bluuebunny/crossref_metadata_2025 huggingface dataset:
Does India Negotiate?
Authors: Nachiappan Karthik
Published: January 2020

As a key state in the international system, India’s positions and contributions on issues like climate change, global health, humanitarian crises, and nuclear disarmament significantly affect how these issues are addressed. Scholarly work mapping India’s multilateral behaviour has extended from covering the United Nations to a wide range of fora where India is seeking to shape issues that affect its security and development. Yet, the literature on Indian multilateralism lags, focusing disproportionately on India’s ostensibly obstructionist tendencies without adequately contextualizing why India behaves this way. There has been no serious exploration of how India concretely negotiates multilateral issues. In this book, Karthik Nachiappan investigates how India negotiates international rules covering issues like climate change, nuclear disarmament, tobacco control and international trade. By unpacking these negotiations, he shows that India’s multilateral persona is more nuanced than is generally understood. When interests converge, Indian negotiators are willing to shape and ratify international agreements, conceding when necessary to cut deals and make compromises.
The benefit stance: responsible ownership in the twenty-first century
Authors: Alexander Frederick H
Published: January 2020

Ownership in the global equities markets is dominated by large institutions that manage the savings of beneficiaries with long investment horizons. These asset managers rely on incomplete investment models that betray the interests of their beneficiaries and threaten their collective future. The models encourage individual companies to compete without regard for health of the critical social and environmental systems that support the long-term value of those beneficiaries’ diversified portfolios and lived experience. These naïve models ignore the growing cost of profit-driven negative externalities. This article examines the latest models of benefit corporation law, a new form of governance that overturns the rule of shareholder primacy, and argues that their principles should be expanded to cover the entire chain of investing, from savers to funds to asset managers and finally to the real economy.
Common variant of CNTNAP2 gene modulate the social performances and functional connectivity of posterior right temporoparietal junction
Authors: Bai Tongjian , Zhang Long , Xie Xiaohui , Xiao Guixian , Huang Wanling , Li Dandan , Zu Meidan , Wei Lin , Zuo Xianbo , J I Gong-Jun , Hu Panpan , Zhu Chunyan , Qiu Bensheng , Tian Yanghua , Wang Kai
Published: January 2020

Social deficits are features of autism and highly heritable traits. A common variant in autism-related CNTNAP2 gene, rs2710102, has been linked with social performance, but the neural substrates are largely unknown. We investigated variations in social performance and functional connectivity (static and dynamic) in the subregions of right temporoparietal junction (RTPJ), a key node of brain social network, using resting-state magnetic resonance imaging (n = 399) by genotype at rs2710102 in healthy volunteers. Social performance was evaluated using the social domain of the Autism-Spectrum Quotient (AQ-social; n = 641) and fixation time on eye areas during an eye-tracking task (n = 32). According to previous evidence that the A-allele is the risk allele for social dysfunction, we classified participants into GG and A-allele carriers (AA/AG) groups. The A-allele carriers showed poor social performance (high AQ-social and short fixation time on eye areas) compared with the GG carriers. In the A-allele carriers, decreased stationary functional connectivity between the orbitofrontal cortex and posterior RTPJ (pRTPJ), and decreased dynamic functional connectivity (dFC) between the medial prefrontal cortex (mPFC) and pRTPJ were observed. The fixation time at eye areas positively were correlated with the pRTPJ-mPFC dFC. These findings provided insight for genetic effect on social behavior and its potential neural substrate.
Reduced Auditory Mismatch Negativity Reflects Impaired Deviance Detection in Schizophrenia
Authors: Koshiyama Daisuke , Kirihara Kenji , Tada Mariko , Nagai Tatsuya , Fujioka Mao , Usui Kaori , Araki Tsuyoshi , Kasai Kiyoto
Published: January 2020

The auditory mismatch negativity (MMN) is a translatable electroencephalographic biomarker automatically evoked in response to unattended sounds that is robustly associated with cognitive and psychosocial disability in patients with schizophrenia. Although recent animal studies have tried to clarify the neural substrates of the MMN, the nature of schizophrenia-related deficits is unknown. In this study, we applied a novel paradigm developed from translational animal model studies to carefully deconstruct the constituent neurophysiological processes underlying MMN generation. Patients with schizophrenia (N = 25) and healthy comparison subjects (HCS; N = 27) underwent MMN testing using both a conventional auditory oddball paradigm and a “many-standards paradigm” that was specifically developed to deconstruct the subcomponent adaptation and deviance detection processes that are presumed to underlie the MMN. Using a conventional oddball paradigm, patients with schizophrenia exhibited large effect size deficits of both duration and frequency MMN, consistent with many previous studies. Furthermore, patients with schizophrenia showed selective impairments in deviance detection but no impairment in adaptation to repeated tones. These findings support the use of the many-standards paradigm for deconstructing the constituent processes underlying the MMN, with implications for the use of these translational measures to accelerate the development of new treatments that target perceptual and cognitive impairments in schizophrenia and related disorders.
Alterations in sleep electroencephalography synchrony in combat-exposed veterans with post-traumatic stress disorder
Authors: Laxminarayan Srinivas , Wang Chao , Ramakrishnan Sridhar , Oyama Tatsuya , Cashmere J David , Germain Anne , Reifman Jaques
Published: January 2020

Study Objectives

We assessed whether the synchrony between brain regions, analyzed using electroencephalography (EEG) signals recorded during sleep, is altered in subjects with post-traumatic stress disorder (PTSD) and whether the results are reproducible across consecutive nights and subpopulations of the study.

