bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and location of survivable skeletal injuries in two North American tree squirrels (Sciurus)
Authors: Moncrief Nancy D , Hightower Liberty , Mead Alfred J , Ivanov Kaloyan
Published: October 2021

Skeletal injuries, especially broken bones, diminish physical mobility of animals, and they may affect an individual’s ability to obtain food and to evade predators. We quantified and compared healed fractures in two sympatric species of tree squirrels (Sciurus niger Linnaeus, 1758 and S. carolinensis Gmelin, 1788) that differ in body size (mass) and locomotor mode. We assessed the number and location of healed fractures in two urban populations of S. carolinensis and in individuals of both species from one rural location. We found a higher-than-expected proportion of healed fractures in older animals of both species. However, we detected no deviations from expected in the number of healed fractures between the two species or between sexes within a species. Urban populations of S. carolinensis exhibited significantly higher-than-expected proportions of healed fractures, and they were approximately 4.5 times more likely to have a healed injury as compared to rural S. carolinensis. Our findings suggest that S. carolinensis in urban populations experience a higher rate of injury and/or a higher rate of survival after injury than those in rural populations.
State Compliance with International Law in Intelligence Matters: A Behavioural Approach
Authors: Duroy Sophie
Published: October 2021

Decision-making in intelligence matters is often assumed to be an extra-legal process. This article however shows that the determining factor in compliance is a legal one: the likelihood of the state being held effectively accountable for a breach of international law. Through a behavioural analysis of state conduct in intelligence matters and the modelling of intelligence decision-making, the article demonstrates that state behaviour in intelligence matters can be explained and predicted. Taking compliance as the standard for assessing the effectiveness of regulation, this finding has strategic implications for the actors of the international legal order attempting to enhance compliance. Specifically, increasing the likelihood of effective accountability increases the probability of compliance and decreases the weight given to extra-legal and domestic considerations in decision-making, regardless of the activity and state considered. Hence, rather than focusing on the regulatory framework itself (international law), regulatory approaches aiming to enhance compliance should focus on improving accountability.
Prediction of out-of-field recurrence after chemoradiotherapy for cervical cancer using a combination model of clinical parameters and magnetic resonance imaging radiomics: a multi-institutional study of the Japanese Radiation Oncology Study Group
Authors: Ikushima Hitoshi , Haga Akihiro , Ando Ken , Kato Shingo , Kaneyasu Yuko , Uno Takashi , Okonogi Noriyuki , Yoshida Kenji , Ariga Takuro , Isohashi Fumiaki , Harima Yoko , Kanemoto Ayae , Ii Noriko , Wakatsuki Masaru , Ohno Tatsuya
Published: October 2021

We retrospectively assessed whether magnetic resonance imaging (MRI) radiomics combined with clinical parameters can improve the predictability of out-of-field recurrence (OFR) of cervical cancer after chemoradiotherapy. The data set was collected from 204 patients with stage IIB (FIGO: International Federation of Gynecology and Obstetrics 2008) cervical cancer who underwent chemoradiotherapy at 14 Japanese institutes. Of these, 180 patients were finally included for analysis. OFR-free survival was calculated using the Kaplan–Meier method, and the statistical significance of clinicopathological parameters for the OFR-free survival was evaluated using the log-rank test and Cox proportional-hazards model. Prediction of OFR from the analysis of diffusion-weighted images (DWI) and T2-weighted images of pretreatment MRI was done using the least absolute shrinkage and selection operator (LASSO) model for engineering image feature extraction. The accuracy of prediction was evaluated by 5-fold cross-validation of the receiver operating characteristic (ROC) analysis. Para-aortic lymph node metastasis (p = 0.003) was a significant prognostic factor in univariate and multivariate analyses. ROC analysis showed an area under the curve (AUC) of 0.709 in predicting OFR using the pretreatment status of para-aortic lymph node metastasis, 0.667 using the LASSO model for DWIs and 0.602 using T2 weighted images. The AUC improved to 0.734 upon combining the pretreatment status of para-aortic lymph node metastasis with that from the LASSO model for DWIs. Combining MRI radiomics with clinical parameters improved the accuracy of predicting OFR after chemoradiotherapy for locally advanced cervical cancer.
Phylogenetic Articulation of Uric Acid Evolution in Mammals and How It Informs a Therapeutic Uricase
Authors: Li Ze , Hoshino Yosuke , Tran Lily , Gaucher Eric A
Published: October 2021

The role of uric acid during primate evolution has remained elusive ever since it was discovered over 100 years ago that humans have unusually high levels of the small molecule in our serum. It has been difficult to generate a neutral or adaptive explanation in part because the uricase enzyme evolved to become a pseudogene in apes thus masking typical signals of sequence evolution. Adding to the difficulty is a lack of clarity on the functional role of uric acid in apes. One popular hypothesis proposes that uric acid is a potent antioxidant that increased in concentration to compensate for the lack of vitamin C synthesis in primate species ∼65 Ma. Here, we have expanded on our previous work with resurrected ancient uricase proteins to better resolve the reshaping of uricase enzymatic activity prior to ape evolution. Our results suggest that the pivotal death-knell to uricase activity occurred between 20 and 30 Ma despite small sequential modifications to its catalytic efficiency for the tens of millions of years since primates lost their ability to synthesize vitamin C, and thus the two appear uncorrelated. We also use this opportunity to demonstrate how molecular evolution can contribute to biomedicine by presenting ancient uricases to human immune cells that assay for innate reactivity against foreign antigens. A highly stable and highly catalytic ancient uricase is shown to elicit a lower immune response in more human haplotypes than other uricases currently in therapeutic development.
Integrating morphological and genetic data at different climate and geographic scales in an endangered freshwater musselUnio durieui(Bivalvia: Unionidae) endemic to northern Tunisia
Authors: Fassatoui Chiheb , Chenuil Anne , Romdhane Mohamed Salah
Published: October 2021

