bluuebunny/crossref_metadata_2025 huggingface dataset:
A data-adaptive Bayesian regression approach for polygenic risk prediction
Authors: Song Shuang , Hou Lin , Liu Jun S
Published: January 2022

Motivation

Polygenic risk score (PRS) has been widely exploited for genetic risk prediction due to its accuracy and conceptual simplicity. We introduce a unified Bayesian regression framework, NeuPred, for PRS construction, which accommodates varying genetic architectures and improves overall prediction accuracy for complex diseases by allowing for a wide class of prior choices. To take full advantage of the framework, we propose a summary-statistics-based cross-validation strategy to automatically select suitable chromosome-level priors, which demonstrates a striking variability of the prior preference of each chromosome, for the same complex disease, and further significantly improves the prediction accuracy.

Results

Simulation studies and real data applications with seven disease datasets from the Wellcome Trust Case Control Consortium cohort and eight groups of large-scale genome-wide association studies demonstrate that NeuPred achieves substantial and consistent improvements in terms of predictive r2 over existing methods. In addition, NeuPred has similar or advantageous computational efficiency compared with the state-of-the-art Bayesian methods.

Availability and implementation

The R package implementing NeuPred is available at https://github.com/shuangsong0110/NeuPred.

Supplementary information

Supplementary data are available at Bioinformatics online.
A systematic review, meta-analysis, and meta-regression of patient education for secondary prevention in patients with coronary heart disease: impact on psychological outcomes
Authors: Shi Wendan , Ghisi Gabriela L M , Zhang Ling , Hyun Karice , Pakosh Maureen , Gallagher Robyn
Published: January 2022

Background

Patient education is a cardiac rehabilitation core component and is associated with improvements in self-management of patients with coronary heart disease (CHD). However, the efficacy of such interventions on psychosocial outcomes and relative impact of duration is less clear.

Objectives

This study aimed to assess the efficacy of patient education for secondary prevention related to behaviour change and risk factor modification on psychological outcomes in CHD patients.

Design

A systematic review and meta-analysis.

Data sources

PsycINFO, CINAHL, Embase, EmCare, MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials were searched from inception to February 2021.

Eligibility criteria for study selection

Randomized controlled trials (RCTs) evaluating patient education in CHD patients, or following myocardial infarction, or revascularization compared with usual care were identified. Outcomes included depression and anxiety at <6 and 6–12 months of follow-up.

Results

A total of 39 RCTs and 8748 participants were included. Patient education significantly improved participants’ depressive symptoms at <6 (SMD −0.82) and 6–12 months (SMD −0.38) of follow-up and anxiety level at <6 (SMD −0.90), and 6–12 months (SMD −0.32) of follow-up. Patient education also reduced the risk for having clinical depression by 35% and anxiety by 60%. Longer patient education of ≥3 months, resulted in more improvement in depressive symptoms at 6–12 months (coefficient −0.210) compared to shorter duration.

Conclusions

Patient education for secondary prevention reduces anxiety and depressive symptoms in CHD patients. Regardless of intensity, longer patient education improves depression more than short duration. More information is needed on the relative impact of other intervention components.

Data registration

PROSPERO (CRD42020200504).
Applying multidate Sentinel-2 data for forest-type classification in complex broadleaf forest stands
Authors: Shirazinejad Golsa , Javad Valadan Zoej Mohammad , Latifi Hooman
Published: January 2022

Biodiversity assessment and forest management require accurate tree species maps, which can be provided by remote sensing. Whereas the application of high-spatial resolution remote sensing data is constrained by high costs, Sentinel-2 (S2) satellites provide free imagery with appropriate spatial, spectral and temporal resolutions for mapping of various forest traits across larger spatial scales. Here we assessed the potential of multidate S2 as well as a Digital Elevation Model (DEM) in classifying tree species across a highly structured and heterogeneous broadleaf forest ecosystem in the Hyrcanian zone of northern Iran. We applied multidate S2 and DEM data as input to a variable selection using random forests algorithm for feature reduction. Ten forest types were classified using random forest algorithm and to evaluate the results we computed area-adjusted confusion matrices. Classifications based on single-date S2 data reached overall accuracies of 67–74 per cent, whereas results for multidate S2 images increased the accuracy by ~28 per cent. Joint use of DEM data along with multidate S2 images showed improvement of overall accuracy by ~3 per cent. In addition, we studied the effect of topographic correction of S2 data on classification performance. The results imply that applying topographically corrected imagery had no significant effect on the classification accuracy. Our results demonstrate the high potential of freely available multisource remotely sensed data for broadleaf tree species classification across complex broad-leaved forest landscapes.
Mechanisms of sex determination and X-chromosome dosage compensation
Authors: Meyer Barbara J
Published: January 2022