Methods

A total of 78 combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive laboratory nights of high-density EEG recordings. We computed a measure of synchrony for each EEG channel-pair across three sleep stages (rapid eye movement [REM] and non-REM stages 2 and 3) and six frequency bands. We examined the median synchrony in 9 region-of-interest (ROI) pairs consisting of 6 bilateral brain regions (left and right frontal, central, and parietal regions) for 10 frequency-band and sleep-stage combinations. To assess reproducibility, we used the first 47 consecutive subjects (18 with PTSD) for initial discovery and the remaining 31 subjects (13 with PTSD) for replication.

Results

In the discovery analysis, five alpha-band synchrony pairs during non-REM sleep were consistently larger in PTSD subjects compared with controls (effect sizes ranging from 0.52 to 1.44) across consecutive nights: two between the left-frontal and left-parietal ROIs, one between the left-central and left-parietal ROIs, and two across central and parietal bilateral ROIs. These trends were preserved in the replication set.

Conclusion

PTSD subjects showed increased alpha-band synchrony during non-REM sleep in the left frontoparietal, left centro-parietal, and inter-parietal brain regions. Importantly, these trends were reproducible across consecutive nights and subpopulations. Thus, these alterations in alpha synchrony may be discriminatory of PTSD.
Maintenance energy requirements and forage intake of purebred vs. crossbred beef cows1
Authors: Andresen Claire E , Wiseman Aksel W , McGee Adam , Goad Carla , Foote Andrew P , Reuter Ryan , Lalman David L
Published: January 2020

The objective of this study was to investigate the impacts of cow breed type and age on maintenance requirements, feed energy utilization, and voluntary forage intake. The main effect of breed type included Angus (ANG; n = 32) and Hereford × Angus (HA; n = 27) lactating cows. The main effect of age included 2- and 3-yr-old (YOUNG; n = 29) and 4- to 8-yr-old (MATURE; n = 30) cows. Within breed type and age class, cows were randomly assigned to 1 of 2 pens for a total of 8 pens, each housing 7 to 9 cow/calf pairs. To determine maintenance energy requirements, cows and calves were limit-fed for 105 d to body weight (BW) and body condition score (BCS) stasis. There were no differences between breeds in cow hip height, BW, average milk yield (P > 0.31), diet digestibility, or cow maintenance energy requirement (P = 0.54). Crossbred cows had greater BCS (P < 0.05) throughout the experiment. Efficiency of calf growth was not different between breeds when expressed as feed intake of the cow/calf pair nor as energy intake of the pair per unit of calf BW gain (P ≥ 0.31). Young cows produced less milk per day and per unit of BW0.75 (P < 0.01); however, there was no effect of cow age on maintenance energy requirement, diet digestibility, or efficiency of calf growth (P > 0.10). Subsequently, a 45-d experiment was conducted to determine voluntary low-quality forage intake. Cows were housed in dry-lot pens equipped with shade, windbreaks, and feed bunks with free-choice access to clean water and a chopped hay ration was provided ad libitum to determine forage intake. Daily forage intake was lower (P = 0.05) for HA compared with ANG (123 vs. 132 g/kg BW0.75, respectively) although there was no difference in BW. However, HA cows sustained greater BCS (P < 0.01). There was no difference (P = 0.60) in forage intake per unit of BW0.75 due to cow age. Results indicate similar calf growth efficiency among breed types although crossbred cows maintained greater body energy stores and consumed less low-quality forage during the voluntary intake experiment. These differences could not be attributed to lower maintenance energy requirements. Neither maintenance energy requirement nor calf growth efficiency was different between young and mature cows.
Effect of corn processing on growth performance, carcass characteristics, and plasma glucose-dependent insulinotropic polypeptide and metabolite concentrations in feedlot cattle1
Authors: Freitas Tiago B , Felix Tara L , Shriver Wayne , Fluharty Francis L , Relling Alejandro E
Published: January 2020

The objectives of this trial were to evaluate the association between corn processing, glucose-dependent insulinotropic polypeptide (GIP) concentration, and intramuscular (IM) fat deposition. We hypothesized that steers fed whole shelled corn (WSC) would have a greater IM fat deposition than steers fed cracked corn (CC) due to an increase in plasma GIP concentration. Backgrounded, Angus-cross cattle (initial body weight [BW] = 279 ± 9.8 kg) were used in a randomized complete block design in a feedlot setting for an average of 230 d. Cattle were allotted in 12 pens (6 pens per treatment with 8 animals per pen). There were three blocks: heifers (n = 32, initial BW = 265 ± 1.3 kg), small steers (n = 32, initial BW = 262 ± 1.3 kg), and large steers (n = 32, initial BW = 310 ± 1.4 kg). Two pens within each block were randomly assigned to one of the following treatments: 1) CC or 2) WSC. Animal growth performance, carcass characteristics, and plasma hormone and metabolite concentrations were analyzed using the MIXED procedure of SAS, including the fixed effects of treatment, or treatment, time, and their interaction. Pen and block were included as random effects. Carcass yield and quality grade distributions were compared using the GLIMMIX procedure of SAS. including the fixed effects of treatment and time with pen and block as random effects. Linear regression was used to evaluate the association of plasma GIP concentration and IM fat content. Average daily gain (P = 0.57) and final BW (P = 0.34) were similar, regardless of treatment. Cattle fed CC had reduced (P < 0.01) dry matter intake (DMI) when compared with those fed WSC. This lesser DMI resulted in improved gain:feed ratio (P < 0.01) for cattle fed CC compared with cattle fed WSC. There was no effect (P ≤ 0.33) of corn processing on plasma glucose, plasma GIP concentrations, hot carcass weight, dressing percentage, or marbling score. There was a positive linear relationship (P = 0.03) between IM fat concentration and plasma GIP concentration. In conclusion, feeding CC increased gain:feed ratio compared with WSC, but there was no difference in plasma GIP concentration, whereas plasma GIP concentration appears to be related to IM fat deposition.
Dermatofibrosarcoma Protuberans on Tattooed Skin: A Case Report
Authors: De Antoni Eleonora , Brambullo Tito , Pescarini Elena , Salmaso Roberto , Bassetto Franco , Vindigni Vincenzo
Published: January 2020