The freshwater mussel Unio durieui is a rare bivalve endemic to North African watersheds. Although this is an important species from an ecological and conservation perspective, information on its genetic diversity and population structure is lacking. Here, we combine geometric morphometric and molecular genetic analyses to characterize and evaluate the status of populations of this endangered species from four Tunisian watershed basins (Cap Bon, Ichkeul, northwest and Mejerda River basins). By using a multiparameter approach, we sought to test the hypothesis that populations from these geographic regions could be considered as distinct management units. Shell outline shapes were assessed using elliptic Fourier analysis followed by linear discriminant analysis of principal components. Multivariate analysis applied on normalized Fourier coefficients showed highly significant differences in shell shape among the populations. Population genetic analysis based on inter-simple sequence repeats revealed low levels of diversity and high differentiation between the populations studied. Two groups of populations are clearly evident, thus separating samples from the Northwest from those from the other watersheds. Although there is no evidence for isolation by distance patterns, genetic and phenotypic diversity appeared significantly correlated with climatic variables. These findings suggest isolation by environment and the nominal species U. durieui may constitute two biological species. Conservation programme actions should consider this substructure in establishing effective recovery strategies for this endangered species.
Northern Bobwhite juvenile survival is greater in native grasslands managed with fire and grazing and lower in non-native field borders and strip crop fields
Authors: Sinnott Emily A , Thompson Frank R , Weegman Mitch D , Thompson Thomas R
Published: October 2021

Effective species conservation requires understanding environmental effects on stage-specific demographics driving population change. Northern Bobwhite (Colinus virginianus) is an early-successional shrub-obligate species that has experienced long-term, range-wide declines due to fire suppression, agricultural intensification, and sprawling development. Local habitat features and landscape context may interactively influence vital rates. Management affects food, cover, and other resources available locally, while surrounding landscapes often determine degree of isolation and predator communities. We evaluated relationships between juvenile bobwhite survival and local (50 m) and landscape (1 km) scale cover type composition and grassland management (i.e. conservation grazing, prescribed burns, mowing/haying) on 3 native grasslands and 2 traditionally managed conservation areas in southwest Missouri, USA, 2016–2018. We radio-tracked brood-attending adults and young from hatch to a maximum of 114 days and estimated juvenile survival with a Bayesian known-fate logistic exposure model. Juvenile survival was greatest on native grasslands that were burned and grazed at least once in the previous 2 years. Percent shrub cover was positively related to survival. Survival was relatively high in local agriculture, but these relationships were sensitive to surrounding landscape composition. For example, small patches of cropland surrounded by nonagriculture such as strip crops surrounded by grassland units on traditionally managed sites had low survival. Relationships between survival and agricultural landscape cover were dependent on local cover types; survival was high within crop fields but low in non-native grasslands surrounded by crop fields such as agricultural field borders. Patch-burn grazing practices on native grasslands provided the best habitat for bobwhite juvenile survival. Agricultural landscapes can support the recruitment of bobwhite if appropriately managed native grasslands are also available.
‘People Will Use Me’
Authors: Treharne Elaine
Published: October 2021

The fourth chapter investigates manuscripts as evidence for those who came across these books and used them to make communities’ histories more permanent. A major function of books as holders of information—information often seemingly irrelevant to the main text copied into the volume—illustrates the importance of particular kinds of manuscripts to their owners, their institutions, and their regions. The writing of names and legal documents into Gospel-books, in particular, demonstrates the shift of the book’s function from transmitter of knowledge to repository of collective memory, akin to the phenomenon of large family Bibles. This becomes of particular importance when what is added in the recording of notes is among the earliest writing in a language, such as the Welsh additions in the St Chad Gospels.
Ductile deformation and microstructures
Authors: Bouchez Jean-Luc , Nicolas Adolphe
Published: October 2021

In contrast to the elastic deformation, which is reversible, usually neglected by field geologists but important for geophysicists working in seismology, ductile deformation is irreversible. This chapter is restricted to solid materials. Materials containing a melt fraction will be examined in Chapter 7. In the geological literature, ‘ductile’ is often used as a synonym for ‘plastic’. The latter is rather used, and will be used to specify deformation mechanisms that dominantly involve the action of dislocations. In contrast to brittle deformation, which by essence is discontinuous and highly localized (see Chapter 3), ductile deformation is generally continuous and affects large volumes of rock. However, ductile deformation may be concentrated into restricted rock volumes (or domains). Such localization is common in shear zones and/or when superplastic deformation mechanism is involved. Plastic deformation mechanisms naturally depend on temperature, magnitude of the applied stress, mineral nature and grain-size of the rocks. In upper parts of the crust, fluids are able to carry chemical elements over large distances and influence the deformation mechanisms. Micrographs of several microstructural types as well as deformation maps for olivine and calcite are given at the end of this chapter.
Some Empirical Results Concerning Causal Learning and Representation
Authors: Woodward James
Published: October 2021

