bluuebunny/crossref_metadata_2025 huggingface dataset:
Emotional, Social, and Existential Loneliness Before and During the COVID-19 Pandemic: Prevalence and Risk Factors Among Dutch Older Adults
Authors: van Tilburg Theo G
Published: June 2021

Objectives

The coronavirus disease 2019 pandemic, with its accompanying isolation measures, has led to increasing loneliness among older adults. In this study, we examine whether the increased level of loneliness observed in the Netherlands persisted into the fall of 2020, whether there were differences in emotional, social, and existential loneliness, and whether the presence of well-known risk factors for loneliness also led to further increases in loneliness during the pandemic.

Methods

Data were obtained from the Longitudinal Aging Study Amsterdam, with observations of 404 community-dwelling older adults aged 74–96 years from 2019 and fall 2020.

Results

Loneliness increased between 2019 and 2020, and the increase was particularly high for emotional loneliness (partial η 2 = 0.19). Having a partner and a high mastery and good physical functioning before the pandemic provided some protection against an increase in loneliness.

Discussion

Loneliness increased for almost all older people. Targeted policies can reduce the negative impact of vulnerabilities. Efforts to combat loneliness during the pandemic should focus not only on groups traditionally considered vulnerable, such as socially isolated people, but also on older adults with a partner and who have daily contact with others.
Brain-specific heterozygous loss-of-function of ATP2A2, endoplasmic reticulum Ca2+ pump responsible for Darier’s disease, causes behavioral abnormalities and a hyper-dopaminergic state
Authors: Nakajima Kazuo , Ishiwata Mizuho , Weitemier Adam Z , Shoji Hirotaka , Monai Hiromu , Miyamoto Hiroyuki , Yamakawa Kazuhiro , Miyakawa Tsuyoshi , McHugh Thomas J , Kato Tadafumi
Published: June 2021

A report of a family of Darier’s disease with mood disorders drew attention when the causative gene was identified as ATP2A2 (or SERCA2), which encodes a Ca2+ pump on the endoplasmic reticulum (ER) membrane and is important for intracellular Ca2+ signaling. Recently, it was found that loss-of-function mutations of ATP2A2 confer a risk of neuropsychiatric disorders including depression, bipolar disorder and schizophrenia. In addition, a genome-wide association study found an association between ATP2A2 and schizophrenia. However, the mechanism of how ATP2A2 contributes to vulnerability to these mental disorders is unknown. Here, we analyzed Atp2a2 heterozygous brain-specific conditional knockout (hetero cKO) mice. The ER membranes prepared from the hetero cKO mouse brain showed decreased Ca2+ uptake activity. In Atp2a2 heterozygous neurons, decays of cytosolic Ca2+ level were slower than control neurons after depolarization. The hetero cKO mice showed altered behavioral responses to novel environments and impairments in fear memory, suggestive of enhanced dopamine signaling. In vivo dialysis demonstrated that extracellular dopamine levels in the NAc were indeed higher in the hetero cKO mice. These results altogether indicate that the haploinsufficiency of Atp2a2 in the brain causes prolonged cytosolic Ca2+ transients, which possibly results in enhanced dopamine signaling, a common feature of mood disorders and schizophrenia. These findings elucidate how ATP2A2 mutations causing a dermatological disease may exert their pleiotropic effects on the brain and confer a risk for mental disorders.
Effectiveness and Safety of Compound Polymyxin B Ointment in Treatment of Burn Wounds: A Meta-analysis
Authors: Lu Li-Chin , Chang Fei-Yu , Lv Guo-Zhong , Lan Shao-Huan
Published: June 2021

Burn injuries represent a global public health concern. The guidelines for burn care mention that the treatment of burn injuries depends on the type of burn injury, depth of tissue, area of wounds, and site on the body. At present, several topical antimicrobial agents are used in the treatment of burn wounds as a first choice. This study aims to investigate the effectiveness of the compound polymyxin B topical agents for the treatment of burn wounds. PubMed, Web of Science, ProQuest, and China National Knowledge Infrastructure databases were searched for articles published until January 2021. The studies that conducted clinical trials comparing compound polymyxin B ointment with other treatment reagents for burn wound treatment were included. A total of three outcomes, which were investigator-assessed clinical response, including mortality, bacterial counts, efficacy and safety were included for analysis in this study. In total, 12 randomized controlled trials, 1 clinical trial, 2 prospective studies, and 1 retrospective study were extracted. The result of mortality showed no significant difference (risk ratio [RR]: 0.70, 95% CI: 0.21–2.31, P = .56); wound healing revealed an RR of 1.59 (95% CI: 1.40–1.81, P < .001); time to heal revealed a mean difference of −5.09 (95% CI: −6.31 to −3.86) days (P < .001); scar incidence was not significantly lower in the treatment group (RR: 0.70, 95% CI: 0.38–1.30, P = .26); and adverse event incidence was significantly lower in the treatment group (RR: 0.26, 95% CI: 0.09–0.72, P < .01). The compound polymyxin B ointment shows the effectiveness of increase in the wound healing and accelerates the time of healing with fewer adverse effects.
The Use of Extracorporeal Membrane Oxygenation in Severely Burned Patients: A Survey of North American Burn Centers
Authors: Hebert Sebastien , Erdogan Mete , Green Robert S , Rasmussen Jack
Published: June 2021