Dermatofibrosarcoma protuberans is an uncommon indolent fibroblastic skin tumor with a tendency for local recurrence. Its etiology is unknown, but there may be a link with vaccination sites, burn scars, and previous skin traumas. This report describes a curious case of dermatofibrosarcoma protuberans occurring secondary to a 16-year-old tattoo.
The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa
Authors: Bruwer Febe A. , Botma Yvonne , Mulder Magda
Published: January 2020

OBJECTIVE

To describe venous ulcer care and wound care practices in Gauteng, a province of South Africa, according to the Donabedian structure-process-outcome quality improvement model.

METHODS

Forty-eight facilities were selected randomly from public and private wound care practices in Gauteng. Structured interviews were conducted with care providers via questionnaire to assess the structural aspects of the Donabedian model. Within these facilities, investigators randomly selected 160 patient files and extracted data using a checklist to assess processes implemented and outcomes reached for patients who had previously presented with lower-leg venous ulcers.

RESULTS

Facilities lack the necessary equipment to perform vital assessments. Handheld Dopplers were available in 66% (n = 48) of the facilities. Sixty-one percent (n = 48) of the personnel at the facilities indicated that they had no formal wound care training. Although the majority of files (92%, n = 147) indicated that an assessment tool was used, many elements were not evaluated comprehensively according to the best available evidence. Aspects such as smoking, body mass index, and anemia were assessed in fewer than 30% of the patients. Distinguishing between superficial and deep infection and the accompanying overuse of antimicrobials and antibiotics were among the challenges identified. Further, 71% of patients received compression therapy, although the ankle-brachial pressure index of only 30% of patients was known. In 27 cases (17%), the outcome was amputation.

CONCLUSIONS

From this survey, it is evident that not all clinicians providing wound care in Gauteng are adequately trained or fully implementing best practice guidelines, and the consequences are detrimental to patients, particularly in terms of amputation. This article highlights the need for improved legislation and regulation for practitioners who deliver wound care services.
A Novel Point-of-Care Solution to Streamline Local Wound Formulary Development and Promote Cost-effective Wound Care
Authors: Song Elaine H. , Milne Catherine , Hamm Tiffany , Mize Jeffrey , Harris Kimberly , Kuplicki Samantha , Smith Amy , Ferreira Lydia Masako , Wong Alex
Published: January 2020

OBJECTIVE

To develop and implement a point-of-care digital solution to streamline the creation and maintenance of wound care product formularies and promote cost-effective wound management.

METHODS

Researchers used Design Thinking methodology to develop the Formulary Module, a point-of-care digital solution within a clinical and reimbursement decision support web application for wound care and hyperbaric clinicians. The module was implemented in a US hospital-based outpatient wound clinic as follows: A baseline list of products was established, with brands automatically grouped by product category. Brands within each dressing category were compared, and redundancy eliminated. Study authors assessed the financial impact of formulary implementation in the wound clinic by comparing inventory expenditure before and after implementation.

RESULTS

Implementation of the digital Formulary Module resulted in a 36% decrease in products (67 to 43 across 22 types), 38.73% decrease in the monthly average dollar spent on chargeable products, 29.56% decrease in the average dollar amount spent on chargeable products per patient visit, and increased staff efficiency.

CONCLUSIONS

The Formulary Module has the potential to increase the adoption of cost-effective practices in wound care significantly.
Efficacy of Topical Insulin Therapy for Chronic Trophic Ulcers in Patients with Leprosy: A Randomized Interventional Pilot Study
Authors: Singh Mehak , Pawar Manoj
Published: January 2020

BACKGROUND

Chronic trophic ulcers (CTUs), especially those located over the plantar region, are a leading cause of deformity and disability in patients with leprosy. Despite the various treatment modalities available, CTUs can be chronic and refractory to treatment. The successful use of topical insulin in various types of wounds led researchers to evaluate its safety and efficacy in the treatment of plantar CTUs.

METHODS

Forty-two patients who had completed a multidrug treatment for leprosy were recruited and randomized into two groups. In the test group, 23 patients received 10 units (0.1 mL) of topical insulin (Actrapid) in 1 mL of normal saline twice daily over treated areas. The placebo group (n = 19) received topical normal saline only. The primary end point was the proportion of patients with complete wound closure by 12 weeks. Secondary end points included time to healing, wound area reduction, Physician Global Assessment of Efficacy scores, and Dermatology Life Quality Index scores at the end of 12 weeks.