Abnormalities in chromosome number have the potential to disrupt the balance of gene expression and thereby decrease organismal fitness and viability. Such abnormalities occur in most solid tumors and also cause severe developmental defects and spontaneous abortions. In contrast to the imbalances in chromosome dose that cause pathologies, the difference in X-chromosome dose used to determine sexual fate across diverse species is well tolerated. Dosage compensation mechanisms have evolved in such species to balance X-chromosome gene expression between the sexes, allowing them to tolerate the difference in X-chromosome dose. This review analyzes the chromosome counting mechanism that tallies X-chromosome number to determine sex (XO male and XX hermaphrodite) in the nematode Caenorhabditis elegans and the associated dosage compensation mechanism that balances X-chromosome gene expression between the sexes. Dissecting the molecular mechanisms underlying X-chromosome counting has revealed how small quantitative differences in intracellular signals can be translated into dramatically different fates. Dissecting the process of X-chromosome dosage compensation has revealed the interplay between chromatin modification and chromosome structure in regulating gene expression over vast chromosomal territories.
Utilization, Contributions, and Perceptions of Paid Home Care Workers Among Households in New York State
Authors: Sterling Madeline R , Ringel Joanna Bryan , Cho Jacklyn , Riffin Catherine A , Avgar Ariel C
Published: January 2022

Background and Objectives

While family caregivers have traditionally provided care for older adults with chronic conditions and disabilities, the demand for paid home care workers has increased in the last decade. Although typically thought to assist with personal care, emerging data suggest that paid home care workers assist with a wider scope of care. However, the extent and quality of the care they deliver remains poorly understood.

Research Design and Methods

Using the Empire State Poll, a telephone-based cross-sectional survey of 800 adults in New York State, we characterized the types of care that paid home care workers provided and the perceived value of that care.

Results

Of 800 participants surveyed, 274 reported that they or an immediate family member received care from a paid home care worker (34.3%). Of these, the majority (73.9%) reported that paid home care workers provided emotional and/or medical care, in addition to personal care. In adjusted models, providing emotional and medical care (compared to personal care alone) was associated with nearly a twofold greater perception of importance and experience by the care recipients.

Discussion and Implications

Our findings provide additional data on how paid home care workers contribute to patient care, from the perspective of the care recipient(s). The type of care provided is associated with varying magnitudes of perceived quality. Although limited to New York, these findings have implications for paid home care workers’ training and compensation. Future studies are warranted to investigate the specific factors that mediate the association between types of care provided and their perceived value.
Evaluation of marketing authorization and clinical implementation of ulipristal acetate for uterine fibroids
Authors: Middelkoop Mei-An , de Lange Maria E , Clark T Justin , Mol Ben Willem J , Bet Pierre M , Huirne Judith A F , Hehenkamp Wouter J K
Published: January 2022

Ulipristal acetate (UPA) is a medical treatment for uterine fibroids and was authorized for surgical pre-treatment in 2012 after the conduct of the PEARL I and II randomized controlled trials and for intermittent treatment after the observational PEARL III and IV trials. However, UPA came into disrepute due to its temporary suspension in 2017 and 2020 because of an apparent association with liver injury. This clinical opinion paper aims to review the process of marketing authorization and implementation of UPA, in order to provide all involved stakeholders with recommendations for the introduction of future drugs. Before marketing authorization, the European Medicines Agency (EMA) states that Phase III registration trials should evaluate relevant outcomes in a representative population, while comparing to gold-standard treatment. This review shows that the representativeness of the study populations in all PEARL trials was limited, surgical outcomes were not evaluated and intermittent treatment was assessed without comparative groups. Implementation into clinical practice was extensive, with 900 000 prescribed treatment cycles in 5 years in Europe and Canada combined. Extremely high costs are involved in developing and evaluating pre-marketing studies in new drugs, influencing trial design and relevance of chosen outcomes, thereby impeding clinical applicability. It is vitally important that the marketing implementation after authorization is regulated in such way that necessary evidence is generated before widespread prescription of a new drug. All stakeholders, from pharmaceutical companies to authorizing bodies, governmental funding bodies and medical professionals should be aware of their role and take responsibility for their part in this process.
Systematic Revision of a New Butterfly Genus,CisandinaNakahara & Espeland, n. gen., with Descriptions of Three New Taxa (Lepidoptera: Nymphalidae: Satyrinae)
Authors: Nakahara Shinichi , Rodríguez-Melgarejo Maryzender , Kleckner Kaylin , Corahua-Espinoza Thalia , Tejeira Rafael , Espeland Marianne , Casagrande Mirna M , Barbosa Eduardo P , See Joseph , Gallice Geoffrey , Lamas Gerardo , Willmott Keith R
Published: January 2022