This chapter explores some empirical results bearing on the descriptive and normative adequacy of different accounts of causal learning and representation. It begins by contrasting associative accounts with accounts that attribute additional structure to causal representation, arguing in favor of the latter. Empirical results supporting the claim that adult humans often reason about causal relationships using interventionist counterfactuals are presented. Contrasts between human and nonhuman primate causal cognition are also discussed, as well as some experiments concerning causal cognition in young children. A proposal about what is involved in having adult human causal representations is presented and some issues about how these might develop over time are explored.
Coda
Authors: Sillars Stuart
Published: October 2021

The larger intersection between word and image, as a way of presenting English identity and especially the countryside, is demonstrated in the films of Humphrey Jennings and the engravings of F. L. Griggs, both suggesting an ideal under threat, first by change, then by coming war. Some government publications offer a final address to the idea of a lost Eden. Edwin Lutyens’ Thiepval memorial, a series of intersecting arches to contain over 70 000 names of the missing, balances the Cenotaph in using words to dominate idea and form. Elsewhere, words and images collapse into each other, as in H. G.Wells’s Mr Britling Sees It Through. The final concern is with what is revealed by the kinds of verbal and visual works discussed throughout the book: a series of glimpses into a society revolving around the home and an imagined countryside, with a mixture of sincerity and vulnerability.
The Accountability Dilemma
Authors: Weller Patrick , Grube Dennis C. , Rhodes R. A. W.
Published: October 2021

This chapter explains the different forms of accountability: whether blame sharing or formal constitutional. In all cases, holding ministers to account involves the assessment of processes that are often shrouded in secrecy and in which facts are contested. Like so many aspects of cabinet government, accountability processes remain flexible and open to interpretation. The dilemmas include the understanding and application of both individual and collective responsibility, and blame games and how to avoid them. They raise issues about judgements of success and failure when assessing the performance of cabinet governments. The chapter emphasises the political nature of accountability and discusses the ways in which ministers and prime ministers strive to show their decision-making in the best light.
Conclusion
Authors: Weller Patrick , Grube Dennis C. , Rhodes R. A. W.
Published: October 2021

The chapter summarizes the findings, first in a series of empirical observations drawn from the five countries. It looks at the impact of party alignments, access to parliament, the benefits of stability, and finally the usefulness of comparative lessons. Then it revisits the theory to show how an interpretivist, agency-centred account can provide insights into the choices the actors make, and how resilience and flexible practices allow them to operate within accepted traditions. This flexibility can explain why cabinet government survives, even if not without challenge, as a dominant mode of government in parliamentary systems. Myths, traditions, and beliefs coupled with rules and precedents can provide a powerful framework.
Precision Medicine and Physical Therapy: A Healthy Living Medicine Approach for the Next Century
Authors: Severin Richard , Sabbahi Ahmad , Arena Ross , Phillips Shane A
Published: October 2021

There is a reciprocal relationship between common health conditions encountered in physical therapist practice, disability, and healthy living factors, such as physical inactivity, blood pressure, sleep quality, diet, and obesity. This relationship is apparent across all practice settings. Physical therapists are well positioned in the health care system to mitigate chronic disease by routinely screening and addressing healthy living factors to improve overall health and lower the risk for chronic disease (healthy living medicine). However, there are several challenges to the successful implementation of this framework in physical therapist practice. This Perspective will elucidate this relationship between healthy living behaviors and physical therapist practice, review the current state of practice regarding screening and intervention of 5 key healthy living behaviors, and outline future steps the profession can take toward implementing precision medicine using a healthy living medicine approach.
Health service use and costs among migrants in an irregular situation: Cross-sectional register-based study from a voluntary-based clinic
Authors: Tjukanov Nina , Tiittala Paula , Salmi Heli
Published: October 2021

Background

As few data based on actual demand for healthcare services in vulnerable migrant populations exist, we studied service use and healthcare costs in a cohort of migrants in an irregular situation.

Methods

In this single-centre retrospective register study, we examined the reasons for encounter, diagnoses, service use and costs of healthcare among patients at a voluntary clinic for migrants in an irregular situation in Helsinki, Finland. ICPC-2 classification and national unit costs for primary healthcare were used for the cost estimation.

Results

A total of 546 patient visits accounted for 620 ICPC-2 coded reasons for encounter, diagnoses and process codes. The most common health problems were teeth/gum disease (10%), acute upper respiratory infection (5%) and oesophageal disease (3%). Visits seldom led to complementary investigations (2%), follow-up visits (5%) or referrals (11%). The total cost of treatment, excluding dental health costs, was 71 euros per visit.

Conclusions

Migrants in an irregular situation present with a variety of health concerns, the majority of which can be treated in a basic primary healthcare facility at a relatively low cost. This encourages research to evaluate the health and cost effects of extending public healthcare for migrants in an irregular situation beyond emergency care.
Racial disparities in skin tone representation of dermatomyositis rashes: a systematic review
Authors: Babool Sofia , Bhai Salman F , Sanderson Collin , Salter Amber , Christopher-Stine Lisa
Published: October 2021

Objective

This systemic review assesses skin tone representation in images of DM rashes in medical education literature.