RESULTS

The majority of CTUs (80%) were situated over the forefoot; the metatarsal head of the hallux was the most common site (86%). Wound healing was faster (0.61 ± 0.31 vs 0.14 ± 0.42 cm2 per week, P < .0001), and the number of days to complete healing was significantly shorter in the test group compared with the placebo group (31.5 ± 17.6 vs 44.3 ± 16.2 days, P = .02). The only observed adverse effect in the test group was white granular deposits over the CTU (n = 10).

CONCLUSIONS

Topical insulin therapy may be a safe, efficacious, cheap, and easily available treatment option in CTUs among patients with leprosy.
Allergen immunotherapy for pediatric asthma: current evidence and knowledge gaps
Authors: Passalacqua Giovanni , Landi Massimo , Peroni Diego G.
Published: January 2020

Purpose of review

The introduction of high-quality and standardized extracts for immunotherapy has renewed the interest in the treatment of pediatric allergic asthma that represents a high-prevalence disease.

Recent findings

In addition to clinical trials, several systematic reviews and metaanalyses were published, confirming overall the clinical efficacy of allergen immunotherapy in pediatric asthma. In addition, new data on the preventive effect of the treatment on asthma onset were published. Despite this, many intriguing questions emerged, in parallel to the development of knowledge.

Allergen immunotherapy is overall effective for the treatment of asthma in children, but a class-effect should not be claimed, rather the efficacy of each single product. According to the recent findings, the challenge for the future research will be to clarify: when to start immunotherapy in children, which are (if they exist) the predictive biomarkers for efficacy in the single individual, the magnitude of the preventive effect and the optimal duration of the treatment.
Mechanism and diagnosis of protein contact dermatitis
Authors: Barbaud Annick
Published: January 2020

Purpose of review

Protein contact dermatitis (PCD) is a chronic eczema because of immediate hypersensitivity to protein and not related to haptens. As it has to be diagnosed by prick tests, it is probably under-recorded and under-estimated that is why it is important for dermatologists, allergists and occupational physicians to better know this peculiar contact dermatitis.

Recent findings

Some recent series have emphasized that PCD is mainly an occupational dermatosis, mainly observed in food handlers.

PCD is a chronic eczematous dermatitis, possibly exacerbated by work, suggested if associated with inflammatory perionyxis (paronychial inflammation) and immediate erythema with pruritis, to be investigated when the patient resumes work after a period of interruption. Prick tests with the suspected protein-containing material are essential, as patch tests have in most of the cases negative results. Prick-by-prick tests with fresh material are recommended. The product has to be ‘pricked’, for instance the food, and immediately after the forearm is pricked. In case of multisensitization revealed by prick tests, it is advisable to analyse IgE against recombinant allergens. History of atopy found in 56--68% of the patients has to be checked for. Most of the cases are observed among food-handlers but PCD can also be because of nonedible plants, latex, hydrolyzed proteins or animal proteins.
Medical science faces the post-truth era: a plea for the grassroot values of science
Authors: Heinrich Sebastian
Published: January 2020

Purpose of review

Science and its public perception are compromised by scientific fraud and predatory journals, and also by the general erosion of the meaning of truth in the so-called post-truth era. These developments have significant influence on scientific medicine and their impact on the public discourse. The purpose of this article is to show how fake science, and also the uncritical dissemination of compromised results in public and social media, threatens scientific medicine.

Recent findings

As social media rises to the preferred source of information of ever larger parts of the modern societies, the dissemination of falsified scientific results within the communities is almost unstoppable. With growing numbers of predatory journals and repetitive cases of fake science, the risk of publication of false results increases. Due to the underlying mechanisms of the post-truth era and social media, these compromised results find their way to the public discourse and continue to be disseminated even when they were, beyond all doubt, proven to be a lie. In medical sciences, dissemination of falsified results directly threats health and life of patients.

In the post-truth era, publication of false results in predatory journals and by fraudulent authors become even more dangerous for the health and life of patients, as their dissemination via new social media is nearly unstoppable and in the public perception truth is losing its meaning. The scientific community has implemented specific counter-measures to minimize the chances of false results being published. However, it is even more important that every participant in the scientific process assumes the responsibility according to his or her role. An orientation towards the values that have constituted and formed science is helpful in fulfilling this responsibility.
Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis
Authors: Natalini Daniele , Ganau Mario , Rosenkranz Ruben , Petrinic Tatjana , Fitzgibbon Karina , Antonelli Massimo , Prisco Lara
Published: January 2020

