bluuebunny/crossref_metadata_2025 huggingface dataset:
Serological Responses to Toxoplasma gondii and Matrix Antigen 1 Predict the Risk of Subsequent Toxoplasmic Encephalitis in People Living With Human Immunodeficiency Virus (HIV)
Authors: Xiao Jianchun , Bhondoekhan Fiona , Seaberg Eric C , Yang Otto , Stosor Valentina , Margolick Joseph B , Yolken Robert H , Viscidi Raphael P
Published: December 2020

Background

Clinically useful predictors for fatal toxoplasmosis are lacking. We investigated the value of serological assays for antibodies to whole Toxoplasma antigens and to peptide antigens of the Toxoplasma cyst matrix antigen 1 (MAG1), for predicting incident toxoplasmic encephalitis (TE) in people living with human immunodeficiency virus (HIV; PLWH).

Methods

We performed a nested case control study, conducted within the Multicenter AIDS Cohort Study (MACS), using serum samples obtained 2 years prior to diagnosis of TE from 28 cases, and 37 HIV disease-matched Toxoplasma seropositive controls at matched time-points. Sera were tested for Toxoplasma antibodies using a commercial assay and for antibodies to MAG1_4.2 and MAG1_5.2 peptides in enzyme-linked immunosorbent assay (ELISA).

Results

Two years prior to clinical diagnosis, 68% of TE cases were MAG1_4.2 seropositive compared with 16% of controls (odds ratio [OR] 25.0, 95% confidence interval [CI] 3.14–199.18). Corresponding results for MAG1_5.2 seropositivity were 36% and 14% (OR 3.6, 95% CI .95–13.42). Higher levels of antibody to MAG1_4.2 (OR 18.5 per doubling of the optical density [OD] value, 95% CI 1.41–242) and to Toxoplasma (OR 2.91 for each OD unit increase, 95% CI 1.48–5.72) were also associated with the risk of TE. When seropositivity was defined as the presence of MAG1 antibody or relatively high levels of Toxoplasma antibody, the sensitivity was 89% and specificity was 68% for subsequent TE.

Conclusions

Antibodies to MAG1 showed predictive value on the occurrence of TE in PLWH, and the predictive performance was further improved by adding the levels of Toxoplasma antibody. These measures could be clinically useful for predicting subsequent diseases in multiple at-risk populations.
A proposed framework for cloud-aware multimodal multimedia big data analysis toward optimal resource allocation
Authors: Sasikala S , Gomathi S , Geetha V , Murali L
Published: December 2020

The main goal of this paper is to demonstrate the structural design of Multimodal Multimedia Services in Cloud Platform (MMSCP). Thus, our proposed MMSCP architecture is built of three levels such as, Service Platform, Execution Platform and Structural platform. The functionality of service platform is to gather different forms of video files generated by the media creators and to store these files on the local platform. The second execution platform integrates both the Hadoop and Mapreduce functionalities. Finally, QoS based cloud computing functionalities (i.e. load balancing, security, resource allocation and network traffic management) is employed at the third structural platform. Likely, we introduced the Crow Search Algorithm (CSA) in structural platform for optimal allocation of resources. We adapt a Hadoop cluster to perform the experiment. Also, to conduct the resource allocation experiment we used some of the conventional optimization algorithms such as, ABC, GA and PSO for comparison with our proposed CSA algorithm imposed on the structural platform. However, to evaluate the performance of the algorithms we configured the CloudAnalyst tool. The simulation results illustrate that the proposed algorithm can allocate the virtual machine (VM) optimally to attain a minimal response time.
A Generic Analogy-Centered Software Cost Estimation Based on Differential Evolution Exploration Process
Authors: Wani Zahid Hussain , Bhat Javaid Iqbal , Giri Kaisar Javeed
Published: December 2020

Software cost estimation is the prediction of development effort and calendar time required to develop any software project. It is considered to be the very fundamental task for successful execution of an on-going project as well as budgetary requirements of futuristic projects. As accuracy in software cost estimation is very hard because of the availability of vague information at the time of inception of the software project, it prompted many researchers to explore in this domain from past decades. Their pioneer works suggest a bulk of techniques for this purpose. However, because of the availability of large number of estimation techniques, it becomes hard for any software practitioners to select an appropriate one. To help the industry practitioners in these situations, a novel analogy-centered model based on differential evolution exploration process is proposed in this research study. The proposed model has been assessed on 676 projects from 5 different data sets and the results achieved are significantly better when compared with other benchmark analogy-based estimation studies. Furthermore, being the very less computational cost of the proposed model, it is suggested that the proposed model be considered as the preliminary stage of any analogy-based software estimation technique.
Additive value of positron emission tomography/computed tomography scan for detection of aortic tube graft infection: a case report
Authors: Larti Farnoosh , Khadembashiri Mohammad Amin , Abbasi Mehrshad , Sherafati Alborz
Published: December 2020

Background

Diagnosis of aortic graft infection is challenging, and delayed diagnosis is associated with poor prognosis. Positron emission tomography/computed tomography (PET/CT) has improved diagnostic accuracy.

Case summary

A patient with a history of congenital heart disease was admitted due to fever. He had a history of four cardiac surgeries, including the Bentall procedure for endocarditis. Blood cultures were negative. A semi-mobile mass was detected in the distal portion of the aortic tube graft in echocardiography. PET/CT scan was used to confirm tube graft infection and to support proceeding to cardiac surgery.