We here establish a new genus in the nymphalid butterfly subtribe Euptychiina, Cisandina Nakahara & Espeland, n. gen. to harbor five species hitherto placed within two polyphyletic genera, namely Magneuptychia Forster, 1964 and Euptychoides Forster, 1964. We compiled data from over 350 specimens in 17 public and private collections, as well as DNA sequence data for all relevant species, to revise the species-level classification of this new genus. According to our multi-locus molecular phylogeny estimated with the maximum likelihood approach, Cisandina lean. comb., Cisandina philippan. comb. & reinst. stat., Cisandina fidan. comb., Cisandina sanmarcosn. comb., and Cisandina trinitensisn. comb. are proposed as new taxonomic combinations, since these species are distantly related to the type species of Magneuptychia and Euptychoides and cannot reasonably be accommodated in any other genus. Lectotypes are designated for Papilio lea Cramer, 1777, Papilio junia Cramer, 1780, Euptychia philippa Butler, 1867, and Eupytchia fida Weymer, 1911. Two new species of Cisandinan. gen. are named and described herein, C. esmeralda Nakahara & Barbosa, n. sp. and C. castanya Lamas & Nakahara, n. sp., increasing the described species diversity of the genus to seven. The immature stages of C. castanyan. sp. and C. philippan. comb. & reinst. stat. are documented along with their natural hostplants, representing the first two species of the genus with known life history information. We describe a new subspecies, Cisandina fida directa Nakahara & Willmott, n. ssp., based on a limited number of specimens from southern Ecuador and central Peru. We were unable to obtain genetic data for the nominate race of C. fidan. comb., and thus, this taxonomic hypothesis is currently based solely on phenotypic characters.
Prenatal telemedicine during COVID-19: patterns of use and barriers to access
Authors: Morgan Allie , Goodman Daisy , Vinagolu-Baur Julia , Cass Ilana
Published: January 2022

Objective

To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic.

Materials and Methods

We conducted a postvisit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in 5 domains: (1) engagement with prenatal care; (2) barriers to telemedicine and in person healthcare; (3) experience of prenatal care; (4) remote pregnancy surveillance tools; and (5) sources of COVID-19 information.

Results

Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to accessing telemedicine was poor internet or phone connectivity, followed by childcare responsibilities, lack of equipment, and lack of privacy. Participants also engaged in additional remote prenatal care including phone calls with registered nurses (7.6%), communication with the obstetrics team through a secure health messaging portal (21.1%), and home health monitoring (76.3%).

Discussion and Conclusions

In this survey, evaluating the experience of pregnant people participating in a prenatal telemedicine visit during the COVID-19 pandemic, respondents had a positive experience with telemedicine overall, but also identified significant barriers to participation including issues with connectivity and lack of equipment for the visit. Most participants used telemedicine in combination with other tools for remote self-care.
A global overview of climate change impacts on freshwater decapods: substantial research gaps across taxa and biogeographic regions
Authors: Toh Elysia X P , Gan Lydia X , Yeo Darren C J
Published: January 2022

Freshwater decapod crustaceans, with representatives from four main taxonomic groups (Anomura, Astacidea, Brachyura, Caridea), form a large and prominent functional group distributed globally across all types of freshwater habitats. Freshwater decapods play critical ecological roles in aquatic communities and ecosystems, and at the same time have widespread cultural and economic significance. A large proportion of freshwater decapods are imperilled by threats including pollution, habitat loss, invasive species, and importantly, climate change. Direct impacts of climate change, as well as its synergistic effects with other threats, pose a substantial but potentially understudied and possibly even underestimated risk to the conservation of freshwater decapod crustaceans. We assessed patterns of climate change impacts on freshwater decapods, as well as the extent of related research, at a global scale. Based on a comprehensive literature survey of all years up to November 2019, we found that only 49 publications, starting from the first relevant article in 2003, contained empirical evidence of climate change effects on freshwater decapods, with a total of 145 native and 11 non-native freshwater decapod species studied in relation to climate change. Climate-change research has also been increasing for all four groups, but more than half of the literature included the freshwater crayfishes Astacidea. We also found a strong bias towards the Australasian region in climate-change research in freshwater decapods, while no published studies were recorded in the Oceania biogeographic region. Importantly, almost three-quarters of native freshwater decapod species studied were projected/reported to be significantly affected by climate change, while more than 90% of the non-native freshwater decapod species studied were projected/reported to be significantly affected by climate change. Considering the severe impacts demonstrated for several species, and coupled with the notable taxonomic and geographic gaps in research into the rest of the freshwater decapods, there is an urgent need for greater representation in climate-change research across species and in regions of high diversity (such as the Neotropical, Afrotropical, and Indomalayan regions), in order for conservation interventions and measures to be beneficial to the most threatened groups.
Effect of daily salinity fluctuation on the intraspecific interactions of a euhalophyte (Suaeda salsa) along a salinity gradient
Authors: Ma Hua , Cui Li-Juan , Li Wei , Ning Yu , Lei Yin-Ru , Pan Xu , Wang Yi-Fei , Zhang Man-Yin
Published: January 2022

