bluuebunny/crossref_metadata_2025 huggingface dataset:
Lightweight Public Key Encryption With Equality Test Supporting Partial Authorization in Cloud Storage
Authors: Lin Hao , Zhao Zhen , Gao Fei , Susilo Willy , Wen Qiaoyan , Guo Fuchun , Shi Yijie
Published: October 2020

Public key encryption with equality test (PKEET) can check whether two ciphertexts are encrypted from the same message or not without decryption. This attribute enables PKEET to be increasingly utilized in cloud storage, where users store their encrypted data on the cloud. In traditional PKEET, the tester is authorized by the data receiver to perform equality test on its ciphertexts. However, the tester can only test one ciphertext or all ciphertexts of one receiver with one authorization. It means that the receiver cannot adaptively authorize the test right of any number of ciphertexts to the tester. A trivial solution is authorizing one ciphertext each time and repeating multiple times. The corresponding size of trapdoor in this method is linear with the number of authorized ciphertexts. This will incur storage burden for the tester. To solve the aforementioned problem, we propose the concept of PKEET supporting partial authentication (PKEET-PA). We then instantiate the concept to a lightweight PKEET-PA, which achieves constant-size trapdoor. Besides, we prove the security of our PKEET-PA scheme against two types of adversaries. Compared with other PKEET schemes that can be used in trivial solution, our PKEET-PA is more efficient in receivers’ computation and has lower trapdoor size.
Size-adjusted aortic valve area: refining the definition of severe aortic stenosis
Authors: Vulesevic Branka , Kubota Naozumi , Burwash Ian G , Cimadevilla Claire , Tubiana Sarah , Duval Xavier , Nguyen Virginia , Arangalage Dimitri , Chan Kwan L , Mulvihill Erin E , Beauchesne Luc , Messika-Zeitoun David
Published: October 2020

Aims

Severe aortic valve stenosis (AS) is defined by an aortic valve area (AVA) <1 cm2 or an AVA indexed to body surface area (BSA) <0.6 cm/m2, despite little evidence supporting the latter approach and important intrinsic limitations of BSA indexation. We hypothesized that AVA indexed to height (H) might be more applicable to a wide range of populations and body morphologies and might provide a better predictive accuracy.

Methods and results

In 1298 patients with degenerative AS and preserved ejection fraction from three different countries and continents (derivation cohort), we aimed to establish an AVA/H threshold that would be equivalent to 1.0 cm2 for defining severe AS. In a distinct prospective validation cohort of 395 patients, we compared the predictive accuracy of AVA/BSA and AVA/H. Correlations between AVA and AVA/BSA or AVA/H were excellent (all R2 > 0.79) but greater with AVA/H. Regressions lines were markedly different in obese and non-obese patients with AVA/BSA (P < 0.0001) but almost identical with AVA/H (P = 0.16). AVA/BSA values that corresponded to an AVA of 1.0 cm2 were markedly different in obese and non-obese patients (0.48 and 0.59 cm2/m2) but not with AVA/H (0.61 cm2/m for both). Agreement for the diagnosis of severe AS (AVA < 1 cm2) was significantly higher with AVA/H than with AVA/BSA (P < 0.05). Similar results were observed across the three countries. An AVA/H cut-off value of 0.6 cm2/m [HR = 8.2(5.6–12.1)] provided the best predictive value for the occurrence of AS-related events [absolute AVA of 1 cm2: HR = 7.3(5.0–10.7); AVA/BSA of 0.6 cm2/m2 HR = 6.7(4.4–10.0)].

Conclusion

In a large multinational/multiracial cohort, AVA/H was better correlated with AVA than AVA/BSA and a cut-off value of 0.6 cm2/m provided a better diagnostic and prognostic value than 0.6 cm2/m2. Our results suggest that severe AS should be defined as an AVA < 1 cm2 or an AVA/H < 0.6 cm2/m rather than a BSA-indexed value of 0.6 cm2/m2.
Testing sex-biased admixture origin of macaque species using autosomal and X-chromosomal genomic sequences
Authors: Osada Naoki , Matsudaira Kazunari , Hamada Yuzuru , Malaivijitnond Suchinda
Published: October 2020