Discussion

Using multimodality imaging, including PET/CT scan in combination with echocardiography, can improve diagnostic accuracy for the detection of aortic tube graft infection, infection of prosthetic valves, or intra-cardiac devices, especially in high-risk surgical cases.
Bank branching, concentration, and local economic growth in pre-WW1 England and Wales
Authors: Jansson Walter
Published: December 2020

This paper explores the relationship between the spread of bank offices, banking sector concentration, and economic growth in English and Welsh counties in the four decades before WW1. During this period, banks rapidly expanded their branch networks, while banking sector concentration increased. Findings from both panel fixed effects and instrumental variable regressions suggest that an increase in the number of bank offices in English and Welsh counties had a positive impact on local economic growth. There is no evidence of banking sector concentration being negatively associated with local economic performance prior to WW1.
Racial Differences in Early Parental Death, Midlife Life Problems, and Relationship Strain With Adult Children
Authors: Kim Yijung K , Kim Kyungmin , Fingerman Karen L , Umberson Debra J
Published: December 2020

Objectives

Black Americans typically experience the death of a parent earlier in the life course than do non-Hispanic Whites, and early parental death is known to hinder subsequent relationship outcomes. Whether early parental death may contribute to racial differences in midlife family relationships and the role midlife adults’ current life problems play remain unexplored.

Method

Using multilevel modeling, we examined how timing of parental death is associated with relationship strain with adult children and whether the association differs by midlife adults’ life problems in Black (n = 166) and non-Hispanic White (n = 467) families from the Family Exchanges Study.

Results

Losing a parent in childhood was associated with more relationship strain with adult children for Black midlife adults, but not for their non-Hispanic White counterparts. Among the bereaved, earlier timing of parental death was associated with more relationship strain with adult children only for Black midlife adults. In both bereaved and nonbereaved sample, participants’ recent physical-emotional problems exacerbated the link between timing of parental death and relationship strain with adult children for Black midlife adults.

Discussion

Experiencing the death of a parent in the early life course can be an added structural disadvantage that imposes unique challenges for Black Americans in midlife. Policies and programs aimed at supporting bereaved children may benefit relationships with their own children later in life, and addressing physical-emotional problems in midlife may be a viable intervention point for those midlife adults who experienced the death of a parent in the early life course.
Approximate separability of symmetrically penalized least squares in high dimensions: characterization and consequences
Authors: Celentano Michael
Published: December 2020

We show that the high-dimensional behavior of symmetrically penalized least squares with a possibly non-separable, symmetric, convex penalty in both (i) the Gaussian sequence model and (ii) the linear model with uncorrelated Gaussian designs nearly agrees with the behavior of least squares with an appropriately chosen separable penalty in these same models. This agreement is established by finite-sample concentration inequalities which precisely characterize the behavior of symmetrically penalized least squares in both models via a comparison to a simple scalar statistical model. The concentration inequalities are novel in their precision and generality. Our results help clarify that the role non-separability can play in high-dimensional M-estimation. In particular, if the empirical distribution of the coordinates of the parameter is known—exactly or approximately—there are at most limited advantages to use non-separable, symmetric penalties over separable ones. In contrast, if the empirical distribution of the coordinates of the parameter is unknown, we argue that non-separable, symmetric penalties automatically implement an adaptive procedure, which we characterize. We also provide a partial converse which characterizes the adaptive procedures which can be implemented in this way.
Partial differential model of lactate neuro-energetics: analytic results and numerical simulations
Authors: Perrillat-Mercerot Angélique , Miranville Alain , Agosti Abramo , Rocca Elisabetta , Ciarletta Pasquale , Guillevin Rémy
Published: December 2020

Interfaces play a key role on diseases development because they dictate the energy inflow of nutrients from the surrounding tissues. What is underestimated by existing mathematical models is the biological fact that cells are able to use different resources through nonlinear mechanisms. Among all nutrients, lactate appears to be a sensitive metabolic when talking about brain tumours or neurodegenerative diseases. Here we present a partial differential model to investigate the lactate exchanges between cells and the vascular network in the brain. By extending an existing kinetic model for lactate neuro-energetics, we first provide analytical proofs of the uniqueness and the derivation of precise bounds on the solutions of the problem including diffusion of lactate in a representative volume element comprising the interface between a capillary and cells. We further perform finite element simulations of the model in two test cases, discussing the relevant physical parameters governing the lactate dynamics.
Measles in the 21st Century: Progress Toward Achieving and Sustaining Elimination
Authors: Gastañaduy Paul A , Goodson James L , Panagiotakopoulos Lakshmi , Rota Paul A , Orenstein Walt A , Patel Manisha
Published: December 2020