Heterogeneity of soil salinity is a prominent environmental characteristic in the intertidal zone of estuaries, affecting the plant growth and the shift of biotic interactions in the salt marsh. This study aims to examine the interactive effects of a salinity gradient and salinity fluctuations on intraspecific interactions of a euhalophyte. We assessed the impact of daily fluctuating salinity on the outcome of intraspecific interactions by cultivating seeds of Suaeda salsa (Chenopodiaceae) in river sand. The experiment was conducted in a greenhouse with three treatments: daily salinity fluctuations (static and fluctuating salinity), a salinity gradient (200 and 400 mmol L−1) and three planting densities (1, 2 and 4 plants/pot). First, height and biomass of plants were measured at both the start and end of the experiment. Then, the growth indexes and log response ratio of S. salsa were analyzed. The outcome of intraspecific interactions of S. salsa shifted from competition in low salinity to facilitation in high salinity, and high conspecific density strengthened the competition and facilitation intensities. Daily salinity fluctuation did not significantly affect the plant growth and the outcome of intraspecific interactions, but did have a significant influence on belowground biomass. Our results suggest that the stress-gradient hypothesis may apply to predicting the variation of the intraspecific relationship of a salt-tolerant species along a salinity gradient, and the magnitude of this variation is density dependent. These findings help us understand how individuals and populations of a euhalophyte species respond to the natural variation or human modification of salinity conditions.
Scaling relations for globular cluster systems in early-type galaxies – II. Is there an environmental dependence?
Authors: De Bórtoli Bruno J , Caso Juan P , Ennis Ana I , Bassino Lilia P
Published: January 2022

The current properties of globular cluster systems (GCSs) are the result of the evolution experienced by their host galaxies, which shape the richness of the GCS as well as its spatial distribution, among other features. We carry out an analysis of the projected radial distribution of globular clusters for a sample of almost 30 early-type galaxies (ETGs) of intermediate and low luminosity, located in cluster environments (Virgo, Fornax, and Coma). We also include in the study six ETGs, for which the parameters of their GCS radial profiles are publicly available. The final analysis is performed on an enlarged sample (∼100 GCSs), by adding the GCSs of ETGs from our previous paper (Paper I). Scaling relations involving different parameters of the GCSs are obtained for the whole sample and complement those obtained in Paper I. Several of such relations point to a second-order dependence on the environmental density. Finally, the results are analysed in the literature context.
Association between sleep disordered breathing in early pregnancy and glucose metabolism
Authors: Sanapo Laura , Bublitz Margaret H , Bai Alice , Mehta Niharika , Messerlian Geralyn M , Catalano Patrick , Bourjeily Ghada
Published: January 2022

Study Objectives

To examine the association between maternal sleep disordered breathing (SDB) and glucose metabolism in early gestation.

Methods

Women with body mass index (BMI) ≥27 kg/m2 and singleton pregnancies underwent in-home sleep study (HSAT) and homeostatic model assessment (HOMA) in early pregnancy. Insulin resistance (HOMA-IR) and β-cell function (HOMA %B) were derived. Exclusion criteria included pregestational diabetes, use of continuous positive airway pressure and chronic steroid therapy. We performed linear regression analyses to evaluate the association between continuous measures of SDB (respiratory event index (REI), and oxygen desaturation index (ODI)) and glucose metabolism parameters (HOMA-IR and HOMA %B). Analyses were adjusted for a set of a priori selected variables which included gestational age, maternal age, BMI, ethnicity, race, and parity.

Results

One hundred and ninety-two pregnant women with median (interquartile range) BMI of 35.14 (8.30) kg/m2 underwent HSAT and HOMA assessment at 11.14 (3) and 15.35 (4.14) gestational weeks, respectively. REI and ODI, as continuous values, were associated with HOMA-IR after adjusting for covariates. OSA (obstructive sleep apnea) diagnosis (REI > 5 events per hour) was not associated with HOMA-IR after adjusting for BMI (p ≥ 0.05). None of the parameters were associated with HOMA %B (p > 0.07).

Conclusions

SDB and insulin resistance are associated in early pregnancy, with a dose response association between respiratory event index severity and insulin resistance. Further studies are needed to establish if pregnant women with overweight and obesity may benefit from early SDB screening to improve glucose metabolic outcome.

Clinical trials: NCT02412696, Positive Airway Pressure, Sleep Apnea, and the Placenta (PAP-SAP) https://clinicaltrials.gov/ct2/show/NCT02412696?term=Bourjeily&draw=2&rank=2 and NCT02917876, Predictors of De-novo Development of Obstructive Sleep Apnea in Pregnancy (Predictors) https://clinicaltrials.gov/ct2/show/NCT02917876?term=Bourjeily&draw=2&rank=1
Neural Adaptation of the Electrically Stimulated Auditory Nerve Is Not Affected by Advanced Age in Postlingually Deafened, Middle-aged, and Elderly Adult Cochlear Implant Users
Authors: He Shuman , Skidmore Jeffrey , Conroy Sara , Riggs William J. , Carter Brittney L. , Xie Ruili
Published: January 2022

Objective:

This study aimed to investigate the associations between advanced age and the amount and the speed of neural adaptation of the electrically stimulated auditory nerve (AN) in postlingually deafened adult cochlear implant (CI) users.