Respiratory failure and acute respiratory distress syndrome can occur in burn patients with or without inhalational injury and can significantly increase mortality. For patients with severe respiratory failure who fail conventional therapy with mechanical ventilation, the use of venovenous extracorporeal membrane oxygenation (ECMO) may be a life-saving salvage therapy. There have been a series of case reports detailing the use of ECMO in burn patients over the last 20 years, but very little is currently known about the status of ECMO use at burn centers in North America. Using a web-based survey of burn center directors in Canada and the United States, we examined the rate of usage of ECMO in burn care, barriers to its use, and the perioperative management of burn patients receiving ECMO therapy. Our findings indicate that approximately half of the burn centers have used ECMO in the care of burn patients, but patient volume is very low on average (less than 1 per year). Of centers that do use ECMO in burn care, only 40% have a specified protocol for doing so. Approximately half have operated on patients being actively treated with ECMO therapy, but perioperative management of anticoagulation varies widely. A lack of experience and institutional support and a perceived lack of evidence to support ECMO use in burn patients were the most commonly identified barriers to more widespread uptake. Better collaboration between burn centers will allow for the creation of consensus statements and protocols to improve outcomes for burn patients who require ECMO.
Pan-cancer network disorders revealed by overall and local signaling entropy
Authors: Feng Li , Sun Yi-Di , Li Chen , Li Yi-Xue , Chen Luo-Nan , Zeng Rong
Published: June 2021

Tumor development is a process involving loss of the differentiation phenotype and acquisition of stem-like characteristics, which is driven by intracellular rewiring of signaling network. The measurement of network reprogramming and disorder would be challenging due to the complexity and heterogeneity of tumors. Here, we proposed signaling entropy (SR) to assess the degree of tumor network disorder. We calculated SR for 33 tumor types in The Cancer Genome Atlas database based on transcriptomic and proteomic data. The SR of tumors was significantly higher than that of normal samples and was highly correlated with cell stemness, cancer type, tumor grade, and metastasis. We further demonstrated the sensitivity and accuracy of using local SR in prognosis prediction and drug response evaluation. Overall, SR could reveal cancer network disorders related to tumor malignant potency, clinical prognosis, and drug response.
Genetic, anatomical, and environmental patterns related to pod shattering resistance in domesticated cowpea [Vigna unguiculata(L.) Walp]
Authors: Lo Sassoum , Parker Travis , Muñoz-Amatriaín María , Berny-Mier y Teran Jorge C , Jernstedt Judy , Close Timothy J , Gepts Paul
Published: June 2021

Pod shattering, which causes the explosive release of seeds from the pod, is one of the main sources of yield losses in cowpea in arid and semi-arid areas. Reduction of shattering has therefore been a primary target for selection during domestication and improvement of cowpea, among other species. Using a mini-core diversity panel of 368 cowpea accessions, four regions with a statistically significant association with pod shattering were identified. Two genes (Vigun03g321100 and Vigun11g100600), involved in cell wall biosynthesis, were identified as strong candidates for pod shattering. Microscopic analysis was conducted on a subset of accessions representing the full spectrum of shattering phenotypes. This analysis indicated that the extent of wall fiber deposition was highly correlated with shattering. The results from this study also demonstrate that pod shattering in cowpea is exacerbated by arid environmental conditions. Finally, using a subset of West African landraces, patterns of historical selection for shattering resistance related to precipitation in the environment of origin were identified. Together, these results shed light on sources of resistance to pod shattering, which will, in turn, improve climate resilience of a major global nutritional staple.
Multiomics analyses reveal the roles of the ASR1 transcription factor in tomato fruits
Authors: Dominguez Pia Guadalupe , Conti Gabriela , Duffy Tomás , Insani Marina , Alseekh Saleh , Asurmendi Sebastián , Fernie Alisdair R , Carrari Fernando
Published: June 2021