The global measles vaccination program has been extraordinarily successful in reducing measles-related disease and deaths worldwide. Eradication of measles is feasible because of several key attributes, including humans as the only reservoir for the virus, broad access to diagnostic tools that can rapidly detect measles-infectious persons, and availability of highly safe and effective measles-containing vaccines (MCVs). All 6 World Health Organization (WHO) regions have established measles elimination goals. Globally, during 2000–2018, measles incidence decreased by 66% (from 145 to 49 cases per million population) and deaths decreased by 73% (from 535 600 to 142 300), drastically reducing global disease burden. Routine immunization with MCV has been the cornerstone for the control and prevention of measles. Two doses of MCV are 97% effective in preventing measles, qualifying MCV as one of the most effective vaccines ever developed. Mild adverse events occur in <20% of recipients and serious adverse events are extremely rare. The economic benefits of measles vaccination are highlighted by an overall return on investment of 58 times the cost of the vaccine, supply chains, and vaccination. Because measles is one of the most contagious human diseases, maintenance of high (≥95%) 2-dose MCV coverage is crucial for controlling the spread of measles and successfully reaching measles elimination; however, the plateauing of global MCV coverage for nearly a decade and the global measles resurgence during 2018–2019 demonstrate that much work remains. Global commitments to increase community access to and demand for immunizations, strengthen national and regional partnerships for building public health infrastructure, and implement innovations that can overcome access barriers and enhance vaccine confidence, are essential to achieve a world free of measles.
Disc–jet coupling changes as a possible indicator for outbursts from GX 339−4 remaining within the X-ray hard state
Authors: de Haas S E M , Russell T D , Degenaar N , Markoff S , Tetarenko A J , Tetarenko B E , van den Eijnden J , Miller-Jones J C A , Parikh A S , Plotkin R M , Sivakoff G R
Published: December 2020

We present quasi-simultaneous radio, (sub-)millimetre, and X-ray observations of the Galactic black hole X-ray binary GX 339−4, taken during its 2017–2018 outburst, where the source remained in the hard X-ray spectral state. During this outburst, GX 339−4 showed no atypical X-ray behaviour that may act as an indicator for an outburst remaining within the hard state. However, quasi-simultaneous radio and X-ray observations showed a flatter than expected coupling between the radio and X-ray luminosities (with a best-fitting relation of $L_{\rm radio} \propto L_{\rm X}^{0.39 \pm 0.06}$), when compared to successful outbursts from this system ($L_{\rm radio} \propto L_{\rm X}^{0.62 \pm 0.02}$). While our 2017–2018 outburst data only span a limited radio and X-ray luminosity range (∼1 order of magnitude in both, where more than 2 orders of magnitude in LX is desired), including data from other hard-only outbursts from GX 339−4 extends the luminosity range to ∼1.2 and ∼2.8 orders of magnitude, respectively, and also results in a flatter correlation (where $L_{\rm radio} \propto L_{\rm X}^{0.46 \pm 0.04}$). This result is suggestive that for GX 339−4 a flatter radio–X-ray correlation, implying a more inefficient coupling between the jet and accretion flow, could act as an indicator for a hard-only outburst. However, further monitoring of both successful and hard-only outbursts over larger luminosity ranges with strictly simultaneous radio and X-ray observations is required from different single sources to explore if this applies generally to the population of black hole X-ray binaries, or even GX 339−4 at higher hard-state luminosities.
Evolving solar wind flow properties of magnetic inversions observed by Helios
Authors: Macneil Allan R , Owens Mathew J , Wicks Robert T , Lockwood Mike
Published: December 2020

In its first encounter at solar distances as close as r = 0.16 au, Parker Solar Probe observed numerous local reversals, or inversions, in the heliospheric magnetic field (HMF), which were accompanied by large spikes in solar wind speed. Both solar and in situ mechanisms have been suggested to explain the existence of HMF inversions in general. Previous work using Helios 1, covering 0.3–1 au, observed inverted HMF to become more common with increasing r, suggesting that some heliospheric driving process creates or amplifies inversions. This study expands upon these findings, by analysing inversion-associated changes in plasma properties for the same large data set, facilitated by observations of ‘strahl’ electrons to identify the unperturbed magnetic polarity. We find that many inversions exhibit anticorrelated field and velocity perturbations, and are thus characteristically Alfvénic, but many also depart strongly from this relationship over an apparent continuum of properties. Inversions depart further from the ‘ideal’ Alfvénic case with increasing r, as more energy is partitioned in the field, rather than the plasma, component of the perturbation. This departure is greatest for inversions with larger density and magnetic field strength changes, and characteristic slow solar wind properties. We find no evidence that inversions that stray further from ‘ideal’ Alfvénicity have different generation processes from those which are more Alfvénic. Instead, different inversion properties could be imprinted based on transport or formation within different solar wind streams.
Variation in Pleiotropic Hub Gene Expression Is Associated with Interspecific Differences in Head Shape and Eye Size in Drosophila
Authors: Buchberger Elisa , Bilen Anıl , Ayaz Sanem , Salamanca David , Matas de las Heras Cristina , Niksic Armin , Almudi Isabel , Torres-Oliva Montserrat , Casares Fernando , Posnien Nico
Published: December 2020

Revealing the mechanisms underlying the breathtaking morphological diversity observed in nature is a major challenge in Biology. It has been established that recurrent mutations in hotspot genes cause the repeated evolution of morphological traits, such as body pigmentation or the gain and loss of structures. To date, however, it remains elusive whether hotspot genes contribute to natural variation in the size and shape of organs. As natural variation in head morphology is pervasive in Drosophila, we studied the molecular and developmental basis of differences in compound eye size and head shape in two closely related Drosophila species. We show differences in the progression of retinal differentiation between species and we applied comparative transcriptomics and chromatin accessibility data to identify the GATA transcription factor Pannier (Pnr) as central factor associated with these differences. Although the genetic manipulation of Pnr affected multiple aspects of dorsal head development, the effect of natural variation is restricted to a subset of the phenotypic space. We present data suggesting that this developmental constraint is caused by the coevolution of expression of pnr and its cofactor u-shaped (ush). We propose that natural variation in expression or function of highly connected developmental regulators with pleiotropic functions is a major driver for morphological evolution and we discuss implications on gene regulatory network evolution. In comparison to previous findings, our data strongly suggest that evolutionary hotspots are not the only contributors to the repeated evolution of eye size and head shape in Drosophila.
Approaching 18% efficiency of ternary organic photovoltaics with wide bandgap polymer donor and well compatible Y6 : Y6-1O as acceptor
Authors: Ma Xiaoling , Zeng Anping , Gao Jinhua , Hu Zhenghao , Xu Chunyu , Son Jae Hoon , Jeong Sang Young , Zhang Caixia , Li Mengyang , Wang Kai , Yan He , Ma Zaifei , Wang Yongsheng , Woo Han Young , Zhang Fujun
Published: December 2020