Design:

Study participants included 26 postlingually deafened adult CI users, ranging in age between 28.7 and 84.0 years (mean: 63.8 years, SD: 14.4 years) at the time of testing. All study participants used a Cochlear Nucleus device with a full electrode array insertion in the test ear. The stimulus was a 100-ms pulse train with a pulse rate of 500, 900, 1800, or 2400 pulses per second (pps) per channel. The stimulus was presented at the maximum comfortable level measured at 2400 pps with a presentation rate of 2 Hz. Neural adaptation of the AN was evaluated using electrophysiological measures of the electrically evoked compound action potential (eCAP). The amount of neural adaptation was quantified by the adaptation index (AI) within three time windows: around 0 to 8 ms (window 1), 44 to 50 ms (window 2), and 94 to 100 ms (window 3). The speed of neural adaptation was quantified using a two-parameter power law estimation. In 23 participants, four electrodes across the electrode array were tested. In three participants, three electrodes were tested. Results measured at different electrode locations were averaged for each participant at each pulse rate to get an overall representation of neural adaptation properties of the AN across the cochlea. Linear-mixed models (LMMs) were used (1) to evaluate the effects of age at testing and pulse rate on the speed of neural adaptation and (2) to assess the effects of age at testing, pulse rate, and duration of stimulation (i.e., time window) on the amount of neural adaptation in these participants.

Results:

There was substantial variability in both the amount and the speed of neural adaptation of the AN among study participants. The amount and the speed of neural adaptation increased at higher pulse rates. In addition, larger amounts of adaptation were observed for longer durations of stimulation. There was no significant effect of age on the speed or the amount of neural adaptation.

Conclusions:

The amount and the speed of neural adaptation of the AN are affected by both the pulse rate and the duration of stimulation, with higher pulse rates and longer durations of stimulation leading to faster and greater neural adaptation. Advanced age does not affect neural adaptation of the AN in postlingually deafened, middle-aged and elderly adult CI users.
Screening, brief intervention, and referral to treatment (SBIRT) training reduces stigma and prepares orthopaedic providers to identify and intervene in opioid misuse: a prospective cohort study
Authors: Mierisch Cassandra , Hartman Cheryl , Quinn Caleb , Hartman David
Published: January 2022

Background:

Despite the evolution of responsible opioid prescription for musculoskeletal pain, patients remain at risk for opioid problematic use, misuse, and addiction. Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based practice to identify, reduce, and prevent those outcomes. This pilot study investigated the use of SBIRT practices developed to target opioid misuse in the orthopaedic practice environment and its applicability in the orthopaedic population.

Methods:

In this prospective cohort study, 19 orthopaedic providers underwent SBIRT training. Participants reported on their use of SBIRT over 6 wk and completed the Medical Condition Regard Scale (MCRS).

Results:

Twelve participants successfully implemented SBIRT, screening an average of 58.5% of patients. Seventeen percent of patients screened to an elevated risk level. Patients who screened as medium or high risk were 5.8 and 8.4 times more likely, respectively, to receive intervention compared with patients who screened to low risk or not screened (P<0.01). Regard for patients with opioid use for pain increased from an MCRS score of 44.6 to 52.5 (P<0.01). Ninety-five percent of participants found the training useful, and 89% would recommend the training to a colleague.

Conclusions:

This study demonstrated integration of SBIRT practices into an orthopaedic environment in which a significant proportion of orthopaedic patients screened to elevated risk of opioid misuse and qualified for brief intervention by the orthopaedic provider. SBIRT training had a positive impact on opioid-use stigma, a recognized barrier to care. Further study is warranted to determine the effect on patient outcomes and optimal implementation strategy.

Level of Evidence:

Level II.
The association between opioid misuse or abuse and hospital-based, acute care after spinal surgery: a retrospective cohort study
Authors: Rogozinski Jonathan A. , Flanigan Trenden L. , Kayanja Mark , Chen Roy J. , Fox Lieutenant Colonel Justin P.
Published: January 2022

Background:

Despite a growing prevalence of opioid use, the impact of opioid misuse or abuse (OMA) on surgical outcomes after spinal fusion surgery is ill-defined. This study was conducted to describe the relationship between a patient’s history of OMA and postoperative outcomes.

Methods:

Using the 2008-2013 Florida, Nebraska, and New York state inpatient databases, the authors identified adult patients who underwent thoracolumbar spinal fusion for degenerative disc disease and postsurgical syndromes. Patients were then subgrouped according to a history of OMA. Regression models were used to describe the association between a history of OMA and in-hospital outcomes, hospital based, acute care after discharge, and subsequent encounters for OMA.

Results:

The final sample included 73,442 patients including 1,332 patients with a history of OMA. Patients with this history tended to be younger, have a history of smoking (63.7% vs. 30.9%) and chronic pain (20.9% vs. 2.0%), and have revision surgery (5.6% vs. 3.9%). In the adjusted analyses, patients with a history of OMA had longer lengths of stay (4.5 vs. 3.8 days), higher healthcare charges ($129,264 vs. $118,065), and were more likely be readmitted within 1 yr (adjusted odds ratio=2.88), including hospital encounters which were OMA-specific 16.3% vs. 0.8).

Conclusions:

Patients with a history of OMA consume greater healthcare resources following spinal fusion surgery. It is important to identify these at-risk patients prior to surgery so their care can be tailored appropriately.