The role of sex-specific demography in hybridization and admixture of genetically diverged species and populations is essential to understand the origins of the genomic diversity of sexually reproducing organisms. In order to infer how sex-linked loci have been differentiated undergoing frequent hybridization and admixture, we examined 17 whole-genome sequences of seven species of the genus Macaca, which shows frequent inter-specific hybridization and predominantly female philopatry. We found that hybridization and admixture were prevalent within these species. For three cases of suggested hybrid origin of species/subspecies, M. arctoides, M. fascicularis ssp. aurea, and Chinese M. mulatta, we examined the level of admixture of X chromosomes, which is less affected by male-biased migration than that of autosomes. In one case, we were able to determine that M. cyclopis and M. fuscata was genetically closer to Chinese M. mulatta than to the Indian M. mulatta, and the admixture level of Chinese M. mulatta and M. fuscata/cyclopis was more pronounced on the X chromosome than on autosomes. Since the mitochondrial genomes of Chinese M. mulatta, M. cyclopis, and M. fuscata were found to cluster together, and the mitochondrial genome of Indian M. mulatta is more distantly related, the observed pattern of genetic differentiation on X-chromosomal loci is consistent with the nuclear swamping hypothesis, in which strong, continuous male-biased introgression from the ancestral Chinese M. mulatta population to a population related to M. fuscata and M. cyclopis generated incongruencies between the genealogies of the mitochondrial and autosomal genomes.
Use of rilpivirine in HIV-1-infected individuals in routine clinical practice from 2012 to 2017 in France
Authors: Potard Valérie , Gallien Sebastien , Canestri Ana , Costagliola Dominique ,   the French Hospital Database on HIV (FHDH-ANRS CO4), Abel S , Abgrall S , Allavena C , Bazus H , Becker A , François Benezit , Bouvet De La Maisonneuve P , Bregigeon S , Brugnon A , Caby F , Calin R , Cheret A , Costagliola D , Truchis P De , Denis B , Duvivier C , Enel P , Fischer H , Ghosn J , Goussef M , Grabar S , Huber F , Jacomet C , Joly V , Katlama C , Khuong M A , Makinson A , Marchand L , Martin-Blondel G , Matheron S , Meynard J L , Miailhes P , Nacher M , Piet E , Piroth L , Ploquin M , Rabier V , Robineau O , Rouveix Nordon E , Tattevin P
Published: October 2020

Objectives

We assessed virological outcomes of rilpivirine use in France from 2012 to 2017, in three groups of people living with HIV (PLHIV): (i) antiretroviral (ARV)-naive PLHIV; (ii) ARV-experienced PLHIV switching to rilpivirine while failing therapy; and (iii) ARV-experienced PLHIV switching to rilpivirine while virologically controlled.

Methods

Virological success (VS) was defined as a plasma HIV-1 viral load (VL) <50 copies/mL and virological failure (VF) as two consecutive VL >50 copies/mL or one VL >50 copies/mL followed by a treatment switch prior to the next VL measurement. The cumulative incidence of VS was assessed considering rilpivirine discontinuation, loss to follow-up and death as competing risks, while estimates of cumulative incidence of VF accounted for loss to follow-up and death.

Results

Among the 2166 ARV-naive PLHIV initiating rilpivirine, the 4 year cumulative incidence of VS was 91.0% and was associated with baseline VL. Among the 2125 ARV-experienced PLHIV switching to rilpivirine while failing therapy, the 4 year cumulative incidence of VS was 82.5% and was associated with lower VL, higher CD4 and less than three prior ARVs. Among the 11 828 ARV-experienced PLHIV switching to rilpivirine while virologically controlled, the 4 year cumulative incidence of VF was 9.6%. The risk of VF was lower among MSM, for PLHIV with CD4 ≥ 500 cell/mm3, without a prior AIDS event, or with a longer VL suppression at baseline.