A series of ternary organic photovoltaics (OPVs) are fabricated with one wide bandgap polymer D18-Cl as donor, and well compatible Y6 and Y6-1O as acceptor. The open-circuit-voltage (VOC) of ternary OPVs is monotonously increased along with the incorporation of Y6-1O, indicating that the alloy state should be formed between Y6 and Y6-1O due to their excellent compatibility. The energy loss can be minimized by incorporating Y6-1O, leading to the VOC improvement of ternary OPVs. By finely adjusting the Y6-1O content, a power conversion efficiency of 17.91% is achieved in the optimal ternary OPVs with 30 wt% Y6-1O in acceptors, resulting from synchronously improved short-circuit-current density (JSC) of 25.87 mA cm−2, fill factor (FF) of 76.92% and VOC of 0.900 V in comparison with those of D18-Cl : Y6 binary OPVs. The JSC and FF improvement of ternary OPVs should be ascribed to comprehensively optimal photon harvesting, exciton dissociation and charge transport in ternary active layers. The more efficient charge separation and transport process in ternary active layers can be confirmed by the magneto-photocurrent and impedance spectroscopy experimental results, respectively. This work provides new insight into constructing highly efficient ternary OPVs with well compatible Y6 and its derivative as acceptor.
Basilar Artery Injury During Endonasal Surgery: Stepwise to Control Bleeding
Authors: Cárdenas Ruiz-Valdepeñas Eugenio , Kaen Ariel , Tirado-Caballero Jorge , Di Somma Alberto , Iglesias Pais Miguel , Vázquez Domínguez Maria , Márquez Rivas Javier , Villa Fernández Juan Manel
Published: December 2020

BACKGROUND

Intraoperative injury during endoscopic endonasal surgery of the carotid artery has been previously described in the literature. However, the accidental damage of the basilar artery in such scenario is not defined.

OBJECTIVE

To define the protocol of action for massive bleeding from an artery in the posterior fossa.

METHODS

The reported patient was diagnosed with a partially calcified clival chordoma featured by a huge intradural component. An endoscopic endonasal transpterygoid transclival approach was selected for the treatment of this tumor. During the surgical procedure, the basilar artery injury was injured, causing intense bleeding. We present and discuss the surgical maneuvers that could save a patient's life after this dramatic complication.

RESULTS

Different techniques were performed in order to control the massive bleeding, including injection of hemotastic matrix with thrombin (Floseal©), bipolar coagulation, and vessel reconstruction by means of a vascular clip. Finally, an autologous muscle graft reinforced with an overlying fibrin sealant patch (Tachosil©) was chosen and was an effective technique. Afterwards, the patient was treated with a flow diverter device to occlude an iatrogenic pseudoaneurysm. A monoplegia of the right upper limb was the only remarkable sequel 6 mo after surgery.

CONCLUSION

The muscle graft together with the coordinated action with interventional neuroradiology for the reconstruction of the vessel are possibly the best options to try to preserve the neurological function. In such a scenario, the assumption of potential ischemic events prevails over the intraoperative death of the patient.
Microsurgical Anterior Controllable Antedisplacement Fusion to Treat Cervical Ossified Posterior Longitudinal Ligament: 2-Dimensional Operative Video
Authors: Duan Wanru , Chou Dean , Jian Fengzeng , Chen Zan
Published: December 2020

The anterior decompression technique, including vertebral body sliding osteotomy
1
and anterior controllable antedisplacement fusion (ACAF),
2
treats ossified posterior longitudinal ligament (OPLL) without actual excision of the OPLL.
3
The fundamental strategy is to separate the mid-portion of the vertebral body along with the OPLL using bilateral anterior osteotomies followed by controllable antedisplacement. These techniques restore the space of the spinal canal anteriorly by anterior translation of the OPLL, avoiding excision and dural manipulation.
4
We illustrate the case of a patient who had failed laminoplasty and the surgical decision making for ACAF. We discuss the other surgical options regarding patient selection, present preoperative and postoperative imaging, to demonstrate the efficacy of ACAF and show strategies of ACAF to make it a safe and effective procedure. We demonstrate our technique of ACAF using the intraoperative microscope and models in this video to illustrate the steps of ACAF. A written consent to the procedure was obtained from the patient.
Resection of a Large Thoracic Schwannoma: 2-Dimensional Operative Video
Authors: Mueller Kyle B , Voyadzis Jean-Marc
Published: December 2020