Methods

A review was performed of 59 dermatology, 11 neurology, 10 neuromuscular, 7 rheumatology and 6 internal medicine textbooks published between 2011 and 2021 and 3 online image databases (UpToDate, VisualDx and DermNet NZ) that were available through an online medical school library. After extracting images, images with poor lighting or unclear rashes were removed. Authors graded skin tone independently on the Massey and Martin Skin Colour Scale (MMSCS) from 1 (very light) to 10 (very dark). The median score was taken for a final score, grouped within MMSCS 1–2, 3–4, 5–7 or 8–10. Inter-rater reliability was assessed using Kendall’s coefficient of concordance (W).

Results

Six hundred and twenty-one images were extracted after reviewing 93 textbooks and 3 online databases. Of the 561 images analysed, 73.1% of images represented MMSCS 1–2, followed by 3–4 (13.4%), 5–7 (11.8%) and 8–10 (1.8%). Inter-rater reliability was high (W = 0.835). Of the images in MMSCS 5–10, 59.2% were in online databases and 80.6% of textbook images were in dermatology books.

Conclusions

Patients with lighter skin tones were represented in a higher number of DM-related educational materials compared with patients with darker skin tones. Our findings add to current research implicating that darker skin tones are under-represented in cutaneous educational materials, specifically for DM. This leads to the inability to properly characterize skin involvement in DM and may lead to inappropriate exclusion from clinical trials due to erroneous skin scoring.
Taxation of trusts in Italy: new developments
Authors: Belluzzo Luigi
Published: October 2021

In August 2021, the Italian Tax Authorities published a discussion Draft Circular Newsletter on the Taxation of Trusts in Italy: New Developments, to practitioners and institutions. A complete change of interpretation seems to happen about indirect taxation of trusts, following constant Court Decisions in the last couple of years. Further clarification came with regard to direct taxation with particular attention paid to the effect on Italian tax resident beneficiaries.
Effects of the association between whole cottonseed and calcium salts of fatty acids on nutrient intake, feedlot performance, and carcass characteristics of Bos indicus animals offered a high-concentrate diet
Authors: Müller Leonardo R , Gouvêa Daniel I C G , Francischinelli André F , Alvarenga Guiherme D A , Castagnino Pablo S , Cappellozza Bruno I , de Sousa Osvaldo A , Meirelles Paulo R L , Costa Ciniro , Martins Cyntia L , Arrigoni Mario B
Published: October 2021

This experiment evaluated the effects of feeding whole cottonseed (WC) and/or calcium salts of fatty acids (CSFA) on dry matter intake (DMI), performance, and carcass characteristics of Bos indicus animals receiving a high-concentrate diet during the finishing phase. On day 0, 96 Nellore bulls were blocked according to initial shrunk body weight (BW; 302 ± 26.7 kg) into group pens (four animals/pen) and, within blocks, pens were randomly assigned to receive: 1) 15% of WC and 2% of CSFA (dry matter [DM] basis) of palm, cottonseed, and soybean oil (15WC; n = 6); 2) 10% of WC and 3% of CSFA (DM basis) of palm, cottonseed, and soybean oil (10WC; n = 6); 3) 5% of WC and 4% of CSFA (DM basis) of palm, cottonseed, and soybean oil (5WC; n = 6); and 4) 0% of WC and 5% of CSFA (DM basis) of palm, cottonseed, and soybean oil (0WC; n = 6). Diets were formulated to be isocaloric, isonitrogenous, and isolipidic. Experimental period lasted 108 d; DMI was evaluated daily, whereas blood samples and carcass measurements were obtained on days 0, 55, and 108 of the study. Upon slaughter on day 109, steaks were collected for determination of the chemical and fatty acid (FA) profile of the meat. No treatment effects (P ≥ 0.35) were observed on DMI, performance, average daily gain (ADG), carcass ultrasound measurements, and chemical variables of the steak. Nonetheless, including WC into the diets decreased C12:0, C16:0, C16:1 trans-9, C17:0, C18:0, C18:1 cis-9, C18:2 cis-9, cis-12, C18:3 cis-9, cis-12, cis-15, saturated, and unsaturated FA intake (P < 0.01). Moreover, adding WC increased DMI fluctuation and feed efficiency (FE; P = 0.03) but decreased marbling (P ≤ 0.03). A treatment × day interaction was observed (P < 0.01) for serum leptin concentration, as 10WC animals had greater leptin concentration on day 103 vs. other treatments (P < 0.01). Regarding steak FA profile, WC addition into the diet increased C18:2 cis-7, trans-9 and C18:3 cis-9, cis-12, cis-15 (P < 0.001), whereas saturated FA was quadratically affected (P = 0.02) and unsaturated FA was reduced for 15WC (P < 0.04). In summary, increasing levels of CSFA into isolipidic finishing diets containing WC did not negatively impact feedlot performance but reduced FE and increased marbling scores of B. indicus bulls, demonstrating its feasibility as a technology to improve carcass traits of low-marbling animals.
Paired analysis of tree ring width and carbon isotopes indicates when controls on tropical tree growth change from light to water limitations
Authors: Brienen Roel , Helle Gerhard , Pons Thijs , Boom Arnoud , Gloor Manuel , Groenendijk Peter , Clerici Santiago , Leng Melanie , Jones Christopher
Published: October 2021