Level of Evidence:

Level III.
Length of hospital stay and mortality of hip fracture surgery in patients with Coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis
Authors: Tayyebi Hamed , Hasanikhah Masoud , Heidarikhoo Mohamadreza , Fakoor Sajad , Aminian Amir
Published: January 2022

Background:

Coronavirus disease 2019 (COVID-19) patients who undergo hip fracture surgery are expected to have worse outcomes because they are vulnerable to developing COVID-19-associated complications. The present review attempted to assess the in-hospital and 30-day mortality rates as well as the length of hospital stay in patients with COVID-19 infection who had hip fracture surgery.

Methods:

Two authors independently searched Google Scholar, PubMed, Web of Knowledge, SCOPUS, and Embase, based on the MeSH-matched scientific keywords. The nine-star Newcastle-Ottawa Scale (NOS) scoring system was employed to assess the methodological quality of all eligible studies.

Results:

Eleven cohort studies that included 336 patients comprised the study. Three studies reported in-hospital mortality. Eight studies reported 30-day postoperative mortality. The pooled in-hospital mortality rate was 29.8% (95% CI: 26.6%-35.6%). The pooled 30-day postoperative mortality rate was 35.0% (95% CI: 29.9%-40.5%). The mean hospital stay was 11.29 days (95% CI: 10.65 days-11.94 days).

Conclusions:

The rates of in-hospital and 30-day mortality in COVID-19 patients who undergo hip fracture surgery is high. These data suggest delaying hip fracture surgery until COVID-19 infection of the patients is controlled.

Level of Evidence:

Level II.
Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly
Authors: Galán-Olleros María , Rodríguez-Zamorano Patricia , García-Coiradas Javier , Llanos Sergio , Mora-Fernández Jesús , Valle-Cruz José Antonio , Marco Fernando
Published: January 2022

Currently, there is a wide awareness of the high degree of functional impairment and morbimortality associated with hip fractures in the elderly, and efforts are being made to improve outcomes. As age rises, physiological reserves decline, and more severe complications occur. Simultaneous bilateral extracapsular hip fractures in the setting of low-energy trauma in the elderly are rare but deserve special attention with treatment strategies that are in between those for unilateral hip fractures and elderly patients with multiple injuries. Adequate initial assessment, a multidisciplinary approach to trauma care, and the integration of medical and orthopaedic surgical attention are paramount. Furthermore, there is a need for early single-stage surgical fixation in medically stable patients and optimization of patients who are unfit. Despite some variations from unilateral cases, the main objective remains to achieve painless hips and stable fixation for early mobilization with the lowest morbidity and mortality rates. General anesthesia for intramedullary nailing using short nonreamed nails for stable fracture patterns and minimal reaming when long nails are used may be regarded as the best option. Physicians should be cautious of the higher risk of complications such as blood loss, fat embolism syndrome, and adult respiratory distress syndrome. Orthogeriatric management and multidisciplinary teams may also improve outcomes, as demonstrated for unilateral hip fractures. Secondary prevention of fractures is promoted through the prescription of antiosteoporotic treatment, nutritional assessment, and skills training. This literature review aims to help optimize the management of patients with simultaneous bilateral extracapsular hip fractures, outlining the differential concerns with respect to unilateral cases.
Controversies in the management of anterior cruciate ligament injuries in skeletally immature patients: a literature review of current treatment options
Authors: Selim Amr , Osmani Humza Tariq , Khan Wasim , Pengas Ioannis
Published: January 2022

Background:

Despite an increasing incidence of injury, there continues to be a paucity of literature, when compared with adult cohorts, for anterior cruciate ligament (ACL) disruption in skeletally immature patients. The detrimental long-term effects of chondral or meniscal damage resulting from an ACL deficient and unstable knee, has led most contemporary orthopaedic surgeons to opt for surgical intervention rather than nonoperative management. However, high failure rates in the young and adolescent group after formal ACL reconstruction, along with the potential risks of physeal disturbance, have been highlighted as a cause for concern. The aim of this review was to provide the state of art management of ACL injuries in skeletally immature patients based on the current evidence.

Methods:

A literature review on the different management options of ACL injuries in skeletally immature patients was conducted. The authors searched PubMed entries from inception until April 2021. The search was performed with the search terms “ACL injuries” AND “skeletally immature”.

Results:

A comprehensive search related to the management of “ACL injuries” generated 13,157 results. Thus, search was narrowed to include the term “children” to focus our study on 570 papers. To further refine our search, we included the terms “ACL injuries” AND “skeletally immature,” which produced 327 results.

Conclusion:

This review highlights pros and cons of current treatment options, based on available evidence, including a detailed assessment of factors affecting the success of repairing the ACL. Overall, further Level 1 studies are necessary to improve the available evidence.