The transcription factor ASR1 (ABA, STRESS, RIPENING 1) plays multiple roles in plant responses to abiotic stresses as well as being involved in the regulation of central metabolism in several plant species. However, despite the high expression of ASR1 in tomato fruits, large scale analyses to uncover its function in fruits are still lacking. In order to study its function in the context of fruit ripening, we performed a multiomics analysis of ASR1-antisense transgenic tomato fruits at the transcriptome and metabolome levels. Our results indicate that ASR1 is involved in several pathways implicated in the fruit ripening process, including cell wall, amino acid, and carotenoid metabolism, as well as abiotic stress pathways. Moreover, we found that ASR1-antisense fruits are more susceptible to the infection by the necrotrophic fungus Botrytis cinerea. Given that ASR1 could be regulated by fruit ripening regulators such as FRUITFULL1/FRUITFULL2 (FUL1/FUL2), NON-RIPENING (NOR), and COLORLESS NON-RIPENING (CNR), we positioned it in the regulatory cascade of red ripe tomato fruits. These data extend the known range of functions of ASR1 as an important auxiliary regulator of tomato fruit ripening.
Genetic variations in 3′UTRs ofSMUG1andNEIL2genes modulate breast cancer risk, survival and therapy response
Authors: Cumova Andrea , Vymetalkova Veronika , Opattova Alena , Bouskova Veronika , Pardini Barbara , Kopeckova Katerina , Kozevnikovova Renata , Lickova Katerina , Ambrus Miloslav , Vodickova Ludmila , Naccarati Alessio , Soucek Pavel , Vodicka Pavel
Published: June 2021

Breast cancer (BC) is the most frequent malignancy in women accounting for approximately 2 million new cases worldwide annually. Several genetic, epigenetic and environmental factors are known to be involved in BC development and progression, including alterations in post-transcriptional gene regulation mediated by microRNAs (miRNAs). Single nucleotide polymorphisms (SNPs) located in miRNA binding sites (miRSNPs) in 3′-untranslated regions of target genes may affect miRNA-binding affinity and consequently modulate gene expression. We have previously reported a significant association of miRSNPs in the SMUG1 and NEIL2 genes with overall survival in colorectal cancer patients. SMUG1 and NEIL2 are DNA glycosylases involved in base excision DNA repair. Assuming that certain genetic traits are common for solid tumours, we have investigated wherever variations in SMUG1 and NEIL2 genes display an association with BC risk, prognosis, and therapy response in a group of 673 BC patients and 675 healthy female controls. Patients with TC genotype of NEIL2 rs6997097 and receiving only hormonal therapy displayed markedly shorter overall survival (HR = 4.15, 95% CI = 1.7–10.16, P = 0.002) and disease-free survival (HR = 2.56, 95% CI = 1.5–5.7, P = 0.02). Our results suggest that regulation of base excision repair glycosylases operated by miRNAs may modulate the prognosis of hormonally treated BC.
The dynamics of stem water storage in the tops of Earth’s largest trees—Sequoiadendron giganteum
Authors: Williams Cameron B , Reese Næsborg Rikke , Ambrose Anthony R , Baxter Wendy L , Koch George W , Dawson Todd E
Published: June 2021

Water stored in tree stems (i.e., trunks and branches) is an important contributor to transpiration that can improve photosynthetic carbon gain and reduce the probability of cavitation. However, in tall trees, the capacity to store water may decline with height because of chronically low water potentials associated with the gravitational potential gradient. We quantified the importance of elastic stem water storage in the top 5–6 m of large (4.2–5.0 m diameter at breast height, 82.1–86.3 m tall) Sequoiadendron giganteum (Lindley) J. Buchholz (giant sequoia) trees using a combination of architectural measurements and automated sensors that monitored summertime diel rhythms in sap flow, stem diameter and water potential. Stem water storage contributed 1.5–1.8% of water transpired at the tree tops, and hydraulic capacitance ranged from 2.6 to 4.1 l MPa−1 m−3. These values, which are considerably smaller than reported for shorter trees, may be associated with persistently low water potentials imposed by gravity and could indicate a trend of decreasing water storage dynamics with height in tree. Branch diameter contraction and expansion consistently and substantially lagged behind fluxes in water potential and sap flow, which occurred in sync. This lag suggests that the inner bark, which consists mostly of live secondary phloem tissue, was an important hydraulic capacitor, and that hydraulic resistance between xylem and phloem retards water transfer between these tissues. We also measured tree-base sap flux, which lagged behind that measured in trunks near the tree tops, indicating additional storage in the large trunks between these measurement positions. Whole-tree sap flow ranged from 2227 to 3752 l day−1, corroborating previous records for similar-sized giant sequoia and representing the largest yet reported for any individual tree. Despite such extraordinarily high daily water use, we estimate that water stored in tree-top stems contributes minimally to transpiration on typical summer days.
A double-ratio method to measure fast, slow and reverse sap flows
Authors: Deng Zijuan , Vice Heather K , Gilbert Matthew E , Adams Mark A , Buckley Thomas N
Published: June 2021

