolignol transport but point to a role for secondary active transporters (such as MFS or MATE transporters). In contrast, proteomic and co-expression analyses suggested a role for ABC transporters and MFS transporters.
Factors associated with treatment failure of high-flow nasal cannula among children with bronchiolitis: a single-centre retrospective study
Authors: D’Alessandro Michelle , Vanniyasingam Thuva , Patel Ashaka , Gupta Ronish , Giglia Lucy , Federici Giuliana , Wahi Gita
Published: August 2020

Objectives

Bronchiolitis is the most common viral lower respiratory tract infection in children under age 2 for which high-flow nasal cannula (HFNC) is increasingly used. Understanding factors associated with HFNC failure is important to identify patients at risk for respiratory deterioration. The objective of this study was to evaluate patient characteristics associated with HFNC failure in bronchiolitis.

Methods

A retrospective review of patients aged 0 to 24 months, with bronchiolitis who received HFNC within a single tertiary paediatric intensive care unit, between January 2014 and December 2018 was conducted. HFNC treatment failure was defined as escalation to non-invasive positive pressure or invasive mechanical ventilation. Multivariable regression analysis was used to identify demographic, clinical, and biochemical parameters associated with HFNC failure.

Results

Two hundred eight patients met inclusion criteria, of which 61 (29.33%) failed HFNC. Risk factors for HFNC failure included younger age (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.03, 1.23; P=0.011) and a Modified Tal score greater than 5 at 4 hours of HFNC therapy (OR 2.81; 95% CI 1.04, 7.64; P=0.042). Duration of HFNC in hours was protective (OR 0.94; 95% CI 0.92, 0.96; P<0.001), such that deterioration is less likely once patients have remained stable on HFNC for a prolonged time.

Conclusion

This is the first study exploring predictors of HFNC failure among Canadian children with bronchiolitis. Patient age, HFNC duration, and Modified Tal score were associated with HFNC failure. These factors should be considered when initiating HFNC for bronchiolitis to identify patients at risk for deterioration.
Anti-carbamylated protein antibodies in premenopausal rheumatoid arthritis women: relation to disease activity and bone loss
Authors: Elsawy Noha A , Mohamed Rim A , Ghazala Rasha A , Abdelshafy Mennatullah A , Elnemr Rehab
Published: August 2020

Objectives

Anti-carbamylated protein antibodies (anti-CarP Abs) are present in patients with RA, however, their association with bone loss is not confirmed. The purpose of this study was to determine the relation between the serum level of anti-CarP Abs in premenopausal RA women and disease activity and bone loss.

Methods

This case–control study was conducted on 48 premenopausal women with RA and 48 matched healthy premenopausal women. All RA women were subjected to clinical examination, disease activity assessment using the 28-joint DAS (DAS28) and Clinical Disease Activity Index (CDAI), functional assessment using the HAQ, physical activity assessment using the International Physical Activity Questionnaire (IPAQ), fatigue assessment using the Modified Fatigue Impact Scale (MFIS), serological tests as well as anti-CarP Abs using ELISA. Moreover, the BMD was measured by DXA and plain X-ray of both hands was done to assess juxta-articular osteopenia and erosions.

Results

The anti-CarP Abs level was significantly higher in RA patients than in healthy controls. The serum level of anti-CarP Abs had a significant positive correlation with the RA DAS28, CDAI, HAQ, MFIS and original Sharp score, while a significant negative correlation was present with the IPAQ. Anti-CarP Abs were negatively correlated with either spine BMD or Z-score and positively correlated with the original Sharp score.

Conclusion

Anti-CarP Abs were higher in premenopausal RA women compared with older and BMI matched healthy women. Anti-CarP Abs are associated with higher RA disease activity, increased disability and fatigability and decreased physical activity. Moreover, anti-CarP Abs are associated with systemic trabecular bone loss as well as local bone loss.
Prevalence of Chronic Skin Wounds and Their Risk Factors in an Inpatient Hospital Setting in Northern China
Authors: Yao Zexin , Niu Jun , Cheng Biao
Published: August 2020

OBJECTIVE

To gain insight into the magnitude of the problem of chronic skin wounds in a hospital in northern China.