Light and water availability are likely to vary over the lifespan of closed-canopy forest trees, with understory trees experiencing greater limitations to growth by light and canopy trees greater limitation due to drought. As drought and shade have opposing effects on isotope discrimination (Δ13C), paired measurement of ring width and Δ13C can potentially be used to differentiate between water and light limitations on tree growth. We tested this approach for Cedrela trees from three tropical forests in Bolivia and Mexico that differ in rainfall and canopy structure. Using lifetime ring width and Δ13C data for trees of up to and over 200 years old, we assessed how controls on tree growth changed from understory to the canopy. Growth and Δ13C are mostly anti-correlated in the understory, but this anti-correlation disappeared or weakened when trees reached the canopy, especially at the wettest site. This indicates that understory growth variation is controlled by photosynthetic carbon assimilation due to variation in light levels. Once trees reached the canopy, inter-annual variation in growth and Δ13C at one of the dry sites showed positive correlations, indicating that inter-annual variation in growth is driven by variation in water stress affecting stomatal conductance. Paired analysis of ring widths and carbon isotopes provides significant insight in what environmental factors control growth over a tree’s life; strong light limitations for understory trees in closed-canopy moist forests switched to drought stress for (sub)canopy trees in dry forests. We show that combined isotope and ring width measurements can significantly improve our insights in tree functioning and be used to disentangle limitations due to shade from those due to drought.
Sustainable Apple Disease Management in China: Challenges and Future Directions for a Transforming Industry
Authors: Liang Xiaofei , Zhang Rong , Gleason Mark L. , Sun Guangyu
Published: October 2021

Apple trees are grown worldwide, and consuming fresh apple fruit is associated with many health benefits. China produces about half of the world’s apple supply. However, apple growing in China differs sharply from that in western countries in terms of the prevalent diseases and corresponding management strategies. For instance, family-owned small-scale orchards dominate China’s apple industry, and manual bagging of fruit has been a long-standing practice for controlling fruit diseases. In recent years, rural labor shortages have been increasingly challenging the traditional production system, and China’s apple industry is experiencing a rapid transition to much larger-scale enterprises featuring high-density orchards with advanced automation and mechanization. Associated with this transition are new challenges and grower demands that are changing the face of apple disease management. This Feature Article summarizes the ongoing transformation of China’s apple industry in the context of sustainable disease management.
Independent and joint association of physical activity and sedentary behavior on all-cause mortality
Authors: Zhou Wei , Yan Wei , Wang Tao , Zhu Ling-Juan , Xu Yan , Zhao Jun , Yu Ling-Ling , Bao Hui-Hui , Cheng Xiao-Shu
Published: October 2021

Backgrounds:

Physical activity (PA) and sedentary behavior (SB) have been associated with mortality, while the joint association with mortality is rarely reported among Chinese population. We aimed to examine the independent and joint association of PA and SB with all-cause mortality in southern China.

Methods:

A cohort of 12,608 China Hypertension Survey participants aged ≥35 years were enrolled in 2013 to 2014, with a follow-up period of 5.4 years. Baseline self-reported PA and SB were collected via the questionnaire. Kaplan–Meier curves (log-rank test) and Cox proportional hazards regression were performed to evaluate the associations of PA and SB on all-cause mortality.

Results:

A total of 11,744 eligible participants were included in the analysis. Over an average of 5.4 years of follow-up, 796 deaths occurred. The risk of all-cause mortality was lower among participants with high PA than those with low to moderate level (5.2% vs. 8.9%; hazards ratio [HR]: 0.75, 95% confidence interval [CI]: 0.61–0.87). Participants with SB ≥ 6 h had a higher risk of all-cause mortality than those with SB <6 h (7.8% vs. 6.0%; HR: 1.37, 95% CI: 1.17–1.61). Participants with prolonged SB (≥6 h) and inadequate PA (low to moderate) had a higher risk of all-cause mortality compared to those with SB < 6 h and high PA (11.2% vs. 4.9%; HR: 1.67, 95% CI: 1.35–2.06). Even in the participants with high PA, prolonged SB (≥6 h) was still associated with the higher risk of all-cause mortality compared with SB < 6 h (7.0% vs. 4.9%; HR: 1.33, 95% CI: 1.12–1.56).

Conclusions:

Among Chinese population, PA and SB have a joint association with the risk of all-cause mortality. Participants with inadequate PA and prolonged SB had the highest risk of all-cause mortality compared with others.
Assessing Postsurgical Outcomes with Prepectoral Breast Reconstruction: A Literature Review and Meta-analysis Update
Authors: Chatterjee Abhishek , Nahabedian Maurice Y. , Gabriel Allen , Sporck Michael , Parekh Mousam , Macarios David , Hammer Jason , Sigalove Steven
Published: October 2021

Background:

Prepectoral implant-based breast reconstruction is an alternative to subpectoral/dual-plane reconstruction.

Methods:

This study examined outcomes of prepectoral reconstruction using a meta-analysis of data pooled with data from our previous review. Thirty studies were included.

Results:

Explantation, seroma, and infection were the most common complications with no animation deformity reported. Significantly lower odds of infection were observed with prepectoral compared with dual-plane reconstruction.