Sap velocity measurements are useful in fields ranging from plant water relations to hydrology at a variety of scales. Techniques based on pulses of heat are among the most common methods to measure sap velocity, but most lack ability to measure velocities across a wide range, including very high, very low and negative velocities (reverse flow). We propose a new method, the double-ratio method (DRM), which is robust across an unprecedented range of sap velocities and provides real-time estimates of the thermal diffusivity of wood. The DRM employs one temperature sensor upstream (proximal) and two sensors downstream (distal) to the source of heat. This facilitates several theoretical, heat-based approaches to quantifying sap velocity. We tested the DRM using whole-tree lysimetry in Eucalyptus cypellocarpa L.A.S. Johnson and found strong agreement across a wide range of velocities.
Vaccine allergy: evidence to consider for COVID-19 vaccines
Authors: Nilsson Lennart , Csuth Ágnes , Storsaeter Jann , Garvey Lene H. , Jenmalm Maria C.
Published: June 2021

Purpose of review

Whereas the COVID-19 pandemic has changed our lives worldwide, we hope that vaccination can combat the disease. We propose how to evaluate suspected severe allergic reactions to the vaccines so that as many as possible may be safely vaccinated.

Recent findings

Rare cases of severe allergic reactions after COVID-19 vaccination have been observed, seemingly at a higher frequency than for other vaccines. Few excipients are likely to have caused these reactions. IgE-mediated reactions to polyethylene glycol (PEG) and its derivatives are the most suspected, albeit hitherto unproven, causes. We suggest to make a diagnosis based on skin tests with PEG and PEG derivatives and that these be considered in relation to the decisions required before the first and the second vaccine dose. A vaccine without these excipients is available, but published data about its side effects are limited.

The underlying immunological mechanisms of the rare severe allergic reactions to the COVID-19 vaccines are poorly understood and need to be clarified. Identifying those who have an undiagnosed allergy to PEG and PEG derivatives is crucial before vaccination, and these substances are found in laxatives, cosmetics and in 30% of all our medications today.
Fibrinogen in traumatic haemorrhage
Authors: Winearls James , Reade Michael C. , McQuilten Zoe , Curry Nicola
Published: June 2021

Purpose of review

Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy (TIC) have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the role of fibrinogen in normal haemostasis, the effect of trauma and TIC on fibrinogen levels and current evidence for fibrinogen replacement in the management of traumatic haemorrhage.

Recent findings

Fibrinogen is usually the first factor to reach critically low levels in traumatic haemorrhage and hypofibrinogenaemia after severe trauma is associated with increased risk of massive transfusion and death. It is postulated that the early replacement of fibrinogen in severely injured trauma patients can improve outcomes. There is, however, a paucity of evidence to support this, and in addition, there is little evidence to support or refute the effects of cryoprecipitate or fibrinogen concentrate for fibrinogen replacement.

The important role fibrinogen plays in haemostasis and effective clot formation is clear. A number of pilot trials have investigated different strategies for fibrinogen replacement in severe trauma. These trials have formed the basis of several large-scale phase III trials, which, cumulatively will provide a firm evidence base to harmonise worldwide clinical management of severely injured trauma patients with major haemorrhage.
The Predictive Role of Emotional Intelligence, Resilience, and Personality Traits in Addiction Potential of Students at Arak University of Medical Sciences
Authors: Rezaei Ali M. , Naeim Mahdi , Asadi Reza , Ardebil Fardad D.T.M. , Bayat Mohsen , Khoshroo Kimia
Published: June 2021

Introduction:

The aim of this study was to examine the predictive role of emotional intelligence, resilience, and personality traits in addiction potential of students at Arak University of Medical Sciences.

Methods:

The study population consisted of students of Arak University of Medical Sciences, of which 200 participants were selected using cluster sampling and filled out the following questionnaires: EI Schutte, Connor-Davidson Resilience Scale (CD-RIS), Personality Inventory (NEO-FFI), and Iranian Addiction Potential Scale. The research design was correlational and data were analyzed using multiple regression and Pearson correlation coefficient.

Results:

The results showed a significant negative correlation between resilience and addiction potential and significant negative relationship between components of emotional intelligence and addiction potential. Among the personality traits, extroversion, agreeableness, conscientiousness, and openness to experience were significantly negatively correlated with addiction potential. However, there was a significant positive relationship between neuroticism and addiction potential. Optimism/emotional regulation, conscientiousness, neuroticism, and appraisal of emotions can predict addiction potential and, in total, explain 48% of the variance in addiction potential.