METHODS

Researchers conducted a retrospective analysis of electronic health records of cases and controls, including 1,977 patients with chronic skin wounds admitted to the hospital’s medical wards over 5 years. Multiple logistic regression was used to establish factors correlating with the development of chronic wounds.

RESULTS

The total prevalence of chronic wounds increased over the study period, and the occurrence of these wounds was significantly correlated with male sex, married status, unemployment, autumn season, and older age. The primary causes of chronic wounds were infection and diabetic ulcer. There were proportionally more wounds secondary to disease than traumatic wounds. The mean duration of hospitalization for patients with wounds was 13 days, and patients were readmitted an average of 10 times.

CONCLUSIONS

With the rapidly aging population in China, disability and chronic wounds are significant problems. Reducing hospital lengths of stay and readmissions remains a challenge. Palliative care may be appropriate for the management of some chronic wounds to prevent and treat further complications. Establishing funding guarantees and the reasonable allocation of health resources is required.
Natural history and long-term follow-up of Hymenoptera allergy
Authors: Ruëff Franziska
Published: August 2020

Purpose of review

Information on the natural history of hypersensitivity reactions is helpful for deciding which patient urgently needs a venom immunotherapy (VIT).

Recent findings

The frequency of self-reported systemic allergic reactions (SAR) to Hymenoptera stings is approximately 3–7% in the Northern Hemisphere. About 25% of SAR are severe (anaphylactic shock). Fatal sting reactions are very rare. The most important risk factor for severe insect sting anaphylaxis is mast cell disease. Other risk factors are higher age, vespid venom allergy (in contrast to honeybee venom allergy), repeated stings, male sex, and treatment with ACE inhibitors. Preceding large local reactions seem not to play a risk factor for subsequent SAR.

The majority of risk factors for severe anaphylaxis are not modifiable. For patients presenting with well defined risk factors for a very severe or even fatal anaphylaxis, VIT is of utmost importance, and they should be performed for the rest of their life. Sting challenge tests are required to identify patients in whom treatment was ineffective. Those patients, who did not receive VIT although presenting with a firm indication, or in whom VIT was stopped, require yearly monitoring to teach preventive measures and to renew the emergency kit.
Allergic conjunctivitis in children: current understanding and future perspectives
Authors: Vazirani Jayesh , Shukla Sachin , Chhawchharia Ritika , Sahu Srikant , Gokhale Nikhil , Basu Sayan
Published: August 2020

Purpose of review

The rising global burden of allergic diseases, particularly in the pediatric population, is of serious concern. Ocular allergy is one of the most common ocular pathologies met in clinical practice. A large proportion of children and adolescents suffer from allergic eye diseases (AEDs), which affect their quality of life. The available treatments and surgical modalities have their limitations and side effects. Therefore, the development of novel and alternate strategies is the need of the hour and requires a timely review of currently available knowledge.

Recent findings

The current review covers the incidence and prevalence of AEDs, factors influencing occurrence and severity of AED (age, sex, socioeconomic status etc.), underlying mechanisms, role of allergy testing and immunotherapy in children, development of diagnostic markers and novel therapies including cells and molecules.

Understanding the demographics, clinical patterns and risk factors of AED can help formulate appropriate preventive and therapeutic strategies for the effective management of this common cause of ocular morbidity. The future therapeutics for AED seems to rely primarily on cells (mesenchymal stem cells, Tregs, mast cells), cell products, molecules with immunosuppressive potential and immunotherapy.
Chemokines in allergic conjunctivitis
Authors: Erdinest Nir , London Naomi , Solomon Abraham
Published: August 2020

Purpose of review

Chemokines are a large group of low molecular weight cytokines that attract and activate leukocytes throughout the body and therefore have a key role in the framework of late-phase allergic responses. The purpose of this article is to provide an overview of the main chemokines involved in allergic conjunctivitis, their primary functions and their physiological roles, and therapies targeted at chemokines and their receptors for ocular allergic diseases.