Awake craniotomy (AC) is the preferred surgical option for intractable epilepsy and resection of tumors adjacent to or within eloquent cortical areas. Monitored anesthesia care (MAC) or an asleep-awake-asleep (SAS) technique is most widely used during AC. We used a random-effects modeled meta-analysis to synthesize the most recent evidence to determine whether MAC or SAS is safer and more effective for AC. We included randomized controlled trials and observational studies that explored the incidence of AC failure, duration of surgery, and hospital length of stay in adult patients undergoing AC. Eighteen studies were included in the final analysis. MAC was associated with a lower risk of AC failure when compared with SAS (global pooled proportion MAC vs. SAS 1% vs. 4%; odds ratio [ORs]: 0.28; 95% confidence interval [CI]: 0.11-0.71; P=0.007) and shorter surgical procedure time (global pooled mean MAC vs. SAS 224.44 vs. 327.94 min; mean difference, −48.76 min; 95% CI: −61.55 to −35.97; P<0.00001). SAS was associated with fewer intraoperative seizures (global pooled proportion MAC vs. SAS 10% vs. 4%; OR: 2.38; 95% CI: 1.05-5.39; P=0.04). There were no differences in intraoperative nausea and vomiting between the techniques (global pooled proportion MAC vs. SAS: 4% vs. 8%; OR: 0.86; 95% CI: 0.30-2.45; P=0.78). Length of stay was shorter in the MAC group (MAC vs. SAS 3.96 vs. 6.75 days; mean difference, −1.30; 95% CI: −2.69 to 0.10; P=0.07). In summary, MAC was associated with lower AC failure rates and shorter procedure time compared with SAS, whereas SAS was associated with a lower incidence of intraoperative seizures. However, there was a high risk of bias and other limitations in the studies included in this review, so the superiority of 1 technique over the other needs to be confirmed in larger randomized studies.
Amputation Versus Limb Reconstruction for Fibula Hemimelia: A Meta-analysis
Authors: Elmherig Aissam , Ahmed Abdulaziz F. , Hegazy Abdelsalam , Herzenberg John E. , Ibrahim Talal
Published: January 2020

Purpose:

Fibula hemimelia is the most common congenital deficiency of long bones. Primary treatment options include amputation with prosthetic fitting or limb reconstruction. The aim of our study was to conduct a systematic review comparing amputation with limb reconstruction for fibula hemimelia.

Methods:

MEDLINE, EMBASE, Web of Science, Elsevier Scopus, and the Cochrane Registry of Clinical Trials were searched from 1951 to 2019 for studies that evaluated amputation versus limb reconstruction for fibula hemimelia. Random effect models were utilized for the meta-analytic comparisons of amputation versus limb reconstruction for patient satisfaction and surgical complications. Descriptive, quantitative, and qualitative data were extracted.

Results:

Seven retrospective cohort studies were eligible for the meta-analysis, with a total of 169 fibula hemimelia cases. Amputation resulted in an odds ratio of 6.8 (95% confidence interval: 2.4, 19.2) when compared with limb reconstruction in terms of patient satisfaction. Furthermore, limb reconstruction was found to have an odds ratio of 28 (95% confidence interval: 7.8, 100.3) for complications. The total surgical complication rates in the amputation and limb reconstruction groups were 0.2 and 1.2 complications per limb. The rate of surgical procedures per patient was 1.5 and 4.2 for amputation and limb reconstruction, respectively.

Conclusions:

The cumulative evidence at present indicates better patient satisfaction with less surgical complications and less number of procedures with amputation for fibula hemimelia when compared with limb reconstruction. Absence of uniform protocols make it difficult to compare results accurately.

Level of Evidence:

Level III—therapeutic.
Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails
Authors: Heffernan Michael J. , Shelton William , Song Bryant , Lucak Thomas J. , Leonardi Claudia , Kadhim Muayad
Published: January 2020

Background:

Closed reduction (CR) is sufficient to reduce the majority of femur fractures treated with flexible intramedullary nailing (FIN). No previous study has examined factors associated with failed CR of pediatric femoral shaft fractures treated with FIN. We sought to determine preoperative factors associated with failed CR. We hypothesized that fracture, patient, and surgeon characteristics would impact the need for open reduction (OR).

Methods:

A retrospective review of children treated for femur fracture between 2012 and 2017 at a tertiary pediatric hospital was performed. Comparisons were made between 2 groups: FIN with CR group and FIN that required OR group. Demographic and baseline characteristics were compared between treatment groups using either χ2 tests or Fisher exact tests for categorical variables and general linear models for continuous variables. Odds ratios with 95% confidence intervals were calculated using univariate logistic regression tests.

Results:

Of 449 consecutive pediatric femur fractures treated at our center, 85 children were treated with FIN and constituted the study cohort. CR failed in 14 patients (16.5%) necessitating OR of the fracture site. Significant differences between study groups were found in fracture location (P=0.018), the mechanism (P=0.003), and displacement on the anteroposterior radiograph (P=0.027). Surgical time was found to be longer in the OR group (P=0.010). We identified 3 preoperative predictors of OR for FIN including fractures caused by high energy mechanisms (odds ratio=7.5), distal third fractures (odds ratio=15.3), and fracture displacement on the anteroposterior view (odds ratio=1.06). Surgeon years in practice, patient weight, age, and time from injury to surgery were not associated with OR.

Conclusions:

This study presents 3 preoperative risk factors that predict the need for OR of femur fractures treated with FIN. Surgical time was longer in cases that required OR. Our findings suggest that surgeons should avoid lengthy attempts at CR and consider a lower threshold for OR of at-risk fractures or use another technique other than flexible nails.

Level of Evidence:

Level III—prognostic.
Superior-segment Bilateral Facet Violation in Lumbar Transpedicular Fixation, Part I
Authors: Xu Yunfeng , Le Xiaofeng , Zhang Qi , Kuai Shengzheng , Leng Huijie , Duan Fangfang , Shi Zhan , Liu Bo , He Da , Lang Zhao , Wu Jingye , Wang Ling , Tian Wei
Published: January 2020

Study Design.