Conclusions:

The results showed that there was a relationship between personality traits, emotional intelligence, and resilience with addiction potential. On the basis of regression analysis results, it is recommended that to reduce addiction potential, instead of investing on all the mentioned variables, to mainly focus on the variables of optimism/emotion regulation, contentiousness, neuroticism and appraisal of emotions, so that a reduction in addiction potential can be achieved with less time and lower cost.
Bilateral Bispectral Index Monitoring Performance in the Detection of Seizures in Nonanesthetized Epileptic Patients: An Observational Study
Authors: Fàbregas Neus , Valencia Jose F. , Belda Isabel , Tercero Ana , Hervias Adriana , Villafuerte Santiago , Gambús Pedro L. , Carreño Mar , Valero Ricard
Published: June 2021

Background:

The aim of this observational study was to determine whether bilateral bispectral index (BIS) monitoring can detect seizures in epileptic patients.

Methods:

Four-channel frontal BIS monitoring and standard 40-channel electroencephalography monitoring were conducted in epileptic patients undergoing evaluation for epilepsy surgery. The BIS numerical value, signal quality index, electromyography, suppression ratio, and color density spectral array were continuously recorded. In patients with electroencephalography-confirmed seizures, the mean value and trend (slope of linear regression) of bilateral BIS monitor parameters were analyzed from 1 minute before to 1 minute after seizure onset.

Results:

Of 48 patients included in the study, 21 (43.8%) had at least 1 seizure. BIS numerical value was not able to detect focal or focal to bilateral tonic-clonic seizures. Considering all seizures, the only significant differences between recordings 1 minute before and 1 minute after seizure onset were a decrease in the signal quality index slope from 1 hemisphere (0.039±0.297 vs. −0.085±0.321, respectively; P=0.029) and in the mean signal quality index recorded from both hemispheres (left hemisphere: 65.775±30.599 vs. 61.032±26.285; P=0.016 and right hemisphere: 63.244±31.985 vs. 59.837±27.360; 0.029); these differences were not maintained after Hochberg adjustment for multiple comparisons. In seizures occurring during sleep, there was a change in the electromyography slope of 1 hemisphere before and after seizure onset (−0.141±0.176 vs. 0.162±0.140, respectively; P=0.038). There were variable responses in BIS parameters in the 3 patients who developed focal nonconvulsive seizure clusters.

Conclusion:

Bilateral BIS monitoring was not able to detect the occurrence of seizures in epileptic patients.
Local Bone Grafting Is Sufficient for Instrumented Adolescent Idiopathic Scoliosis Surgery: A Preliminary Study
Authors: Yataganbaba Alper , Gahukamble Abhay , Antoniou Georgia , Freeman Brian J.C. , Cundy Peter J.
Published: June 2021

Background:

Several options for grafting exist; iliac crest bone grafting, allografts, and bone substitutes. Local bone graft (LBG) offers high-quality bone graft and no commercial cost. The aim of this study was to assess the clinical and radiologic results of adolescent idiopathic scoliosis (AIS) surgery with posterior instrumentation and fusion (PIF) in patients using only LBG and to measure the quantities harvested.

Methods:

A total of 218 AIS patients who underwent pedicle screw PIF surgery using only LBG with a minimum 1-year follow-up were reviewed. Bone was harvested during surgery from the excised facet joints, spinous processes (not from the end instrumented vertebrae) and decortication of laminae and transverse processes in the operative field. The harvested bone graft weight of 127 patients was recorded prospectively and then computed to graft weight per kilogram body weight (GWPK) and graft weight per motion segment (GWPMS).

Results:

The median follow-up time was 24.7 months (12.1 to 133 mo) with 128 of the 218 patients having over 2 years follow-up. A total of 280 curves were fused. One hundred fifty-six of the patients had single curve instrumentation and 62 had double curve surgery. The median preoperative primary Cobb angle was 57.0 (31 to 100) degrees and postoperatively was 20.0 (0 to 66) degrees, indicating a median correction of 65.3% (17.5% to 100%). The median graft weight was 30 g (14 to 62 g), GWPK was 0.54 g/kg (0.24 to 1.29 g/kg) and GWPMS was 3.3 g/motion segments (2.3 to 10.0 g/kg). Twelve of 218 patients (5.5%) required subsequent surgery. Only 2 patients developed pseudarthrosis (0.91%), noting that modern segmental instrumentation warrants longer follow-up for increased confidence of complete fusion.

Conclusions:

LBG achieved successful fusion in over 99% of patients undergoing PIF for AIS. The described terms GWPK and GWPMS can be insightful for future studies. LBG offers a safe and low-cost solution for bone grafting in AIS surgery.

Level of Evidence:

Level IV.
Has There Been a Change in the Age of Presentation of Patients With DDH After the Implementation of a Dedicated Ultrasound-screening Program?
Authors: Roof Mackenzie A. , Gibon Emmanuel , Rios-Ruíz Gilberto , Castañeda Pablo
Published: June 2021

Background:

We sought to determine if the age of patients presenting to a tertiary subspecialty hospital dedicated to pediatric orthopaedics has changed over the last 21 years and determine if a dedicated ultrasound-screening program implemented in 2006 made any difference.