Recent findings

In recent years, there have been considerable advances in the understanding of ocular pathophysiology of ocular surface inflammatory diseases including both allergic eye diseases and dry eye syndrome. Several therapies being developed for dry eye inflammation are recognized as possible therapies for ocular allergic diseases as there are often common chemokines involved in both disease spectra.

Chemokines represent an integral part of the late-phase cascade of ocular allergic inflammation. A deep understanding of specific chemokines and their interactions will help in targeting therapies to effectively manage ocular clinical findings and symptoms of allergic eye disease.
Comorbid Pain and Cognitive Impairment in a Nationally Representative Adult Population
Authors: Nahin Richard L. , DeKosky Steven T.
Published: August 2020

Objective:

Using a nationally representative sample of adults and pain definitions consistent with the United States National Pain Strategy, we examined the associations of pain and cognitive impairment (CI) with each other and with measures of health status, physical impairment, social impairment, health care utilization, and dissatisfaction with health care.

Materials and Methods:

Prevalence estimates and multivariable logistic regression analyses of the 2017 National Health Interview Survey were performed.

Results:

As the level of reported pain increased from “no pain” to high-impact chronic pain (HICP), there was an increase in the prevalence of CI from 2.99% in those with no pain to 18.19% in those with HICP. Similarly, as the level of CI increased from no impairment to substantial CI, the prevalence of any pain increased from 62.44% to 83.20%. As pain severity and CI increased, we found increased prevalence for all outcomes examined, with the highest prevalence seen in participants with HICP and substantial CI. While 4.15% of individuals without either pain or CI reported poor/fair health, this increased to 33.98% in those with substantial CI or “dementia” but no pain, to 52.22% in those with HICP but no CI, and to 81.8% in individuals reporting both HICP and substantial CI or “dementia.”

Discussion:

Our data suggest that individuals with comorbid chronic pain and CI are in a much higher state of self-reported disability than those with chronic pain or CI alone. Best practice guidelines are generally silent on multidisciplinary, integrated care for these comorbid conditions, increasing the potential for inadequate care.
Headless compression screw fixation of Jones fractures: a clinical and radiographic comparison study
Authors: Ruta David J. , Ellis R. Tyler , Grear Benjamin J. , Richardson David R. , Murphy G. Andrew
Published: August 2020

Background:

Promising results have been reported with indication-specific partially threaded screws and variable-pitched headless compression screws. Our objective was to compare clinical and radiographic results of Jones fractures treated with these two screw types. We also evaluated the association of patient and fracture characteristics with surgical failure.

Methods:

Retrospective review identified all Jones fractures treated with primary intramedullary screw fixation from 1995 through 2015. Chart review yielded patient and fracture characteristics, implants, postoperative course, and serial radiographs for fracture classification (Torg and anatomic zone) and radiographic union. The primary endpoint was surgical failure (delayed union, nonunion, or refracture). Secondary endpoints included time to radiographic union, weight bearing, and pain resolution.

Results:

Fifty-nine consecutive patients (47 with partially threaded screws and 12 with headless compression screws) with a mean age of 30 yr and follow-up of 9.6 mo were included. The group with partially threaded screws showed more failures (10/47, 21.3% vs. 1/12, 8.3%; P=0.31) and longer time to full weight bearing (4.2 vs. 3.3 wk, P=0.06), without differences in time to radiographic union or pain resolution. Pooled union rate was 96.6%.

Conclusions:

Factors significantly correlated with failure were age, diabetes, and body mass index, without significant correlation with tobacco or gender. No differences were found between zone II and III fractures. The two groups had similar clinical and radiographic results, both with high union rates. The 21% failure rate with partially threaded screws is concerning and may warrant further investigation. This supports the headless compression screw as a viable Jones fracture treatment.