This is an in vitro biomechanical study.

Objectives.

The aim of this study was to investigate the biomechanical variations of lumbar spine motor units and that under different moments after screw heads blocking superior-adjacent bilateral facets through the cadaver specimen biomechanical experiment.

Summary of Background Data.

Facet joint violation by pedicle screws is not a rare adverse event in instrumented lumbar fusion surgery, and one of the most common types is the screw head blocking the superior-adjacent facet. However, its contribution to biomechanical instability at the supradjacent level is unknown.

Methods.

The range of motion (ROM) of 12 lumbar spines (L4-S1) were measured in flexion-extension, lateral bending, and axial rotation for L4/5. All specimens were randomly divided into two groups: the control group and the blocking group, each with 6 specimens. Spine were tested on intact and instrumented specimens, respectively. The relative ROM changes were compared between the blocking and control groups.

Results.

In the blocking group, the supradjacent-level flexion-extension ROM significantly decreased under all moments (7.5, 6.0, 4.5 Nm) relative to the intact spine and a significant decrease in the lateral bending relative ROM was found at 4.5 Nm. In the control group, no significant change of supradjacent-level ROM was found relative to the intact noninstrumented spine at each moment. When performing flexion-extension, the relative ROM change between the 2 groups was significantly different at 4.5 Nm. When performing lateral bending, the relative ROM change between the 2 groups was significantly different at moments of 6.0 and 4.5 Nm.

Conclusion.

When screw heads blocked superior-adjacent bilateral facets, the supradjacent-level flexion-extension ROM and lateral bending ROM decreased. In the long run, this may be a risk of persistent low-back pain due to frequent impingement.

Level of Evidence: N/A
Global Trends of Researches on Sacral Fracture Surgery
Authors: Huang Tianji , Wu Huayong , Yang Shengdong , Su Bao , Tang Ke , Quan Zhengxue , Zhong Weiyang , Luo Xiaoji
Published: January 2020

Study Design.

Bibliometric analysis.

Objective.

This study aims to identify and summarize the articles related to sacral fracture surgery, to compare the papers from different countries and journals, to show the trends of researches on sacral fracture surgery.

Summary of Background Data.

In recent years, studies on sacral fracture are growing rapidly, but there were no bibliometric studies regarding sacral fracture surgery.

Methods.

Excel 2016 and VOSviewer were used to identify and summarize the articles from Web of Science between 1900 and 2018. Publication number, publication year, publication country, publication organization, publication source, author, sum of times cited, H-index, and journal's impact factors were recorded and analyzed. Bibliometric maps of co-citations and maps of co-occurrence of keywords are drawn.

Results.

A total of 611 publications were extracted. United States published most articles (227, 37.2%), both total citations (3536) and H-index (32) of United States ranked first of all the countries. The most productive organization on sacral fracture surgery is Johns Hopkins University (14). Spine (43) published the most articles on sacral fracture surgery. The latest keyword “patterns” appeared in 2017 in 5 articles. Other relatively new keywords include “proximal junctional kyphosis,” “spondylopelvic dissociation,” “fragility fracture,” “lumbopelvic fixation” that appeared in 2017 in eight, six, six, and 25 articles, respectively.

Conclusion.

This bibliometric study showed that there is a growing trend both in published articles related to sacral fracture surgery and relative research interest in the last 30 years. United States dominates the research regarding sacral fracture surgery. Johns Hopkins University, Johannes Gutenberg University of Mainz, and Harborview Medical Center are the best institutions related to sacral fracture surgery research. Spine, J Orthop Trauma, and Injury are the top three productive journals on sacral fracture surgery. Sacral fracture patterns, proximal junctional kyphosis, spondylopelvic dissociation, fragility fracture, and lumbopelvic fixation may be the new research hotspot in this field.

Level of Evidence: 5
Preoperative Urinary Tract Infection Increases Postoperative Morbidity in Spine Patients
Authors: Yoon James S. , King Joseph T.
Published: January 2020

Study Design.

Retrospective review.

Objective.

Compare postoperative infection rates and 30-day outcomes in spine surgery patients with and without a preoperative urinary tract infection (UTI).

Summary of Background Data.

There is mixed evidence regarding safety and risks when operating on spine patients with a preoperative UTI.

Methods.

Using data from the American College of Surgeons National Surgical Quality Improvement Program, we identified all adult patients undergoing spine surgery between 2012 and 2017 with a preoperative UTI. Patients with other preoperative infections were excluded. Our primary outcome was any postoperative infection (pneumonia, sepsis, surgical site infection, and organ space infection). Our secondary outcomes included surgical site infections, non-infectious complications, return to operating room, and 30-day readmission and mortality. We used univariate, then multivariate Poisson regression models adjusted for demographics, comorbidities, laboratory values, and case details to investigate the association between preoperative UTI status and postoperative outcomes.

Results.