Conclusions:

Current literature suggests that prepectoral reconstruction may be associated with lower rates of postsurgical infections.
Significant Prognostic Factors Influencing the Survival Difference of Oral Tongue Squamous Cell Carcinoma
Authors: Boonpoapichart Sarinya , Punyavong Pattama , Jenwitheesuk Kamonwan , Surakunprapha Palakorn , Winaikosol Kengkart
Published: October 2021

Background:

Oral tongue squamous cell carcinoma is the most common malignancy in the oral cavity. Overall survival varies across many countries, and poor prognosis is prevalent in developing countries, including Thailand. Our study aimed to identify prognostic factors that affected survival for oral tongue cancer in Thailand.

Methods:

We performed a retrospective study of 183 patients diagnosed with oral tongue squamous cell carcinoma between January 2012 and December 2016 and who underwent multidisciplinary treatment. The disease stage was classified by tumor-nodes-metastasis (TNM) staging system. The survival outcome was calculated and represented in median survival time. Univariate and multivariate Cox proportional hazards models were used to identify factors that impacted survival outcomes.

Results:

A clear margin was achieved in 88.8% of the 125 operated patients. Radiotherapy was given to 115 patients (62.84%). The survival shown in Kaplan-Meier curves was significantly lower according to advanced TNM stage, poor histologic grade, nonsurgical treatment, and patients treated with radical neck dissection. Radiotherapy was a good prognostic factor [hazard ratio (HR) 0.25, P = 0.022]. Poor prognostic factors were body mass index less than 18.5 kg per m2 (HR 3.03), vertical tumor dimension 20 mm or more (HR 5.84), non-well-differentiated grade tumor (HR 3.09), and operated cases with radical neck dissection (HR 4.29).

Conclusions:

Surgical treatment can improve the survival outcome, whereas advanced stage and poor histological grading can worsen the overall survival. For oral tongue squamous cell carcinoma, radiotherapy was a good prognostic factor. On the contrary, a tumor with large vertical size, closed surgical margin, poor histologic grade, and radical neck dissection in the operated group were poor prognostic factors.
Health Conditions Among Special Operations Forces Versus Conventional Military Service Members: A VA TBI Model Systems Study
Authors: Garcia Amanda , Kretzmer Tracy S. , Dams-O'Connor Kristen , Miles Shannon R. , Bajor Laura , Tang Xinyu , Belanger Heather G. , Merritt Bryan P. , Eapen Blessen , McKenzie-Hartman Tamara , Silva Marc A.
Published: October 2021

Objective:

To examine traumatic brain injury (TBI) characteristics and comorbid medical profiles of Special Operations Forces (SOF) Active Duty Service Member/Veterans (ADSM/Vs) and contrast them with conventional military personnel.

Setting:

The 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers.

Participants:

A subset of participants in the VA TBI Model Systems multicenter longitudinal study with known SOF status. These included 157 participants who identified as SOF personnel (average age = 41.8 years; 96% male, 81% active duty), and 365 who identified as Conventional Forces personnel (average age = 37.4 years; 92% male, 30% active duty).

Design:

Retrospective analysis of prospective cohort, cross-sectional.

Main Measures:

The Health Comorbidities Interview.

Results:

SOF personnel were more likely to have deployed to a combat zone, had more years of active duty service, and were more likely active duty at time of TBI. SOF personnel were more likely to have had mild TBI (vs moderate/severe) and their TBI caused by violent mechanism. SOF personnel had a higher number of comorbidities, with more diagnoses of chronic pain, osteoarthritis, hyperlipidemia, hip fractures, and obstructive sleep apnea.

Conclusion:

SOF personnel are at a higher risk for multimorbidity after TBI. Current rehabilitation practices should incorporate early screening and treatment of common conditions in this population, while future practices may benefit from a focus on prevention.
Manufacturing defect of a Zeiss multifocal intraocular lens
Authors: McKee Hamish D. , Jhanji Vishal
Published: October 2021

Introduction:

A case of cataract surgery with multifocal intraocular lens (IOL) insertion where the lens was found to have a manufacturing defect with decentred diffractive rings on the optic is reported.

Patient and clinical findings:

A toric AT LISA tri (Carl Zeiss Meditec AG) IOL was implanted into the capsular bag in the right eye of a 58-year-old woman. After implantation it was noted that the diffractive rings were off center and not aligned with the toric lens markings.

Diagnosis, intervention, and outcomes:

The IOL was explanted and another IOL of the same type and power was inserted.

Conclusions:

This case shows that centration defects of multifocal IOLs exist. Surgeons need to be aware of this and make sure they have instruments on hand for explantation and backup IOLs for each case.
Classification and citation analysis of the 100 top-cited articles on adult spinal deformity since 2011: A bibliometric analysis
Authors: Liu Po-Chun , Lu Yi , Lin Hsi-Hsien , Yao Yu-Cheng , Wang Shih-Tien , Chang Ming-Chau , Chien Tsair-Wei , Chou Po-Hsin
Published: October 2021

Background:

Studies of the 100 most-cited articles are reported for many subjects. However, none has analyzed the article characteristics associated with high citation frequency. This study aims to (1) graphically depict characteristics of the 100 top-cited articles addressing adult spinal deformity (ASD), (2) diagram the association between articles according to subject and major topic medical subject headings (MeSHs), and (3) investigate whether major topic MeSH correlates with article citation frequency.