Level of Clinical Evidence:

Level III.
Orthopaedic implant cost perceptions: a survey of surgeons and healthcare administrators
Authors: Albersheim Melissa , Parikh Harsh R. , Peck Sarah C. , Lindell Jackson S. , Vang Sandy , Blaschke Breanna L. , Cole Peter A. , Cunningham Brian P.
Published: August 2020

Background:

Few studies to date have investigated healthcare administrators’ knowledge of implant costs, and, to the authors’ knowledge, none have evaluated surgeons’ knowledge of implant costs comparing their own cases to a general cohort. The purpose of this study was to analyze cost perceptions surrounding orthopaedic implants across subspecialties within a cohort of musculoskeletal surgeons and healthcare administrators.

Methods:

A 10-question survey, consisting of 10 fracture patients with their associated postoperative radiographs and the corresponding implant list, was distributed to administrators and musculoskeletal surgeons at a single Level I trauma hospital. Surgeons and administrators were asked to estimate the total cost of each of the constructs given on the survey. The estimates were subtracted from the actual implant costs, with average cost differences assessed as a net value for cohorts, surgeon specialties, and question type.

Results:

Administrators averaged an overestimation of $4655.22/case and surgeons averaged an overestimation of $41.61/case. The surgeon cohort averaged an underestimation of $608.06/case for their subspecialty cases and an underestimation of $3160.07/case for the control cases, neurosurgeons excluded. Traumatologists averaged an underestimation of $381.24/case overall, an underestimation of $379.72/case for their subspecialty cases, and an underestimation of $13.06/case for control cases.

Conclusions:

This study identified that neither surgeons nor administrators could accurately estimate implant costs. Orthopaedic surgeons appeared more accurate and may be uniquely positioned to interface with administrators. Although our study was limited by a small sample size, it pointed to opportunity for collaboration between surgeons and administrators to better understand implant costs and maximize value.

Level of Evidence:

Level VI.
Characteristics and Hospital Costs of Spica Cast Treatment of Non–accidental-related Diaphyseal Femoral Fractures in Children Before Walking Age
Authors: Magee Lacey C. , Mahmoud Mahmoud A.H. , Baldwin Keith , Talwar Divya , Gandhi Jigar S. , Arkader Alexandre
Published: August 2020

Background:

Fractures are one of the most common presentations of child abuse second only to soft tissue damage, with ∼60% of fractures being femur, humerus or tibia fractures. Although studies have shown increased health care costs associated with nonaccidental trauma (NAT), there is little data regarding the cost of NAT-associated fractures compared with accidental trauma (AT) related fractures. The purpose of this study was to consider the economic burden of NAT related femoral fractures compared with AT femoral fractures.

Methods:

We performed a retrospective study of children under the age of one with femoral fractures treated with a spica cast at a Level 1 Pediatric Trauma Center between 2007 and 2016. Variables included age, sex, length of hospital stay, and estimated total billing cost obtained from this hospital’s billing department. In addition, fracture site (mid-shaft, distal, proximal, and subtrochanteric) and pattern were assessed.

Results:

Sixty children with a mean age of 7 months were analyzed. NAT was suspected in 19 cases (31.7%) and confirmed in 9 (15%) before discharge. Two groups were analyzed: the NAT group included suspected and confirmed cases of abuse (28) and the AT group contained the remaining 32 cases. There was no significant difference in the demographics between these 2 groups. Children in NAT group had a longer length of stay compared with AT group (78.9 vs. 36.7 h, P<0.001). Overall consumer price index-adjusted hospital costs were $24,726 higher for NAT group compared with AT group (P=0.024), with costs of laboratory workup, radiology, and nonorthopaedic physician fees being the top 3 components contributing to the increased costs.