Methods:

We reviewed the hospital charts for 9299 patients diagnosed with developmental dysplasia of the hip (DDH) and determined the age at the time of presentation; this was a consecutive series of all patients presenting between 1998 and 2019. We determined the diagnosis and age from the chart, 8011 were female (86.15%), and 1288 were male (13.85%). The left hip was affected in 4588 cases (49.34%), the right hip in 1824 cases (19.62%), and there were 2887 bilateral cases (31.05%).

Results:

Over the 21 years, the mean age of presentation was 2.36 years (range, 0.1 to 17 y). In 1998, the mean age was 2.49 years (range, 0.1 to 16 y). In 2006, a dedicated ultrasound-screening clinic was instituted. The mean age decreased to 1.70 years in 2019 (range, 0.1 to 14 y). The mean age at presentation decreased significantly from 2.65 years, between 1998 and 2005, to 2.19 between 2006 and 2019 (P=0.0067).

Conclusions:

The implementation of a dedicated ultrasound-screening protocol was significantly correlated with a decrease in the mean age of diagnosis of DDH. The results of treatment of DDH are known to be better the sooner the diagnosis is made. Given that the age of presentation remains a challenge, especially in developing countries, a dedicated ultrasound-screening program is one step to improve our ability to detect DDH in patients at a younger age.

Level of Evidence:

Level IV—diagnostic.
Modified Oxford Bone Scores Are Reduced in Patients With Slipped Capital Femoral Epiphysis Compared With Healthy Controls
Authors: Pflug Emily M. , Herrero Christina , Zhong Jack R. , Castañeda Pablo
Published: June 2021

Background:

The etiology and pathogenesis of slipped capital femoral epiphysis (SCFE) are attributable to abnormalities of the proximal femoral epiphysis. This study aimed to examine if there is a difference in the bone age of patients diagnosed with SCFE compared with patients without hip pathology.

Methods:

We identified a consecutive series of patients treated for SCFE between December 2012 and December 2019 from a departmental database. Retrospective chart review was performed to collect demographic information and patient medical history. We then obtained a control group of statistically similar patients based on age and sex. These patients did not have hip pathology or medical comorbidities that could alter their bone age. The modified Oxford bone score (mOBS) was calculated for both groups by 3 blinded reviewers. We excluded patients with unstable slips, endocrine disorders, and inadequate imaging.

Results:

We identified 60 patients with stable idiopathic SCFE during the study period; 45 met inclusion criteria and were included in the final analysis. There were 27 males and 18 females. The average age of patients with SCFE was higher in males than females (12.6 vs. 11.1, P<0.01). Patients in the comparison cohort did not differ significantly from the SCFE cohort in terms of age (11.6 vs. 12.0, P=0.06) or sex (P=0.52). The comparison group’s median mOBS was significantly higher than the SCFE group (22.5 vs. 20.5, P<0.01). The difference in the mOBS between male and female patients in the SCFE group approached significance (20.0 vs. 21.0, P=0.05). The weighted κ coefficient was 0.93.

Conclusions:

Patients with SCFE have a decreased bone age compared with patients without hip pathology. Male patients with SCFE were more likely to be older compared with female patients.

Level of Evidence:

Level IV—retrospective study.
Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature
Authors: Rushton Paul R.P. , Nasto Luigi , Parent Stefan , Turgeon Isabelle , Aldebeyan Sultan , Miyanji Firoz
Published: June 2021

Study Design.

Prospective case series.

Objective.

Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients.

Summary of Background Data.

The value of AVBT is currently unclear given the paucity of available data.

Methods.

Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for >2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU).

Results.

One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 ± 1.4 years (8.2–16.7) and Risser 0.5 ± 0.9 (0–3). Follow up was mean 37 ± 9 months (15–64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8° ± 10.2 (31–81) and corrected significantly to 26.6° ± 10.1 (−3–61) at FE radiograph (P < 0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1° ± 12.4 (−37–57) (P < 0.001). There was a small but significant increase between 1-year and FU to 25.7° ± 16.3 (−32–58) (P < 0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0° ± 9.5 (3–57) to 20.3° ± 10.3 (0–52) at FU (P < 0.001). Rib hump was corrected from 14.1 ± 4.8 (0–26) to 8.8° ± 5.4 (0–22) at FU (P < 0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions.

Conclusion.

AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure.

Level of Evidence: 3
What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?
Authors: Lee Nathan J. , Buchanan Ian A. , Zuckermann Scott L. , Boddapati Venkat , Mathew Justin , Geiselmann Matthew , Park Paul J. , Leung Eric , Buchholz Avery L. , Khan Asham , Mullin Jeffrey , Pollina John , Jazini Ehsan , Haines Colin , Schuler Thomas C. , Good Christopher R. , Lombardi Joseph M. , Lehman Ronald A.
Published: June 2021

Study Design.