Methods:

The 100 top-cited ASD publications since 2011 were retrieved using a PubMed Central search on May 6, 2020. Using titles and abstracts, eight subject categories were identified: surgery, conservative treatment, normal values in spinopelvic alignment, review, cervical alignment, classification, compensatory mechanism, and spine-hip relationship. Sankey diagrams were used to organize the information. Network analysis was performed according to article subject and major topic MeSHs. Pearson’s r was used to determine whether the weighted number of citations correlates with major topic MeSHs and the number of citations.

Results:

The average number of citations per article was 34.8 (range, 19–156). The most represented country was USA (n = 51). The most productive and highly cited journal was Spine (Phila Pa 1976) (n = 34; average, 38.2 citations per article). The most frequent subject categories and major topic MeSHs were “surgery” (n = 53) and “scoliosis” (weighted count, 9.8), while articles with the subject “compensatory” had the highest average number of citations (64.7). The most highly cited article, by Dr. F. Schwab in 2012, had 156 citations. Network analysis revealed the relationships between these articles according to major topic MeSHs. The weighted number of citations according to major topic MeSHs correlated significantly with article citation frequency (Pearson’s r, 0.57; p < 0.001).

Conclusion:

Multiple characteristics of the 100 top-cited ASD articles are presented in diagrams to guide evidence-based clinical decision-making in ASD.
Does rotation during catheter withdrawal in embryo transfer increase pregnancy rates?
Authors: Gurbuz Ali Sami , Yildiz Yunus
Published: October 2021

Background:

The aim of this study was to determine whether there is a difference in pregnancy rates between groups that we removed directly and removed by rotating the embryo transfer catheter 360°.

Methods:

The study group consisted of 552 patients who were withdrawn by 360° rotation and 797 patients who were withdrawn without catheter rotation. All patients underwent one or two fresh ETs on day 3 or 5. Groups were compared in terms of cycle characteristics and clinical pregnancy rates.

Results:

There were no significant differences in demographic and clinical characteristics of both groups, such as age, body mass index (BMI), duration of infertility, causes of infertility, and basal hormone levels. Clinicals pregnancy rate, in the study group, 48% (265/552) and in the control group, 50.8% (405/797) were similar in both groups. When the implantation rate and miscarriage rate were examined, both groups were found to be similar.

Conclusion:

It was found that 360° rotation while pulling catheter during embryo transfer had no effect on pregnancy and clinical pregnancy.
Total knee replacement for patients with severe hemophilic arthropathy in Taiwan: A nationwide population-based retrospective study
Authors: Chen Cheng-Fong , Yu Yuan-Bin , Tsai Shang-Wen , Chiu Jan-Wei , Hsiao Liang-Tsai , Gau Jyh-Pyng , Hsu Hui-Chi
Published: October 2021

Background:

Total knee replacement (TKR) surgery is a treatment option for advanced hemophilic arthropathy. Due to its rarity and complexity, previous reports could only demonstrate the results of single-site studies including few cases. This population-based study aimed to investigate the major epidemiological characteristics, mean consumption of coagulation factors, length of hospital stays, complications, and failure rate of primary TKR for severe hemophilia patients in Taiwan.

Methods:

A cohort of 996 hemophilia patients registered between 1995 and 2011 was included, and 103 primary TKRs were performed on 75 patients. Unilateral TKR was performed on 47 patients and bilateral TKRs on the remaining 28 patients, including 12 simultaneous and 16 staged surgeries. The mean age at surgery was 32.3 years (range, 17.3–55.7), and the mean follow-up duration was 77.9 months (range, 2.3–176.8).

Results:

Failure was noted in 8 patients (8.5%) at mean 32.8 months (range, 2.3–95) after surgery. Four patients revealed aseptic loosening, whereas infection in 4. The 10-year prosthesis survivorship was 88.6%. For patients receiving unilateral TKR, the mean length of hospital stay was 15 days (range, 7–32). The mean cost of factor supplement was United States Dollar (USD) 43 543 with a mean 4-unit packed red blood cells transfusion (range, 0–38). The total admission cost was USD 48 326 (range, USD 4165–262 619).

Conclusion:

The prevalence of TKA for hemophilia patients was 7.5% in Taiwan. The mean hospital stay was 14 days, and the 10-year prosthesis survivorship was 88.6%. The mean daily factor usage was decreased from 235.7 units preoperatively to 202.1 units postoperatively. In comparison with the staged-bilateral TKRs, the simultaneous procedures significantly reduced the mean total cost from USD 101 923 to USD 61 587 (p = 0.023). Therefore, in terms of cost-effectiveness, bilateral simultaneous TKR is more preferable than staged procedures.
Group-based trajectory analysis of postoperative pain in epidural analgesia for video-assisted thoracoscopic surgery and risk factors of rebound pain
Authors: Chang Wen-Kuei , Li Yi-Shiuan , Wu Hsiang-Ling , Tai Ying-Hsuan , Lin Shih-Pin , Chang Kuang-Yi
Published: October 2021

Background:

The current study aimed to investigate the patterns of postoperative pain trajectories over time and their associated risk factors in patients receiving video-assisted thoracoscopic surgery (VATS) and epidural analgesia (EA) for non–small cell lung cancer (NSCLC).

Methods:

This retrospective study was conducted at a tertiary medical center and included patients undergoing VATS for stage I NSCLC between 2011 and 2015. Maximal pain intensity was recorded daily during the first postoperative week. Group-based trajectory analysis was performed to categorize variations in pain scores over time. Associations between pain trajectory classification and amount of EA administered and length of hospital stay (LOS) after surgery were also evaluated.