Conclusions:

The overall incidence of NAT was 46.6% in children presenting with femoral fracture under 1 year of age. The overall hospital cost of treating fractures in the NAT group was 1.5 times higher than the AT group, with imaging charges the most significant contributor to cost difference.

Level of Evidence:

Level III—retrospective review.
External Validation of an Algorithm to Predict Adjacent Musculoskeletal Infection in Pediatric Patients With Septic Arthritis
Authors: Hunter Sarah , Kennedy Jim , Baker Joseph F.
Published: August 2020

Background:

Septic arthritis (SA) remains a potentially morbid disease in the pediatric population. Magnetic resonance imaging (MRI) is the most sensitive tool for recognizing associated osteomyelitis and intramuscular abscess, but is a limited resource. The aim of this study is to externally validate a previously developed algorithm (Rosenfeld and colleagues) to predict adjacent infection in pediatric patients diagnosed with SA.

Methods:

We identified 120 children under 16 with presumed SA presenting to a tertiary referral center between 2008 and 2018. Patients without confirmed SA, those with insufficient data, and patients who did not receive perioperative MRI were excluded, leaving 53 patients. The previous algorithm suggests that patient age (above 4 y), C-reactive protein (>8.9 mg/L), platelet count (<310×103 cells/µL), duration of symptoms (>3 d), and absolute neutrophil count (>7.2×103 cells/µL) are risk factors for adjacent infection, with 3 or more variables signifying a “positive” result. Comparing against the gold standard of MRI, the accuracy of the algorithm was validated in terms of sensitivity, specificity, likelihood ratio (LR), and positive and negative predictive value. Discrimination and calibration of this algorithm have been assessed using receiver operating curve analysis and calibration plots.

Results:

The sensitivity and specificity of criteria from Rosenfeld algorithm were 73% and 44%, respectively. Receiver operating curve showed poor discrimination [area under the curve=0.54, confidence interval (CI): 0.26-0.83]. The positive predictive value was 55.9% and the negative predictive value was 63.1% with LR +1.23 (CI: 0.87-1.98) and LR −0.61 (CI 0.28-1.30). Only 53% of patients with 4 or more criteria had an adjacent infection on MRI. Examining our cohort, children with a positive MRI finding had higher mean C-reactive protein (77 vs. 122 mg/L, P=0.04) and were more likely to have waited >72 hours days between symptom onset and hospital presentation (P=0.03).

Conclusion:

Although treatment algorithms are an attractive tool to guide clinicians and resource allocation, they need to take into account the local population characteristics before routine implementation.

Level of Evidence:

Level IV–retrospective cohort study.
Lengthening Less Than 7 Months Leads to Greater Spinal Height Gain With Rib-based Distraction
Authors: Qiu Catherine , Lott Carina , Agaba Perez , Cahill Patrick J. , Anari Jason B.
Published: August 2020

Background:

Severe early-onset scoliosis (EOS) has been associated with a multitude of comorbidities, chief among them being deficient thoracic spine growth and pulmonary complications. EOS management with rib-based instrumentation involves repeated lengthening. Despite expansion practice patterns, there is limited literature and no evidence-based guidelines for optimal expansion intervals. Our study evaluates clinical outcomes in relation to lengthening intervals with the aim of optimizing the timing of surgical expansion in EOS patients.

Methods:

A single-institution retrospective review of 60 EOS patients treated with rib-based growth instrumentation with a minimum of 3-year follow-up and 3 expansion/revision surgeries. Patients were separated into 2 expansion cohorts: (1) more frequent lengthening [MFL group (≤7 mo)] and (2) less frequent lengthening [LFL group (>7 mo)]. Demographic information and clinical factors were recorded. Univariate and bivariate analyses were performed.