Spinal schwannomas most likely occur at the thoracic level and within the intradural extramedullary compartment. They are benign, typically slow-growing, peripheral nerve sheath tumors that produce symptoms by displacing or compressing the nerve roots and spinal cord. There is an association with patients that have neurofibromatosis type 2. Surgical pearls including the utilization of intraoperative ultrasound for localization, D wave monitoring, and microsurgical dissection are demonstrated. Pertinent high-yield radiographic and histological features of schwannomas are reviewed.
1-4

 We report the case of a 59-yr-old female who presented with progressively worsening gait instability that was associated with lower extremity numbness progressing to weakness. She had myelopathic findings on examination, which included brisk patellar reflexes and persistent clonus with sensory changes to the umbilicus and mild leg weakness. Full body examination revealed no stigmata of neurofibromatosis. Magnetic resonance imaging of the neuroaxis demonstrated a large, intradural extramedullary mass with peripheral enhancement that spanned the T9 to T11 vertebral levels with severe compression of the spinal cord. There were no intracranial, cervical, or lumbar findings. Surgical intervention was planned with the following objectives: decompression of the neural elements, curative resection, and diagnosis. Patient consent for the procedure was obtained. Institutional Review Board approval for solitary case reports are not needed at our institution.
Planning Brain Tumor Resection Using a Probabilistic Atlas of Cortical and Subcortical Structures Critical for Functional Processing: A Proof of Concept
Authors: Sarubbo Silvio , Annicchiarico Luciano , Corsini Francesco , Zigiotto Luca , Herbet Guillaume , Moritz-Gasser Sylvie , Dalpiaz Chiara , Vitali Luca , Tate Matthew , De Benedictis Alessandro , Amorosino Gabriele , Olivetti Emanuele , Rozzanigo Umberto , Petralia Benedetto , Duffau Hugues , Avesani Paolo
Published: December 2020

BACKGROUND

Functional preoperative planning for resection of intrinsic brain tumors in eloquent areas is still a challenge. Predicting subcortical functional framework is especially difficult. Direct electrical stimulation (DES) is the recommended technique for resection of these lesions. A reliable probabilistic atlas of the critical cortical epicenters and subcortical framework based on DES data was recently published.

OBJECTIVE

To propose a pipeline for the automated alignment of the corticosubcortical maps of this atlas with T1-weighted MRI.

METHODS

To test the alignment, we selected 10 patients who underwent resection of brain lesions by using DES. We aligned different cortical and subcortical functional maps to preoperative volumetric T1 MRIs (with/without gadolinium). For each patient we quantified the quality of the alignment, and we calculated the match between the location of the functional sites found at DES and the functional maps of the atlas.

RESULTS

We found an accurate brain extraction and alignment of the functional maps with both the T1 MRIs of each patient. The matching analysis between functional maps and functional responses collected during surgeries was 88% at cortical and, importantly, 100% at subcortical level, providing a further proof of the correct alignment.

CONCLUSION

We demonstrated quantitatively and qualitatively the reliability of this tool that may be used for presurgical planning, providing further functional information at the cortical level and a unique probabilistic prevision of distribution of the critical subcortical structures. Finally, this tool offers the chance for multimodal planning through integrating this functional information with other neuroradiological and neurophysiological techniques.
Clinical utility of correction factors for febrile young infants with traumatic lumbar punctures
Authors: Rogers Sarah , Gravel Jocelyn , Anderson Gregory , Papenburg Jesse , Quach Caroline , Burstein Brett
Published: December 2020

Objectives

Correction factors have been proposed for traumatic lumbar punctures (LPs) in febrile young infants. However, no studies have assessed their diagnostic utility. We sought to determine the proportion of traumatic LPs safely reclassified as low risk for bacterial meningitis using recently derived white blood cell (WBC) and protein correction factors.

Methods

We retrospectively analyzed traumatic LPs among all febrile infants ≤60 days old at two tertiary paediatric hospitals from 2006 through 2018. Traumatic LPs were defined as ≥10,000 RBCs/mm3. Abnormal cerebrospinal fluid (CSF) WBCs and protein were adjusted downward using a newly derived correction factor (877 red blood cells [RBCs]: 1 WBC), three commonly used correction factors (500 WBCs: 1 RBC; 1,000 WBCs: 1 WBC; peripheral RBCs: WBCs), and a newly derived protein correction factor (1,000 RBCs: 0.011 g/L protein).

Results

There were 437 traumatic LPs including 357 (82%) with pleocytosis and 4 (0.9%) with bacterial meningitis. Overall, fewer infants were classified as having CSF pleocytosis using 877:1 and 1,000:1 ratios (38% and 43%, respectively), with 100% sensitivity and negative predictive value, and improved specificity (63% for 877:1, 58% for 1,000:1 ratios versus 19% for uncorrected counts). Among infants with pleocytosis, 877:1 and 1,000:1 ratios reclassified 191 (54%) and 171 (48%) as normal with no misclassified bacterial meningitis cases. Ratios of 500:1 and peripheral RBC:WBC misclassified 1 infant that had bacterial meningitis. Corrected CSF protein outperformed uncorrected protein in specificity but did not add diagnostic value following WBC-based correction.

Conclusions

Correction ratios of 877:1 and 1,000:1 safely reclassified half of all febrile infants ≤60 days. These corrections should be considered when interpreting CSF results of traumatic LPs.
Fifth metatarsal fractures in skeletally immature patients do not need routine orthopedic surgeon assessment and follow-up
Authors: Meschino Danielle , Adamich John , Rioux Trottier Eliane , Camp Mark
Published: December 2020

Objectives

The aim of this study was to determine the rate of delayed or nonunion of fifth metatarsal fractures in skeletally immature patients. Using this information, we sought to develop an evidence-based clinical care pathway in order to mitigate unnecessary patient radiation exposure, costs to families, and costs to the health system.