Conclusions

Rilpivirine-containing regimens yielded high rates of viral suppression in most participants, while it was ineffective when used outside the marketing authorization in naive participants.
Associations among individual gilt birth weight, litter birth weight phenotype, and the efficiency of replacement gilt production
Authors: Patterson Jennifer , Bernardi Mari L , Allerson Matt , Hanson Aaron , Holden Nick , Bruner Laura , Pinilla Juan C , Foxcroft George
Published: October 2020

Selection for larger litter size has increased the number of low individual birth weight (BWi) pigs and produced sows with a repeatable low average litter birth weight phenotype (BWP). Using an average of 3.6 litters records per sow, BWP was established in 644 nucleus-multiplication sows producing replacement gilts in a large commercial operation and classified as low (L-BWP, <1.18 kg, n = 85), medium (M-BWP, ≥1.18 to ≤1.35 kg, n = 250), or high (H-BWP, >1.35 kg, n = 309) on the basis of a BWi of 1.18 kg below which there was a high risk of early mortality and the average BWi (1.35 kg) for the population. In subsequent litters, potential replacement gilts born to these sows (n = 7,341) received a unique identification tag that allowed the impact of BWi, BWP, and their interactions on the efficiency of replacement gilt production to be evaluated. Negative effects of BWi on mortality until day 4 after birth were confirmed (P < 0.05) and cumulative losses to weaning, to day 70 of age, and to final pre-selection at 165 d of age were affected (P ≤ 0.05) by the interaction between BWP and BWi. Among the 2,035 gilts for which records for selection efficiency and production to fourth parity were available, a lower BWi decreased the probability of gilts reaching pubertal estrus (P < 0.05) after 21 and 28 d of boar stimulation starting at 180 d of age, with no effect of BWP. Overall, neither BWi, BWP, nor their interaction affected age at puberty. After breeding, only the main effect of BWP affected productivity and retention in the sow herd. In parities 1 and 2, percent stillborn was higher in litters born to gilts from H-BWP compared with L-BWP dams (P < 0.05), and in parity 2, total born and born alive were lower in sows derived from H-BWP compared with other BWPs. There were no differences in retention based on BWP classes until parity 2, after which retention tended (P ≤ 0.09) to be lower in sows derived from H-BWP compared with L-BWP dams. These results provide evidence that sow BWP is an important factor in the overall efficiency of replacement gilt management. This study also confirms that effective gilt selection and pre-breeding management protocols support excellent sow lifetime productivity and mitigate the risk of a high BWP in the litter of origin affecting retention in the breeding herd.
Application of a Validated UPLC–MS-MS Method for the Determination of Diphenidol in Biological Samples in 15 Authentic Lethal Cases
Authors: Yang Liu , Shen Min , Xiang Ping , Shen Baohua , Deng Hongxiao , Qiang Huosheng , Dang Yonghui , Shi Yan
Published: October 2020

Diphenidol (DPN) is a nonphenothiazinic antivertigo and antiemetic drug that has been widely used in clinical practice in China because of its good antivertigo curative effect, minimal side effects and high safety. In recent years, there have been some cases of sporadic suicide and accidental poisoning related to DPN. Hence, a validated method for the determination of DPN in biological samples by ultra-high-performance liquid chromatography–tandem mass spectrometry (UPLC–MS-MS) was developed. The method is characterized by the use of a simple, fast and inexpensive liquid–liquid extraction (LLE) for sample preparation, a rapid run time (5 min) and a low required sample volume (0.1 mL or 0.1 g). The lower limits of quantitation (LLOQs) were 0.05 ng/mL and 0.3 ng/g for blood and liver tissue, respectively. The method was shown to be linear over a concentration range of 0.05–200 ng/mL (blood) and 0.3–400 ng/g (liver). The accuracy was in the range of 92.77–112.75%. The relative standard deviations of the intraday and interday imprecisions were in the range of 3.22% to 12.17%, and the recoveries were in the range of 58.75–95.27%. Furthermore, the method was successfully applied to the detection and quantification of DPN in 15 real forensic cases. The postmortem concentration range of heart blood was 0.87–99 μg/mL.
Chandra spectral measurements of the O supergiant ζ Puppis indicate a surprising increase in the wind mass-loss rate over 18 yr
Authors: Cohen David H , Wang Jiaming , Petit Véronique , Leutenegger Maurice A , Dakir Lamiaa , Mayhue Chloe , David-Uraz Alexandre
Published: October 2020