Results:

Both the MFL group (35 patients) and LFL group (25 patients) were similar in sex distribution, diagnosis, preoperative parameters of interest, and treatment duration. The mean follow-up was 6.0 years. There was an increase in postoperative T1-S1 spine height gained in the MFL group (P=0.006) as well as a higher percent expected spine growth based on normative values (P=0.03) when compared with the LFL group. The MFL group had more expansion/revision surgeries (P=0.003) but no increase in the number of complications (P=0.86).

Conclusions:

More frequent lengthenings were associated with statistically significant overall spinal height gain and percent expected growth without a significant increase in complication rates. It was shown that change in major curve and space available for the lungs was not associated with the lengthening intervals.

Level of Evidence:

Level III—a comparative retrospective study.
Surgical Reconstruction of Missed Monteggia Lesions in Children
Authors: Zheng Evan T. , Waters Peter M. , Vuillermin Carley B. , Williams Kathryn , Bae Donald S.
Published: August 2020

Background:

Chronic Monteggia lesions in children may cause pain, deformity, decreased range of motion, and neurological symptoms. Numerous surgical techniques have been advocated to reconstruct long-standing Monteggia injures in efforts to maximize long-term upper limb function. The purpose of this investigation was to assess the clinical and radiographic results of a modified surgical technique for missed Monteggia fracture-dislocations.

Methods:

A retrospective evaluation of 52 patients who underwent surgical reconstruction of missed Monteggia fracture-dislocations at a tertiary pediatric hospital was performed. The median patient age at the time of surgery was 6.8 years, and the median time from injury to surgery was 12.9 weeks. Electronic medical records, including clinic notes, radiographic images, and operative reports, were reviewed for study analysis. Median clinical and radiographic follow-up was 19.1 months.

Results:

The median elbow range of motion improved from 108 degrees of flexion and 5 degrees short of full extension preoperatively to 140 degrees of flexion (P<0.001) and full extension (P=0.10) postoperatively. Forearm range of motion also improved from a median of 80 degrees of pronation and 58 degrees of supination preoperatively to 80 degrees of pronation (P=0.54) and 80 degrees of supination (P<0.001) postoperatively. Congruent radiocapitellar alignment was maintained in 39 patients (75%). Nine patients (17%) had redislocation of the radiocapitellar joint, and 4 patients (8%) had radiographic resubluxation. Six of the 9 patients who experienced redislocation underwent early revision and achieved uncomplicated longer term results. Patients who received repair of the native annular ligament were more likely to achieve lasting radiocapitellar joint stability (P=0.03) when compared with patients who received annular ligament reconstruction or if the annular ligament was not addressed.

Conclusion:

Meaningful improvements in elbow motion and radiocapitellar stability can be safely achieved in the majority of children following surgical reconstruction of missed Monteggia lesions.

Level of Evidence:

Level IV—retrospective case series.
Preoperative 6-Minute Walk Performance in Children With Congenital Scoliosis
Authors: Nakashima Hiroaki , Kawakami Noriaki , Matsumoto Hiroko , Redding Gregory J.
Published: August 2020

Background:

The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies.

Methods:

The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis.

Results:

The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=−0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49).

Conclusions:

The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment.

Level of Evidence:

Level IV—retrospective cohort study.
Is Proximal Fibula Epiphysiodesis Necessary When Performing a Proximal Tibial Epiphysiodesis?
Authors: Boyle Jonathan , Makarov Marina R. , Podeszwa David A. , Rodgers Jennifer A. , Jo Chan-Hee , Birch John G.
Published: August 2020

Background:

Controversy exists regarding the need for proximal fibular epiphysiodesis in conjunction with proximal tibial epiphysiodesis to prevent relative overgrowth of the fibula. The purpose of this study was to determine the incidence of relative fibular overgrowth in patients who had undergone proximal tibial epiphysiodesis with or without proximal fibular epiphysiodesis to manage leg-length discrepancy.

Methods:

We identified patients who had undergone proximal tibial epiphysiodesis, with or without concomitant fibular epiphysiodesis, followed to skeletal maturity, and with adequate scanograms to measure tibial and fibular lengths. We assessed tibial and fibular lengths, ratios, and distances between the tibia and fibula proximally and distally preoperatively and at skeletal maturity, and obvious radiographic proximal migration of the fibular head.