Methods

We retrospectively reviewed the charts and radiographs of patients who presented to an academic tertiary-care paediatric hospital between 2009 and 2014 with isolated fifth metatarsal fractures.

Results

A total of 114 patients (61 males and 53 females) with mean age of 11.2 (SD 3.0) years old were included in the study. No patients required operative management. There was one case of delayed union and no cases of nonunion. There was no association of these complications with fracture type, location, or mechanism of injury. There was no association of complications with immobilization type or immobilization period. Despite the low complication rate and need for surgery, fracture clinic resource utilization was significant. Fractures were managed with a mean number of 3.1 (SD 0.89) clinic visits and a mean number of 2.7 (SD1.0) radiology department visits where a mean total of 7.9 (SD 3.4) x-rays were performed.

Conclusions

Based on our retrospective review, skeletally immature patients presenting with isolated fifth metatarsal fractures have a very low rate of delayed or nonunion. A selective follow-up strategy will decrease radiation exposure, reduce costs to families and the healthcare system, without compromising clinical outcomes.
Comparison of Five Lists to Identify Potentially Inappropriate Use of Non-Steroidal Anti-Inflammatory Drugs in Older Adults
Authors: Nguyen Thi Ngoc Mai , Laetsch Dana Clarissa , Chen Li-Ju , Holleczek Bernd , Meid Andreas D , Brenner Hermann , Schöttker Ben
Published: December 2020

Objective

To compare the prevalence of potentially inappropriate non-steroidal anti-inflammatory drugs (NSAIDs) among NSAIDs users defined with frequently used potentially inappropriate medication (PIM) lists and to identify the determinants of their use.

Design and Setting

Cross-sectional survey among community-dwelling older adults from Germany.

Subjects

N = 284 NSAIDs users aged 65–89 years.

Methods

All currently regularly or as-needed used drugs were recorded during a home visit. Multivariate logistic regression models were applied to assess the potential determinants of potentially inappropriate NSAIDs use.

Results

Prevalence of potentially inappropriate NSAIDs use was 54.2%, 45.4%, 29.9%, 20.4%, and 3.5% when applying the STOPP, 2019 Beers, EU(7)-PIM, FORTA, and PRISCUS list, respectively. No study participant was identified as a potentially inappropriate NSAIDs user by all five lists simultaneously. The majority (68%) were identified only by one or two lists. Merely the STOPP and Beers criteria had a moderate inter-instrument agreement. Lower pain severity, gout, peptic ulcer (PU), cardiovascular disease (CVD), and chronic kidney disease (CKD) were statistically significantly associated with potentially inappropriate NSAIDs use defined by the STOPP criteria and the latter three conditions also with the 2019 Beers criteria.

Conclusions

The STOPP and Beers criteria may be superior to the other lists because they more frequently identify potentially inappropriate NSAIDs use in conditions implying a high risk for NSAIDs' adverse events (i.e., PUD, CKD and CVD). We developed a harmonized, country-independent PIM list for NSAIDs with the same advantages as observed for the STOOP and 2019 Beers criteria and recommended its use.
What does the COVID-19 pandemic mean for the next decade of onchocerciasis control and elimination?
Authors: Hamley Jonathan I D , Blok David J , Walker Martin , Milton Philip , Hopkins Adrian D , Hamill Louise C , Downs Philip , de Vlas Sake J , Stolk Wilma A , Basáñez Maria-Gloria
Published: December 2020

Background

Mass drug administration (MDA) of ivermectin for onchocerciasis has been disrupted by the coronavirus disease 2019 (COVID-19) pandemic. Mathematical modelling can help predict how missed/delayed MDA will affect short-term epidemiological trends and elimination prospects by 2030.

Methods

Two onchocerciasis transmission models (EPIONCHO-IBM and ONCHOSIM) are used to simulate microfilarial prevalence trends, elimination probabilities and age profiles of Onchocerca volvulus microfilarial prevalence and intensity for different treatment histories and transmission settings, assuming no interruption, a 1-y (2020) interruption or a 2-y (2020–2021) interruption. Biannual MDA or increased coverage upon MDA resumption are investigated as remedial strategies.

Results

Programmes with shorter MDA histories and settings with high pre-intervention endemicity will be the most affected. Biannual MDA is more effective than increasing coverage for mitigating COVID-19’s impact on MDA. Programmes that had already switched to biannual MDA should be minimally affected. In high-transmission settings with short treatment history, a 2-y interruption could lead to increased microfilarial load in children (EPIONCHO-IBM) and adults (ONCHOSIM).