A total of 270,371 patients who underwent spine surgery were analyzed. The most common procedure was laminectomy (41.9%), followed by spinal fusion (31.7%) and laminectomy/fusion (25.6%). Three hundred fourty one patients had a preoperative UTI (0.14%). Patients with a preoperative UTI were more likely to be older, female, inpatients, emergency cases, with a higher American Society of Anesthesiologists score, and a longer operating time (for all, P < 0.001). Patients with a preoperative UTI had higher rates of infectious and non-infectious complications, return to operating room, and unplanned readmissions (for all, P < 0.001). However, there was no significant difference in mortality (0.6% vs. 0.2%, P = 0.108). Even after controlling for demographics, comorbidities, labs, and case details, preoperative UTI status was significantly associated with more postoperative infectious complications (incidence rate ratio [IRR]: 2.88, 95% confidence interval [CI]: 2.25–3.70, P < 0.001).

Conclusion.

Preoperative UTI status is significantly associated with postoperative infections and worse 30-day outcomes. Spine surgeons should consider delaying or cancelling surgery in patients with a UTI until the infection has cleared to reduce adverse outcomes.

Level of Evidence: 3
Sleep Disturbance in Patients With Lumbar Spinal Stenosis
Authors: Lee Na-Kyoung , Jeon Seung Won , Heo Young Woo , Shen Feng , Kim Ho-Joong , Yoon In-Young , Chang Bong-Soon , Lee Choon-Ki , Chun Heoung-Jae , Yeom Jin S.
Published: January 2020

Study Design:

This was a cross-sectional cohort study.

Objective:

The objective of this study was to identify the prevalence of sleep disturbance in patients with symptomatic lumbar spinal stenosis (LSS) and to establish the relationship between sleep disturbance and both functional disability and health-related quality of life in patients with symptomatic LSS.

Summary of Background Data:

Despite the possible association between LSS and poor sleep quality, there has been no study regarding the relationship between LSS and sleep disturbance.

Materials and Methods:

A total of 148 patients with LSS were divided into the poor sleeper and nonpoor sleeper groups according to Global Pittsburgh Sleep Quality Index (PSQI) score. Demographic data, Visual Analog Scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5-dimension questionnaire (EQ-5D) were compared between both groups. Multiple regression analysis was performed with ODI or ODI without sleep component as the dependent variable and age, sex, PSQI, VAS for back pain, VAS for leg pain as independent variables.

Results:

Of the 148 patients who participated in this study, 54 (36.5%) and 94 (63.5%) patients were classified into nonpoor sleeper and poor sleeper groups. Although there were no differences in demographic data or VAS for back or leg pain between the nonpoor sleeper and poor sleeper groups, poor sleepers demonstrated significantly higher ODI scores, and lower EQ-5D than nonpoor sleepers (P=0.003 and 0.004, respectively). There were significant correlations between the global PSQI score and both the ODI score and EQ-5D. Although the surgical treatment group showed significantly higher VAS for back pain, VAS for leg pain, ODI scores, and lower EQ-5D than the conservative treatment group, the ratio of poor to nonpoor sleepers was not different between both groups (P=0.733). In the surgical treatment group, the percent of poor sleeper decreased from 65.1% to 47.6% 6 months after surgery (P<0.001).

Conclusions:

The present study demonstrated that ‘poor sleep quality’ is a prevalent condition (63.5%) in patients with symptomatic LSS. Poor sleep quality has an adverse effect on functional disability and health-related quality of life in symptomatic LSS patients.
Antitumor activity of triptolide in SKOV3 cells and SKOV3/DDP in vivo and in vitro
Authors: Hu Hui , Zhu Sihong , Tong Yan , Huang Genhua , Tan Buzhen , Yang Lilan
Published: January 2020

This study was designed to investigate the antitumor activity of triptolide in ovarian cancer inoculated with SKOV3 and SKOV3/cisplatin (DDP) cells, and to assess the mechanisms. In-vivo and in-vitro experiments were designed to evaluate the effects of triptolide on the tumor growth of SKOV3 and SKOV3/DDP cells. The experiments were divided into four groups: a SKOV3 group, a SKOV3 + TP treatment group, a SKOV3/DDP group and a SKOV3/DDP + TP treatment group. The expression of Sorcin, vascular endothelial growth factor and matrix metalloproteinase-2 were detected by western blotting and immunohistochemistry. Tumor cell apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling. In-vitro experiments showed that compared with SKOV3 control group, the level of colony-stimulating factor 1 and expression of Sorcin in SKOV3/DDP was significantly higher. Interestingly, triptolide treatment could reduce colony-stimulating factor 1 level and expression of Sorcin in both SKOV3 and SKOV3/DDP cell lines. In-vivo experiments showed that tissue necrosis area in SKOV3 + TP and SKOV3/DDP + TP was larger than SKOV3 and SKOV3/DDP group, respectively. Triptolide treatment induced apoptosis in both SKOV3 and SKOV3/DDP cells. Compared with SKOV3 group, the size of tumors was large, and the expression of MMP-2, Sorcin and vascular endothelial growth factor was higher in SKOV3/DDP group. Triptolide treatment reduced the size of tumors, and the expression of MMP-2, Sorcin and vascular endothelial growth factor in SKOV3/DDP as well as in SKOV3 tumors. In conclusion, triptolide has antitumor activity in both SKOV3 and SKOV3/DDP cells likely through inducing apoptosis and regulating MMP-2, Sorcin and vascular endothelial growth factor expression.
Metastatic intracranial solitary fibrous tumors/hemangiopericytomas: description of two cases with radically different behaviors and review of the literature
Authors: Lavacchi Daniele , Antonuzzo Lorenzo , Briganti Vittorio , Berti Valentina , Abenavoli Elisabetta Maria , Linguanti Flavia , Messerini Luca , Giaccone Giuseppe
Published: January 2020