Results:

A total of 234 patients met inclusion criteria, including 112 girls and 122 boys. In total, 179 patients had undergone concomitant fibular epiphysiodesis, and 55 had not. The fibular epiphysiodesis group was significantly younger preoperatively than the nonfibular epiphysiodesis group (average: 12.3 vs. 13.6 y), which accounted for most of the preoperative differences noted between the groups. Within the subset of younger patients (≥2 y of growth remaining at the time of epiphysiodesis), there were statistically significant differences between those with or without fibular epiphysiodesis at skeletal maturity in the proximal tibial-fibular distance (P<0.01) and the tibia:fibula ratio (0.96±0.02 vs. 0.98±0.02; P<0.02), but not in the distal tibial-fibular distance (P=0.46). Obvious fibular head proximal migration was noted in 10 patients, including 5/179 with concomitant proximal fibular epiphysiodesis, and 5/55 without (P<0.01). No patient was recorded as symptomatic with radiographic overgrowth, and no peroneal nerve injury occurred in any patient in this cohort.

Conclusions:

On the basis of this study, concomitant proximal fibular epiphysiodesis does not appear to be necessary in patients with 2 years or less of growth remaining, nor does it unequivocally prevent fibular head overgrowth. While the tibia:fibula ratio was quite consistent in general, there were individuals with relative fibular head prominence for whom fibular epiphysiodesis may be appropriate, particularly in relatively immature patients.

Level of Evidence:

Level III—retrospective comparative study.
Hip Reconstruction in Nonambulatory Children With Cerebral Palsy: Identifying Risk Factors Associated With Postoperative Complications and Prolonged Length of Stay
Authors: Shea Jodie , Nunally Kianna D. , Miller Patricia E. , Difazio Rachel , Matheney Travis H. , Snyder Brian , Shore Benjamin J.
Published: August 2020

Background:

The purpose of this study is to examine the relationship between preoperative comorbidities, surgical complications, and length of stay (LOS) after hip reconstruction in nonambulatory children with cerebral palsy (CP).

Methods:

This single-center retrospective cohort study included 127 patients undergoing hip surgery between 2007 and 2016 who were diagnosed with CP (GMFCS IV/V). The cohort was 54% Gross Motor Function Classification System (GMFCS) V with an average age at surgery of 9 years (range, 3-19 y). Preoperative comorbidities included: presence of a gastrostomy tube, respiratory difficulty requiring positive-pressure ventilation or tracheostomy, history of seizures, and nonverbal status. Complications were dichotomized into major and minor complications according to severity. Multivariable general linear modeling was used to identify factors associated with complications and prolonged LOS.

Results:

The median LOS in the hospital was 6 days (intequartile range, 5-9 d). The majority of procedures (72%) involved both the femur and acetabulum and 82% of surgeries were performed bilaterally. Patients who experienced a major complication were mostly GMFCS level V and were more likely to spend time in intensive care unit than postanesthetic care unit (P=0.001). Multivariable analysis for a major complication determined that the addition of each comorbid risk fact increased the odds of developing a major complication by 2.6 times (odds ratio, 2.64; 95% confidence interval, 1.56-4.47; P<0.001) regardless of GMFCS level. Multivariable analysis for prolonged LOS determined that major complications (P<0.001), bilaterality (P=0.01), age (P=0.02), female sex (P=0.01), and GMFCS V (P<0.001) were all factors that increased LOS. Migration percentage, acetabular index odds ratio, and pelvic obliquity were not associated with prolonged LOS or the presence of a major complication.

Conclusions:

From our analysis, the authors found that a patient’s premorbid comorbidities were more predictive of the likelihood of sustaining a major complication than their GMFCS level. Identifying high-risk patients preoperatively may help reduce complications and LOS, which ultimately will improve the quality of care the authors deliver to nonambulatory children with CP undergoing hip reconstruction surgery.