Conclusions

Programmes with shorter (annual MDA) treatment histories should be prioritised for remedial biannual MDA. Increases in microfilarial load could have short- and long-term morbidity and mortality repercussions. These results can guide decision-making to mitigate the impact of COVID-19 on onchocerciasis elimination.
Tuning intrinsic disorder predictors for virus proteins
Authors: Almog Gal , Olabode Abayomi S , Poon Art F Y
Published: December 2020

Many virus-encoded proteins have intrinsically disordered regions that lack a stable, folded three-dimensional structure. These disordered proteins often play important functional roles in virus replication, such as down-regulating host defense mechanisms. With the widespread availability of next-generation sequencing, the number of new virus genomes with predicted open reading frames is rapidly outpacing our capacity for directly characterizing protein structures through crystallography. Hence, computational methods for structural prediction play an important role. A large number of predictors focus on the problem of classifying residues into ordered and disordered regions, and these methods tend to be validated on a diverse training set of proteins from eukaryotes, prokaryotes, and viruses. In this study, we investigate whether some predictors outperform others in the context of virus proteins and compared our findings with data from non-viral proteins. We evaluate the prediction accuracy of 21 methods, many of which are only available as web applications, on a curated set of 126 proteins encoded by viruses. Furthermore, we apply a random forest classifier to these predictor outputs. Based on cross-validation experiments, this ensemble approach confers a substantial improvement in accuracy, e.g., a mean 36 per cent gain in Matthews correlation coefficient. Lastly, we apply the random forest predictor to severe acute respiratory syndrome coronavirus 2 ORF6, an accessory gene that encodes a short (61 AA) and moderately disordered protein that inhibits the host innate immune response. We show that disorder prediction methods perform differently for viral and non-viral proteins, and that an ensemble approach can yield more robust and accurate predictions.
Drilling Speed and Bone Temperature of a Robot-assisted Ultrasonic Osteotome Applied to Vertebral Cancellous Bone
Authors: Lang Zhao , Wang Qilong , Wu Xinfeng , Liu Yajun , He Da , Fan Mingxing , Shi Zhan , Tian Wei
Published: December 2020

Study Design.

An experimental investigation of a robot-assisted ultrasonic osteotome applied to vertebral cancellous bone.

Objective.

The aim of this study was to investigate the effect of various ultrasonic parameter settings on temperature in the drilling site and penetration time and determine the most suitable parameters for efficient and safe robot-based ultrasonically assisted bone drilling in spinal surgery

Summary of Background Data.

A robot-assisted ultrasonic osteotome device may be safe and effective for spinal drilling.

Methods.

Sixty specimens of bovine vertebral cancellous were randomly assigned to one of six groups, which varied by mode of ultrasonic vibration (L-T and L) and feed rate (one percent [0.8 mm/s], two percent [1.6 mm/s], and three pecent [2.4 mm/s]). Maximum temperature in the drilling site and penetration time was recorded.

Results.

Maximum temperature in the drilling site decreased as output power increased for L-T and L modes, was significantly lower for L-T compared to L mode at each feed rate and power setting, was significantly different at feed rates of 1.6 mm/s versus 0.8 mm/s and 2.4 mm/s versus 0.8 mm/s for L-T mode at an output power of 60 W and 84 W, but was not influenced by feed rate for L mode. Penetration time did not significantly improve as output power increased for both L-T and L modes, was significantly decreased with increased feed rates, but was not significantly different between L-T and L modes.

Conclusion.

The optimal parameters for applying a robot-assisted ultrasonic osteotome to vertebral cancellous bone are L-T mode, maximum output power of 120 W, and maximum feed rate of 2.4 mm/s.

Level of Evidence: 4
“July Effect” Revisited: July Surgeries at Residency Training Programs are Associated with Equivalent Long-term Clinical Outcomes Following Lumbar Spondylolisthesis Surgery
Authors: Chan Andrew K. , Patel Arati B. , Bisson Erica F. , Bydon Mohamad , Glassman Steven D. , Foley Kevin T. , Shaffrey Christopher I. , Potts Eric A. , Shaffrey Mark E. , Coric Domagoj , Knightly John J. , Park Paul , Wang Michael Y. , Fu Kai-Ming G. , Slotkin Jonathan R. , Asher Anthony L. , Virk Michael S. , Kerezoudis Panagiotis , Alvi Mohammed A. , Guan Jian , Choy Winward , Haid Regis W. , Mummaneni Praveen V.
Published: December 2020

Study Design.

Retrospective analysis of a prospective registry.

Objective.

We utilized the Quality Outcomes Database (QOD) registry to investigate the “July Effect” at QOD spondylolisthesis module sites with residency trainees.

Summary of Background Data.

There is a paucity of investigation on the long-term outcomes following surgeries involving new trainees utilizing high-quality, prospectively collected data.

Methods.

This was an analysis of 608 patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Surgeries were classified as occurring in July or not in July (non-July). Outcomes collected included estimated blood loss, length of stay, operative time, discharge disposition, complications, reoperation and readmission rates, and patient-reported outcomes (Oswestry Disability Index [ODI], Numeric Rating Scale [NRS] Back Pain, NRS Leg Pain, EuroQol-5D [EQ-5D] and the North American Spine Society [NASS] Satisfaction Questionnaire). Propensity score-matched analyses were utilized to compare postoperative outcomes and complication rates between the July and non-July groups.

Results.

Three hundred seventy-one surgeries occurred at centers with a residency training program with 21 (5.7%) taking place in July. In propensity score-matched analyses, July surgeries were associated with longer operative times ( average treatment effect = 22.4 minutes longer, 95% confidence interval 0.9–449.0, P = 0.041). Otherwise, July surgeries were not associated with significantly different outcomes for the remaining perioperative parameters (estimated blood loss, length of stay, discharge disposition, postoperative complications), overall reoperation rates, 3-month readmission rates, and 24-month ODI, NRS back pain, NRS leg pain, EQ-5D, and NASS satisfaction score (P > 0.05, all comparisons).