Solitary fibrous tumor/hemangiopericytoma with primary tumor location in the central nervous system accounts for less than 1% of all central nervous system tumors. Despite the relatively indolent clinical course, extracranial metastases are reported in 28% of cases. In recent years, NAB2-STAT6 gene fusion has been recognized as the pathognomonic molecular feature of solitary fibrous tumor/hemangiopericytoma and STAT6 immunohistochemistry has been shown to be a sensitive and specific surrogate for the identification of the gene fusion in these patients. Here we report two cases of patients who experienced occurrence of diffuse extracranial metastases several years after successful surgery for an intracranial solitary fibrous tumor/hemangiopericytoma. In the first patient, the metastases had maintained similar histological features to the primary tumor; in contrast, in the second case, a dedifferentiation occurred with loss of expression of CD34 and Bcl-2. These different histological features were associated with radically different behaviors. Whereas the first case experienced an indolent course of the disease, the second patient had a rapid disease progression and deterioration of clinical conditions. The molecular imaging findings in these two cases and the role of functional imaging for tumor detection, disease staging and monitoring in this rare cancer are also discussed. Recurrences and metastases maintained high expression of somatostatin receptors confirmed by somatostatin receptor imaging in the first case. In contrast, in the second patient, the abrupt transition into a highly aggressive form was associated with the absence of somatostatin receptors at 111In Pentetreotide scan and intense hypermetabolism at 18F-FDG PET.
Alterations in Skin Blood Flow at the Fingertip Are Related to Mortality in Patients With Circulatory Shock
Authors: Mongkolpun Wasineenart , Orbegozo Diego , Cordeiro Carolina P. R. , Franco Claudio J. C. S. , Vincent Jean-Louis , Creteur Jacques
Published: January 2020

Objectives:

Skin blood flow is rapidly altered during circulatory shock and may remain altered despite apparent systemic hemodynamic stabilization. We evaluated whether changes in skin blood flow during circulatory shock were related to survival.

Design:

Prospective study.

Setting:

Thirty-five-bed medical-surgical university hospital department of intensive care.

Subjects:

Twenty healthy volunteers and 70 patients with circulatory shock (< 12 hr duration), defined as the need for vasopressors to maintain mean arterial pressure greater than or equal to 65 mm Hg and signs of altered tissue perfusion.

Interventions:

We assessed skin blood flow using skin laser Doppler on the fingertip for 3 minutes at basal temperature (SBFBT) and at 37°C (SBF37) (thermal challenge test) once in volunteers and at the time of inclusion and after 6, 24, 48, 72, and 96 hours in patients with shock. Capillary refill time and peripheral perfusion index were measured at the same time points on the contralateral hand.

Measurements and Main Results:

The thermal challenge response (ΔSBF/ΔT) was calculated using the following formula: (SBF37–SBFBT)/(37–basal temperature). Area under the receiver operating characteristic curves were calculated to evaluate variables predictive of ICU mortality. At inclusion, skin blood flow and ΔSBF/ΔT were lower in patients than in volunteers. Baseline skin blood flow (31 [17–113] vs 16 [9–32] arbitrary perfusion units; p = 0.01) and ΔSBF/ΔT (4.3 [1.7–10.9] vs 0.9 [0.4–2.9] arbitrary perfusion unit/s) were greater in survivors than in nonsurvivors. Capillary refill time was shorter in survivors than in nonsurvivors; peripheral perfusion index was similar in the two groups. ΔSBF/ΔT (area under the receiver operating characteristic curve 0.94 [0.88–0.99]) and SBFBT (area under the receiver operating characteristic curve 0.83 [0.73–0.93]) had the best predictive value for ICU mortality with cutoff values less than or equal to 1.25 arbitrary perfusion unit/°C (sensitivity 88%, specificity 89%) and less than or equal to 21 arbitrary perfusion unit (sensitivity 84%, specificity 81%), respectively.

Conclusions:

Alterations in fingertip skin blood flow can be evaluated using a laser Doppler thermal challenge technique in patients with circulatory shock and are directly related to outcome. These novel monitoring techniques could potentially be used to guide resuscitation.
Immunobiology of Merkel cell carcinoma
Authors: Samimi Mahtab , Kervarrec Thibault , Touze Antoine
Published: January 2020

Purpose of review

Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer, which is associated in 80% of cases with the Merkel cell polyomavirus (MCPyV). Advanced stages respond to immune checkpoint inhibitors in 50% of cases. Major issues remain unanswered regarding its oncogenesis and optimal treatment.

Recent findings

MCPyV-negative and MCPyV-positive MCCs have been hypothesized to derive from distinct cells, although the cell of origin remains a matter of debate. The crucial role the MCPyV small T oncoprotein was recently confirmed by its ability to inactivate p53, together with its contribution to the metastatic progression. In advanced cases, tumoral microenvironment may adequately predict responses to immunotherapies, and several mechanisms of primary and secondary resistance have been investigated.

Identifying the mechanisms of oncogenesis allow experimentation of new therapeutic targets, which remain mandatory even at the era of immunotherapies. Although new insights in the mechanisms of primary and secondary resistance pave the way for development of further immunotherapy strategies, neoadjuvant strategies may challenge our whole approach of the disease.