Level of Evidence:

Level III—retrospective cohort study.
What Should I Wear to Clinic? A National Survey of Pediatric Orthopaedic Patients and Parents
Authors: Bauer Jennifer M. , Welling Sebastian E. , Ross Kirsten E. , Mackenzie W. G. Stuart , Larson Jill E. , Leshikar Holly , Strauss Nicole M.
Published: August 2020

Background:

A number of factors have been shown to affect how surgeons are subjectively viewed, including their appearance in clinic. Patient preference for pediatric orthopaedic surgeon attire has not previously been studied, nor has its influence on initial perception of the surgeon.

Methods:

At 5 pediatric regional sites across the United States, parents and patients presenting to the pediatric orthopaedic clinic were given anonymous surveys showing 8 photos of surgeons in different clinical dress including in business or scrub dress, each with or without white coat (WC). Subjects reported their demographics, single preferred photo, rated characteristics of the surgeons in each photo on a 5-point Likert scale, and answered specific questions on scrubs and WCs. The first consecutively completed 100 parent and 100 patient surveys were included from each site.

Results:

One thousand surveys were collected from patients (500) and parents (500). The majority felt a surgeon’s clinical dress would not affect how they are cared for (83%), and that it was ok to wear scrubs in clinic (90%). Overall, WC was preferred to those without no matter the age, but there was no difference between scrub and business choices. Of those stating a preference, woman in business and WC (24%) and woman in scrubs and WC (21%) were most selected, with the only geographic difference being the midwest’s preference for man in business and WC. Females were more likely to prefer women photographs (P<0.0001).

Conclusions:

In general, pediatric orthopaedic patients and parents do not have a strong specific preference toward what their surgeon wears to clinic, including whether or not we are dressed in scrubs, but some initial biases exist. When asked to choose, the traditional WC worn over any attire is preferred, and female patients and parents uncover a preference for a surgeon of their own sex.

Level of Evidence:

Level III.
Universal Screening for COVID-19 in Children Undergoing Orthopaedic Surgery: A Multicenter Report
Authors: Blumberg Todd J. , Adler Adam C. , Lin Elaina E. , Fazal Faris Z. , Talwar Divya , Ellingsen Kyle , Chandrakantan Arvind , Chen Jingyang , Shah Apurva S.
Published: August 2020

Background:

The COVID-19 pandemic has substantially altered the typical process around performing surgery to ensure protection of health care workers, patients, and their families. One safety precaution has been the implementation of universal preoperative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examines the results of universal screening on children undergoing orthopaedic surgery.

Methods:

This is a retrospective cohort study evaluating the incidence and symptomatology of COVID-19 in all patients presenting for orthopaedic surgery at 3 pediatric tertiary care children’s hospitals during the COVID-19 pandemic (March to June 2020). All patients underwent universal screening with a nasopharyngeal swab to detect presence of SARS-CoV-2. Bivariate and multivariate logistic regression analysis was performed to identify risk factors for positive COVID-19 screening.

Results:

In total, 1198 patients underwent preoperative screening across all 3 institutions and 7 (0.58%) had detection of SARS-CoV-2. The majority of patients (1/7, 86%) were asymptomatic. Patients that tested positive were significantly more likely to be Hispanic (P=0.046) and had greater number of medical comorbidities (P=0.013), as scored on the American Society of Anesthesiologists (ASA) physical status score. A known COVID-19 positive contact was found to be a significant risk factor in the multivariate analysis (P=0.004).

Conclusions:

Early results of universal preoperative screening for COVID-19 demonstrates a low incidence and high rate of asymptomatic patients. Health care professionals, especially those at higher risk for the virus, should be aware of the challenges related to screening based solely on symptoms or travel history and consider universal screening for patients undergoing elective surgery.

Level of Evidence:

Level II.