Results:

A total of 635 patients with 4647 pain scores were included in the analysis, and 2 postoperative pain trajectory groups were identified: group 1, mild pain trajectory (78%); and group 2, rebound pain trajectory (22%). Risk factors for rebound pain trajectory were a surgical time longer than 3 hours (odds ratio [OR], 1.97; 95% CI, 1.27–3.07), female sex (OR, 1.62; 95% CI, 1.04–2.53), and higher pain score on postoperative day 0 (OR, 1.21; 95% CI, 1.08–1.36; linear effect). Although group 2 had a longer LOS (p < 0.001), they did not receive more EA than group 1 (p = 0.805).

Conclusion:

Surgical time, sex, and pain intensity after surgery were major determinants of rebound pain trajectory, and more aggressive pain control strategies should be considered in high-risk patients.
Clinical characteristics and outcomes of drug-induced liver injury in Taiwan: With emphasis on the impact of chronic hepatitis B infection
Authors: Huang Yi-Shin , Tseng Shao-Yu , Chen Wen-Wen , Chang Ting-Tsung , Peng Cheng-Yuan , Lo Gin-Ho , Hsu Chao-Wei , Hu Chi-Tan , Huang Yi-Hsiang
Published: October 2021

Background:

Whether hepatitis B virus (HBV) infection can affect the outcomes of drug-induced liver injury (DILI) is controversial. This study aimed to evaluate the characteristics and outcomes of DILI in Taiwan, with an emphasis on the impact of HBV infection.

Methods:

We prospectively recruited patients with DILI from multiple centers in Taiwan from 2010 to 2018.

Results:

A total of 1,014 patients were enrolled. The leading culprit drug category was antimicrobials (481, 47.4%), followed by nonsteroidal anti-inflammatory drugs, anticonvulsants, and statins. Among the antimicrobials, antituberculosis agents were most likely to induce liver injury (257, 25.3%), followed by antibacterial, antifungal, and antiviral agents. The liver-related mortality rate was 8.2% (83/1,014). The patients who died had higher rates of hepatocellular-type liver injury, elevated liver biochemical tests, preexisting liver cirrhosis, jaundice, chronic HBV infection, and antituberculosis drug-induced liver injury (ATDILI) than the survivors. A total of 131 patients (12.9%) with DILI were HBV carriers, of whom 23 (17.6%) died of hepatic failure. The rate of HBV-DNA > 2000 IU/mL was higher in the patients who died (47.8% vs. 26.9%, p = 0.047) than in the survivors. After adjusting for possible risk factors, active HBV infection with HBV-DNA > 2000 IU/mL was the most significant risk factor for liver-related mortality (adjusted HR, 4.40, 95% CI, 2.31%-8.38%, p < 0.001). The other independent risk factors for mortality were ATDILI and albumin-bilirubin (ALBI) score (adjusted HR, 1.25 and 4.09, respectively, p < 0.003).

Conclusion:

Antituberculosis agents were the leading cause of DILI in Taiwanese, and they were associated with poorer outcomes than other drug categories. Active HBV infection, ATDILI and ALBI score were independent risk factors for fatal DILI. Close monitoring of liver tests and timely antiviral therapy should be implemented in HBV carriers during the administration of high-risk drugs, such as antituberculosis agents.
Discriminant Validity of the Parent-Proxy Preschool HEAR-QL
Authors: Zhang Amy L. , Jeffe Donna B. , Lieu Judith E. C.
Published: October 2021

Objective:

The parent-proxy Preschool HEAR-QL (Hearing Environments And Reflections on Quality of Life) is a quality of life (QOL) measure for 2 to 6-year-old children with hearing loss (HL). We compared Preschool HEAR-QL scores for children with HL and children with normal hearing (NH) to examine the measure's discriminant validity.

Study Design:

Cross-sectional study.

Setting:

Three tertiary care pediatric otolaryngology clinics.

Patients:

Two hundred forty-eight parents of children 2 to 6 years old with NH or HL participated.

Interventions:

None.

Main Outcome Measure:

The Preschool HEAR-QL has five domains: Behavior and Attention, Hearing Environments, New Social Situations, Social Interactions, and Communications. Scores range from 0 to 100; higher scores indicate higher QOL. Scores for children with NH and with HL were compared using analysis of variance (ANOVA) and area under the receiver operating characteristic (AUROC) curves.

Results:

Total HEAR-QL mean (SD) scores were higher for children with NH compared to children with HL (75.7 [10.5] vs. 67.5 [15.5], p < 0.001). Scores were not significantly different between children with unilateral and bilateral HL. Children 2 to 4 years old received lower Communications-domain scores than children 4 to 6 years old across all children (63.7 [25.4] vs. 74.1 [24.3], p = 0.01) and within the HL cohort (61.3 [25.1] vs. 72.6 [25.3]; p = 0.009). The Hearing Environments domain displayed excellent discrimination (AUROC = 0.858); other domains showed little to no discrimination.

Conclusions:

The Hearing Environments-domain of the Preschool HEAR-QL differentiated between children with and without HL. Children with NH had higher scores than children with HL on both Total HEAR-QL and Hearing Environment-domain scores.