Conclusion.

Although July surgeries were associated with longer operative times, there were no associations with other clinical outcomes compared to non-July surgeries following lumbar spondylolisthesis surgery. These findings may be due to the increased attending supervision and intraoperative education during the beginning of the academic year. There is no evidence that the influx of new trainees in July significantly affects long-term patient-centered outcomes.

Level of Evidence: 3
Snare Tip Is an Alternative Tool for Colorectal Endoscopic Submucosal Dissection
Authors: Wu Chih-Chien , Chang Min-Chi , Lee Ming-Hung , Hsu Chiao-Hui , Hsu Chao-Wen
Published: December 2020

BACKGROUND:

Colorectal endoscopic submucosal dissection is typically performed by specialized knife, such as a dual knife. However, it is not covered by Taiwan’s National Health Insurance. In the literature review, using a traditional snare tip for endoscopic submucosal dissection has been reported for stomach lesions only.

OBJECTIVE:

The purpose of this study was to evaluate the outcomes of colorectal endoscopic submucosal dissection using a snare tip.

DESIGN:

We retrospectively reviewed the clinical using of a snare tip compared with a dual knife for colorectal endoscopic submucosal dissection. Postoperative short- and long-term outcomes were investigated after the procedure.

SETTINGS:

This study was conducted at a single tertiary care institution.

PATIENTS:

Patients who could not afford the expense of a specialized knife were included.

MAIN OUTCOME MEASURES:

Dissection time, dissection speed, and perioperative complications were used for short-term outcome measurement. Recurrence-free rate was used for long-term outcome measurement.

RESULTS:

Twenty-one lesions were in the snare tip group and 57 lesions in the dual knife group. The outcomes, including rate of en bloc resection, complication, local recurrence, and recurrence-free interval, between the 2 groups were similar. The mean resected specimen diameter in the dual knife group is larger than the snare tip group (p = 0.041). The dissection time of the snare tip group was shorter than the dual knife group (p = 0.025). However, the dissection speed was significantly slower in the snare tip group than in the dual knife group (p = 0.008).

LIMITATIONS:

This study was a retrospective and single doctor chart review in nature with a limited patient number.

CONCLUSIONS:

The snare tip is an alternative tool for colorectal endoscopic submucosal dissection in a selected population without the support of specialized knives, such as the dual knife. Although the dissection speed is slower using a snare tip, it is still a recommended technique for developing country or low-income patients.
Effects of digital learning in anaesthesiology
Authors: Shih Yu-Chih D. , Liu Chih-Chung , Chang Chuen-Chau , Lee Yuan-Wen
Published: December 2020

BACKGROUND

Digital methods of instruction have proven to be effective in assisting learning in many fields at various levels. However, none of the meta-analyses have studied the effects of digital learning vs. traditional learning in the field of anaesthesiology.

OBJECTIVE

We conducted a meta-analysis to review the role of digital learning in anaesthesiology by comparing the effect sizes of the involved studies.

DESIGN

A systematic review and meta-analysis of randomised controlled trials and assessment of the quality of evidence by the Medical Education Research Study Quality Instrument.

DATA SOURCES

Educational databases (EBSCOhost and LearnTechLib) and medical databases (PubMed, Embase and Cochrane) were searched from January 1998 to February 2019.

ELIGIBILITY CRITERIA

We conducted a search by using key words related to digital learning and anaesthesiology. Articles that compared traditional instruction and digital instruction methods for learners in anaesthesiology were considered.

RESULTS

The 15 studies involved 592 trainees from the field of anaesthesiology. Considering substantial heterogeneity (I
2 = 73%), a random-effect model was used. Pooled effect size presented a standardised mean deviation of 0.79, P < 0.001, indicating a statistically significant difference between traditional and digital learning groups, favouring the digital learning group. Results of subgroup analyses showed that using clinical performance to measure learning outcomes exhibited no heterogeneity, digital learning method was more consistent and effective for anaesthetic professionals, and the digital learning method was more effective than traditional learning method in the studies teaching the instructional contents of echocardiography and clinical scenarios.

CONCLUSION

The current study demonstrated positive effects of digital instruction in the field of anaesthesiology. Training through digital materials may assist professional training between the stages of didactic training and clinical training.
RECALCITRANT CYSTOID MACULAR EDEMA? BILATERAL INTRARETINAL HYPOREFLECTIVE SPACES ON SD-OCT AS A PRESENTATION OF A PITUITARY MACROADENOMA
Authors: Wu Andres , Wu Lihteh
Published: December 2020

Purpose:

To report a case of a pituitary macroadenoma that presented with bilateral intraretinal hyporeflective spaces located primarily in the inner nuclear layer on the macular SD-optical coherence tomography.

Methods:

Case report.

Results:

Based on the findings of a macular SD-optical coherence tomography, a 53-year-old man was considered as having cystoid macular edema secondary to a retinovascular condition. He was treated with intravitreal vascular endothelial growth factor inhibitors and corticosteroids with no improvement. Confrontation visual fields suggested a bitemporal defect. MRI confirmed the presence of a nonsecreting pituitary macroadenoma compressing the optic chiasm.

Conclusion:

Not all intraretinal hyporeflective spaces in the optical coherence tomography are secondary to a retinal vascular condition. Hyporeflective spaces in the inner nuclear layer on optical coherence tomography imaging that do not leak on fluorescein angiography may be secondary to optic atrophy from chiasmal compression.