Level of Evidence:

Level I.
Update on current enhanced recovery after surgery (ERAS) pathways for hip and knee arthroplasty: a review of the literature
Authors: Patel Om V. , Scuderi Giles R.
Published: January 2022

Enhanced recovery after surgery (ERAS) pathways for total hip and knee arthroplasty require continuous, comprehensive updates with the most current evidence-based guidelines. Guidelines are rapidly evolving in this topic because of interest in rapid recovery and outpatient total joint arthroplasty. This review article summarizes current literature to provide recommendations involving preoperative patient education and patient optimization, preoperative fasting and carbohydrate loading, analgesia, mode of anesthesia, intraoperative temperature management, hemostasis, postoperative nausea and vomiting management, early mobilization, and thromboprophylaxis. By promoting consensus, the authors aim to improve ERAS utilization and ultimately improve patient outcomes while also decreasing lengths of stay.
Incidence of Subsequent Surgical Intervention at Short-term Follow-up in Previously Healing and Stable Juvenile Osteochondritis Dissecans of the Knee
Authors: Metz Allan K. , Riederer Mark , Gagnier Joel , Crawford Eileen A.
Published: January 2022

Background:

Juvenile osteochondritis dissecans (OCD) of the knee is a defect of subchondral bone seen primarily in active children and adolescents. Studies have evaluated the incidence of surgery in knee OCD, but the incidence of subsequent surgery in patients with stable, healing lesions cleared to return to activities is unknown. This study sought to determine the incidence of surgery in participants with knee OCD lesions cleared to return to activities and evaluate predictors of subsequent surgery.

Methods:

A single center, retrospective review was performed of participants aged 7 to 18 with knee OCD. Inclusion criteria were stable lesion, skeletal immaturity, no history of previous knee surgery, release to activity without surgery, and at least 12 months of follow-up. Documentation of subsequent surgery was queried in the electronic health record. Participants with no recorded surgery were contacted through phone. Analysis included bivariate and logistic regression.

Results:

Twenty-five individuals were included in this study, with 7 undergoing surgery after returning to activity. Medial femoral condyle lesions were less likely to undergo surgery (B=−2.6, P=0.038). Average lesion size for the Surgery and No Surgery groups was 1.76±0.65 and 1.32±0.81 cm2, respectively, though not significantly different (P=0.21). The Surgery group returned to activity sooner (3.7 mo, range 1.1 to 6.4) than the No Surgery group (8.1 mo, range 1.8 to 35.4), though not significantly different (P=0.18). Mean follow-up time for the study was 42.7 (range 12.6 to 77.6) months. No participants contacted by phone progressed to surgery or reported symptoms that limited their activities.

Conclusions:

While the majority of participants with stable, healing, and asymptomatic knee OCD lesions have favorable outcomes with nonoperative management, some lesions may progress to surgery. Lesions on the medial femoral condyle may be predictive of lower likelihood of progression to surgery. Our study provides insight on the outcomes of nonoperative management of OCD lesions.

Level of Evidence:

Level IV—prognostic study.
Radiographic Follow-up After Normal Ultrasound Screening of the Hip in Breech Infants
Authors: Kim Nak Tscheol , Yang Hee Jin , Choi Chang Won , Park Moon Seok , Sung Ki Hyuk
Published: January 2022

Background:

Breech presentation is one of the most important risk factors for developmental dysplasia of the hip, and all breech infants should be screened. The necessity of further follow-up of developmental dysplasia of the hip after normal clinical and sonographic screening is a controversial subject. The purpose of this study to identify the incidence of delayed dysplasia in breech infants after normal ultrasound screening and the necessity of further clinical and radiologic follow-up in these patients.

Methods:

We included the 292 breech babies (128 boys and 164 girls) who showed normal hip ultrasound screening results. To determine the incidence of delayed radiographic dysplasia, anteroposterior hip radiographs were taken between 12 and 24 months of age to measure the acetabular index (AI).

Results:

The mean AI values were 22.8±3.4 in boys and 24.9±3.1 in girls. Applying the Tönnis criteria, 29 patients (9.9%) were considered to have delayed radiographic dysplasia (16 boys and 13 girls). No significant difference was found in any demographic variables between babies with and without delayed radiographic dysplasia. None of these 29 infants underwent any treatment for radiographic dysplasia. Applying Kuong’s criteria to 292 infants, only 2 patients (0.7%) demonstrated radiographic dysplasia on the hip anteroposterior radiographs taken at 14 months.

Conclusions:

The incidence of radiographic dysplasia significantly varied depending on which criteria were applied. In order to find out more accurate incidence rates of delayed radiographic dysplasia, large-scale studies of the normative AI data for Korean infants are required.

Level of Evidence:

Prognostic Level III.
Thread Delamination in 4.5 mm AO Cannulated Screws: A Small Case Series in the Pediatric Trauma Population
Authors: Murawski Christopher D. , Reddy Rajiv P. , Tisherman Robert T. , Bosch Patrick P. , Grudziak Jan S. , Mendelson Stephen A. , Ward W. Timothy , Olgun Zeynep Deniz
Published: January 2022

Background:

Thread delamination associated with cannulated screws have been reported but likely represent an under-recognized complication in the orthopaedic literature. The purpose of this study is to report the occurrence of repeated hardware failures through thread delamination in the setting of a commonly used orthopaedic cannulated screw implant in a small cohort involving pediatric fracture care at a single academic level I trauma center.