Multicenter cohort.

Objective.

To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level).

Summary of Background Data.

There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches.

Methods.

We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery.

Results.

After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05).

Conclusion.

Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed.

Level of Evidence: 3
Reducing Postoperative Opioid-prescribing Following Posterior Lumbar Fusion Does Not Significantly Change Patient Satisfaction
Authors: Bloom David A. , Manjunath Amit K. , Dinizo Michael , Fried Jordan W. , Jazrawi Laith M. , Protopsaltis Themistocles S. , Fischer Charla R.
Published: June 2021

Study Design.

Retrospective comparative; LOE-3.

Objective.

The purpose of this study was to investigate what effect, if any, an institutional opioid reduction prescribing policy following one- or two-level lumbar fusion has on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results.

Summary of Background Data.

Previous research has demonstrated that high levels of opioid-prescribing may be related, in part, to a desire to produce superior patient satisfaction.

Methods.

A retrospective review of prospectively collected data was conducted on patients who underwent one- or two-level lumbar fusions L3-S1 between October 2014 and October 2019 at a single institution. Patients with complete survey information were included in the analysis. Patients with a history of trauma, fracture, spinal deformity, fusions more than two levels, or prior lumbar fusion surgery L3-S1 were excluded. Cohorts were based on date of surgery relative to implementation of an institutional opioid reduction policy, which commenced in October 1, 2018. To better compare groups, opioid prescriptions were converted into milligram morphine equivalents (MME).

Results.

A total of 330 patients met inclusion criteria: 259 pre-protocol, 71 post-protocol. There were 256 one-level fusions and 74 two-level fusions included. There were few statistically significant differences between groups with respect to patient demographics (P > 0.05) with the exception of number of patients who saw the pain management service, which increased from 36.7% (95) pre-protocol to 59.2% (42) post-protocol; P < 0.001. Estimated blood loss (EBL) decreased from 533 ± 571 mL to 346 ± 328 mL (P = 0.003). Percentage of patients who underwent concomitant laminectomy decreased from 71.8% to 49.3% (P < 0.001). Average opioids prescribed on discharge in the pre-protocol period was 534 ± 425 MME, compared to after initiation of the protocol, that is 320 ± 174 MME (P < 0.001). There was no statistically significant difference with respect to satisfaction with pain control, 4.49 ± 0.85 pre-protocol versus 4.51 ± 0.82 post-protocol (P = 0.986).

Conclusion.

A reduction in opioids prescribed at discharge after one- or two-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.

Level of Evidence: 3
Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population
Authors: Nguyen William , Chang Ki-Eun , Formanek Blake , Ghayoumi Pouriya , Buser Zorica , Wang Jeffrey
Published: June 2021

Study Design:

This was a large database study.

Objective:

The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion).

Summary of Background Data:

CSM is a major contributor to disability and reduced quality of life worldwide.

Methods:

Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson χ2 analysis with Yate continuity correction was used.

Results:

Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P=0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P=0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P=0.0005), circulatory complications (2.01%, <1%, P=0.0183), and C5 palsy (4.84%, 1.74%, P≤0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P=0.0468), and revision surgery (8.23% 5.85%, P=0.0395). Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P=0.0089) or ACCF (3.93% vs. 8.59%, P<0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P=0.0108), and revision surgery (9.51%, 5.85%, P=0.0086).

Conclusions:

The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.
Significance of Cervical Spine Computed Tomography Hounsfield Units to Predict Bone Mineral Density and the Subsidence After Anterior Cervical Discectomy and Fusion
Authors: Lee Ho Jin , You Soon Tae , Kim Jung Hee , Kim Il Sup , Sung Jae Hoon , Hong Jae Taek
Published: June 2021

Study Design:

This study was a retrospective review.

Objective:

The purpose of this study was to investigate the correlation analysis between Hounsfield units (HU) and dual x-ray absorptiometry (DXA) based on the clinical results of patients who underwent anterior cervical discectomy and fusion (ACDF) surgery.

Summary of Background Data:

There is no technique to directly measure bone mineral density (BMD) in the cervical spine. As computed tomography is a very popular preoperative planning modality, using the HU value from that analysis to predict osteoporosis is important for patient outcomes and applications in the clinical field.