New long Chandra grating observations of the O supergiant ζ Pup show not only a brightening of the X-ray emission line flux of 13 per cent in the 18 yr since Chandra’s first observing cycle, but also clear evidence – at more than 4σ significance – of increased wind absorption signatures in its Doppler-broadened line profiles. We demonstrate this with non-parametric analysis of the profiles as well as Gaussian fitting and then use line-profile model fitting to derive a mass-loss rate of 2.47 ± 0.09 × 10−6${\mathrm{M_{\odot }~{\mathrm{y}r^{-1}}}}$, which is a 40 per cent increase over the value obtained from the cycle 1 data. The increase in the individual emission line fluxes is greater for short-wavelength lines than long-wavelength lines, as would be expected if a uniform increase in line emission is accompanied by an increase in the wavelength-dependent absorption by the cold wind in which the shock-heated plasma is embedded.
Plant-ImputeDB: an integrated multiple plant reference panel database for genotype imputation
Authors: Gao Yingjie , Yang Zhiquan , Yang Wenqian , Yang Yanbo , Gong Jing , Yang Qing-Yong , Niu Xiaohui
Published: October 2020

Genotype imputation is a process that estimates missing genotypes in terms of the haplotypes and genotypes in a reference panel. It can effectively increase the density of single nucleotide polymorphisms (SNPs), boost the power to identify genetic association and promote the combination of genetic studies. However, there has been a lack of high-quality reference panels for most plants, which greatly hinders the application of genotype imputation. Here, we developed Plant-ImputeDB (http://gong_lab.hzau.edu.cn/Plant_imputeDB/), a comprehensive database with reference panels of 12 plant species for online genotype imputation, SNP and block search and free download. By integrating genotype data and whole-genome resequencing data of plants from various studies and databases, the current Plant-ImputeDB provides high-quality reference panels of 12 plant species, including ∼69.9 million SNPs from 34 244 samples. It also provides an easy-to-use online tool with the option of two popular tools specifically designed for genotype imputation. In addition, Plant-ImputeDB accepts submissions of different types of genomic variations, and provides free and open access to all publicly available data in support of related research worldwide. In general, Plant-ImputeDB may serve as an important resource for plant genotype imputation and greatly facilitate the research on plant genetic research.
Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center
Authors: Wiencek Joesph R , Head Carter L , Sifri Costi D , Parsons Andrew S
Published: October 2020

Background

The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance.

Methods

We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC).

Results

Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs.

Conclusions

Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.
Combining information on nocturnal rapid eye movement sleep latency and atonia to facilitate diagnosis of pediatric narcolepsy type 1
Authors: Silvani Alessandro , Vandi Stefano , Pizza Fabio , Antelmi Elena , Ferri Raffaele , Plazzi Giuseppe
Published: October 2020

Study Objectives

The diagnosis of narcolepsy type 1 (NT1) at its onset in children and adolescents is often difficult, with substantial diagnostic delay. We aimed to test and validate the effectiveness of rapid eye movement (REM) sleep latency (REML), the REM sleep atonia index (RAI), and their combination for the automatic identification of pediatric patients with NT1 based on the standard scoring of nocturnal polysomnograms.

Methods

A retrospective cohort of 71 pediatric patients with NT1 and 42 controls was subdivided in test and validation cohorts. A novel index (COM) was developed as a nonlinear function of REML and RAI. The effectiveness of REML, RAI, and COM in identifying patients with NT1 was assessed with receiver operating characteristic (ROC) curves.

Results

REML, RAI, and COM significantly identified patients with NT1 both in the test and validation cohorts. Optimal thresholds that maximized identification accuracy were estimated in the test cohort (REML, 49.5 min; RAI, 0.91; COM, 4.57 AU) and validated in the other cohort. COM performed significantly better in identifying patients with NT1 than either REML or RAI, with ROC area under the curve of 94%–100%, sensitivity 85%–96%, and specificity 92%–100%, and with good night-to-night agreement (Cohen’s k = 0.69).