Methods:

Between August 2015 and December 2020, 9 cases of hardware failure associated with 4.5 mm arbeitsgemeinschaft für osteosynthesefragen cannulated stainless-steel screws were identified within a pediatric orthopaedic division at a single academic level I trauma center. Three cases were excluded, and 6 cases of thread delamination were retrospectively reviewed.

Results:

Six cases of thread delamination comprised a cohort of patients with a mean age of 13.7 years (range: 12 to 15 y). All cases involved 4.5 mm arbeitsgemeinschaft für osteosynthesefragen cannulated screws, including 5 partially threaded and 1 fully threaded screw. Five cases involved open reduction and internal fixation of incarcerated medial humeral epicondylar fragments and the other case was an open reduction and internal fixation of a displaced medial malleolar fracture. Five of these occurred within a recent 18-month period of time. There were 4 cases of partial, distal thread delamination, 1 case of partial proximal thread delamination and another case of complete thread delamination which had unwound into the tibiotalar joint and required an anterior ankle arthrotomy to retrieve the thread. None of the 5 patients in this series who currently harbor a retained thread have experienced symptoms because of this issue.

Conclusions:

Thread delamination associated with cannulated screw implantation likely represents an under-reported phenomenon in orthopaedic surgery. In cases where retained, delaminated threads exist, these do not appear to cause short-term concern.

Level of Evidence:

Level IV—case series.
Surgical Treatment of the Intraspinal Rib Head Dislocation in Children With Dystrophic Scoliosis Secondary to Type 1 Neurofibromatosis
Authors: Gao Rongxuan , Guo Dong , Zhang Xuejun , Sun Baosheng , Yao Ziming , Cao Jun , Long Clara Y. , Bai Yunsong , Liu Haonan
Published: January 2022

Background:

The purpose of this study was to explore the surgical treatment of intraspinal rib head dislocation (IRH) in children with dystrophic scoliosis secondary to type 1 neurofibromatosis (NF1-DS).

Methods:

From 2006 to 2019, 32 of 128 patients with NF1-DS were found to have IRH and enrolled in this study. There were 19 boys and 13 girls with an average age of 8.8±2.6 years. Patients were divided into 2 groups: group A (n=25) without IRH resection and group B (n=7) with IRH resection. The intraspinal rib proportion (IRP), apical vertebra rotation, apical vertebral translation, main thoracic curve Cobb angle, trunk shift and thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis were measured before and after the operation. Spinal injury was graded based on the American Spinal Injury Association (ASIA) Impairment Scale.

Results:

The study group had a total of 42 IRH. The mean follow-up duration was 46.1±28.7 months. The preoperative IRP in both groups was similar (35.5±14.3% vs. 31.2±15.3%, P=0.522). The postoperative IRP was lower in group B (18.5±11.2% vs. 0%, P=0.002). The IRP in group A decreased from preoperative (31.2±15.3%) to postoperative (18.5±11.2%) (P<0.05). There was no significant difference in the apical vertebra rotation, apical vertebral translation, main thoracic curve Cobb angle, trunk shift, thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis between the 2 groups before surgery and after surgery. Four patients with nerve injury caused by the IRH had full neurological recovery postoperatively. All patients were ASIA grade E at the last follow-up.

Conclusions:

The surgical treatment of IRH in children with NF1-DS should be determined on the basis of the presence of preoperative neurological symptoms. This study supports the practice of correcting spinal deformities only in patients with mild or no spinal cord injury. If there are obvious neurological symptoms, IRH resection is necessary to relieve spinal cord compression to recover nerve function.

Level of Evidence:

Level III.
Rapid Unmasking of Immune-related Adverse Events After Discontinuation of Chemotherapy in Chemo-immunotherapy Regimens
Authors: Riopel Nicholas D. , Chu Quincy , Walker John , Ye Carrie
Published: January 2022

Pembrolizumab is an immune-checkpoint inhibitor (ICI) of programmed cell death protein 1 (PD-1), which restores T–cell-mediated antitumor immune activity and therefore enhances the body’s immune response to cancer cells. Due to the nature of this therapy, immune-related adverse events (irAE) can manifest in nearly every organ system. Chemo-immunotherapy regimens are now considered first-line treatment for several cancers, with recent literature suggesting there are higher rates of certain irAEs with ICI monotherapy when compared with chemo-immunotherapy combinations. In certain regimens chemo-immunotherapy induction is followed by ICI maintenance monotherapy, and data regarding irAE incidence in this transition period are very limited. We report 3 cases of patients on pembrolizumab in combination with cytotoxic chemotherapy who developed an irAE shortly following discontinuation of a chemotherapy agent. Cases were identified in the Rheumatology in Immuno-Oncology clinic at the University of Alberta and clinical data were extracted by retrospective chart review after obtaining written consent from individual patients. These findings demonstrate that chemotherapy may suppress irAEs in patients using ICIs, and that when chemotherapy agents in combined regimens are discontinued, irAEs can be “unmasked” within the following 6 weeks. Clinicians should be aware of this risk and monitor for irAE development during this critical time period. To the best of the authors’ knowledge, this has not been previously reported in the literature.