Materials and Methods:

We reviewed the records for 235 patients who underwent 1-level (n=120) or 2-level (n=115) ACDF surgery. In the 1-level ACDF group, the HU was measured from C3 to C6 vertebra, while that for the 2-level ACDF group was measured from 3 surgical index vertebrae. The correlation patterns were analyzed with the corresponding DXA (T-score) for each patient. Subsidence of fusion segment was defined as change in distance between plate-tip and upper (lower) margin of the vertebra (index level) after 4 months of follow-up. In addition, to determine the relevant factors that influence fusion segment subsidence, other preoperative (C2 slope, C7 slope, C2–C7 angle, and C2–C7 sagittal vertical axis) and postoperative parameters (coronal angle and segmental angle change) were measured.

Results:

The correlation coefficient between HU and DXA ranged from 0.57 to 0.71 in the 1-level ACDF group and from 0.59 to 0.66 in the 2-level ACDF group. The correlation between HU and DXA was statistically significant regardless of the degree of anterior osteophyte (r=−0.65 to 0.78). Total subsidence height was 3.8 mm after ACDF, and both HU and DXA were statistically correlated with total subsidence (r=0.26–0.28). In multivariate analysis, HU (middle vertebra) value was statistically associated with the degree of total subsidence. The high-subsidence group (≥4.5 mm) showed smaller HU values (284.1 vs. 316.0) and T-scores (−0.5 vs. 0.1) compared to the low-subsidence group (<4.5 mm). The discrepancy group, defined as cases with excess plate shift on 1 side, also showed smaller HU values (260.4 vs. 312.4) and higher degrees of total subsidence than the matched group.

Conclusions:

The correlation between HU in cervical computed tomography and lumbar DXA (T-score) was statistically significant in both 1-level and 2-level ACDF. The level of BMD (HU or DXA) is a very important factor for clinically determining the amount and regularity of subsidence after ACDF. Therefore, HU can be a good alternative assessment to accurately reflect as much of the BMD degree as DXA in the cervical spine.
Transitions of Care After Critical Illness—Challenges to Recovery and Adaptive Problem Solving*
Authors: Haines Kimberley J. , Hibbert Elizabeth , Leggett Nina , Boehm Leanne M. , Hall Tarli , Bakhru Rita N. , Bastin Anthony J. , Butcher Brad W. , Eaton Tammy L. , Harris Wendy , Hope Aluko A. , Jackson James , Johnson Annie , Kloos Janet A. , Korzick Karen A. , Mactavish Pamela , Meyer Joel , Montgomery-Yates Ashley , Quasim Tara , Slack Andrew , Wade Dorothy , Still Mary , Netzer Giora , Hopkins Ramona O. , Iwashyna Theodore J. , Mikkelsen Mark E. , McPeake Joanne , Sevin Carla M.
Published: June 2021

OBJECTIVES:

Investigate the challenges experienced by survivors of critical illness and their caregivers across the transitions of care from intensive care to community, and the potential problem-solving strategies used to navigate these challenges.

DESIGN:

Qualitative design—data generation via interviews and data analysis via the framework analysis method.

SETTING:

Patients and caregivers from three continents, identified through the Society of Critical Care Medicine’s THRIVE international collaborative sites (follow-up clinics and peer support groups).

SUBJECTS:

Patients and caregivers following critical illness.

INTERVENTIONS:

Nil

MEASUREMENTS AND MAIN RESULTS:

From 86 interviews (66 patients, 20 caregivers), we identified the following major themes: 1) Challenges for patients—interacting with the health system and gaps in care; managing others’ expectations of illness and recovery. 2) Challenges for caregivers—health system shortfalls and inadequate communication; lack of support for caregivers. 3) Patient and caregiver-driven problem solving across the transitions of care—personal attributes, resources, and initiative; receiving support and helping others; and acceptance.

CONCLUSIONS:

Survivors and caregivers experienced a range of challenges across the transitions of care. There were distinct and contrasting themes related to the caregiver experience. Survivors and caregivers used comparable problem-solving strategies to navigate the challenges encountered across the transitions of care.
Confidentiality of Information Stored on the Desktop of Computers in a Psychiatric Hospital
Authors: Ahmadian Leila , Raeesi Ahmad , Abbasi Reza
Published: June 2021

The aim of this before-after study was to evaluate the effect of an educational intervention on the confidentiality status of unprotected information stored on computer desktop in a psychiatric hospital. All switched-on computer systems were inspected in 2017-2018 at the baseline and 7 months after placing an educational poster. The log-in conditions and files stored on the desktop were reviewed using a researcher-made checklist; moreover, users answered questions about the possible mechanism of deleting information stored on the desktop. The number of files stored on desktops, the number of systems left switched on and unused, and the number of systems without a log-in password decreased in the second phase than the first phase of this study. Furthermore, automatic locking of computers after a specified period increased. The educational intervention reduced significantly the storage of information on desktops and improved security mechanisms such as using passwords and autolock. This study showed using an educational poster can encourage users to preserve the security of information, comply with security guidelines such as locking unused computers, and prevent access to confidential information.