Conclusions

The analysis of REML, RAI, and particularly their combination in the COM index may help shorten diagnostic delay of NT1 in children and adolescents based on the standard scoring of nocturnal polysomnography.
Multi-ethnic GWAS and meta-analysis of sleep quality identify MPP6 as a novel gene that functions in sleep center neurons
Authors: Khoury Samar , Wang Qiao-Ping , Parisien Marc , Gris Pavel , Bortsov Andrey V , Linnstaedt Sarah D , McLean Samuel A , Tungate Andrew S , Sofer Tamar , Lee Jiwon , Louie Tin , Redline Susan , Kaunisto Mari Anneli , Kalso Eija A , Munter Hans Markus , Nackley Andrea G , Slade Gary D , Smith Shad B , Zaykin Dmitri V , Fillingim Roger B , Ohrbach Richard , Greenspan Joel D , Maixner William , Neely G Gregory , Diatchenko Luda
Published: October 2020

Poor sleep quality can have harmful health consequences. Although many aspects of sleep are heritable, the understandings of genetic factors involved in its physiology remain limited. Here, we performed a genome-wide association study (GWAS) using the Pittsburgh Sleep Quality Index (PSQI) in a multi-ethnic discovery cohort (n = 2868) and found two novel genome-wide loci on chromosomes 2 and 7 associated with global sleep quality. A meta-analysis in 12 independent cohorts (100 000 individuals) replicated the association on chromosome 7 between NPY and MPP6. While NPY is an important sleep gene, we tested for an independent functional role of MPP6. Expression data showed an association of this locus with both NPY and MPP6 mRNA levels in brain tissues. Moreover, knockdown of an orthologue of MPP6 in Drosophila melanogaster sleep center neurons resulted in decreased sleep duration. With convergent evidence, we describe a new locus impacting human variability in sleep quality through known NPY and novel MPP6 sleep genes.
The Antimicrobial Properties of Extracts Isolated from Lichen Parmelia vagans.
Authors: Bondarenko Vladimir , Korczynski Michael , Techathaveewat Worawith
Published: October 2020

This study was aimed to determine the antibacterial properties of extracts isolated from lichen Parmelia vagans.

Many pharmaceutical products today have derivatives from living organisms. Recently, Lichens have been found to have secondary metabolites which have been found to have various physiological effects including antimicrobial activity. A lichen is a composite organism composed of a photobiont such as an alga or cyanobacterium and a mycobiont, a fungus. In this study, the antimicrobial activity of extracts from a lichen identified as Parmelia vagans was evaluated.

Extracts of Parmelia vagans were initially obtained by using various solvents to find the most efficient extraction of antimicrobial compound(s). We found that extracts obtained using ethyl acetate have the highest antimicrobial activity and were further used to study the properties of the extracted compounds. The antimicrobial activity of the extracts was evaluated using the Resazurin cell viability assay; the microbes investigated were Staphylococcus aureus, Bacillus subtilis, Streptococcus pneumoniae, Klebsiella pneumoniae, and Escherichia coli. It was observed that extracts had no inhibitory effect on the growth of Escherichia coli, and Klebsiella pneumonia at the tested concentrations, but inhibition of growth was observed in Staphylococcus aureus, Bacillus subtilis, and Streptococcus pneumoniae.

The constituents of the crude extracts were separated using Thin Layer Chromatography (TLC). After separation, each fraction was tested to identify which contained the antimicrobial activity. From the several fractions, one was found to contain nearly all of the antimicrobial activity and was further evaluated against different strains of bacteria.

Our data indicate that purified TLC fractions containing antibacterial activities that inhibit a growth of both gram positive and gram negative bacterial strains.

Support or Funding Information

Touro University Nevada Intramural Research Grant
Pediatric osteoarticular infection: trend in surgically treated patients and association of methicillin-resistant Staphylococcus aureus with requirement of secondary procedures
Authors: Jain Mohit J. , Bradko Viachaslau , Zhu Huirong , Inneh Ifeoma , Shinava Vinitha R.
Published: October 2020

Acute pediatric osteoarticular infection demonstrates variability in both presentation and response to treatment. Many respond to antibiotics ± single operation, while some require multiple surgeries. Currently, it is difficult to predict who may require additional procedures. Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with more complications. The purpose of this study is to determine MRSA trends and degree of association with the occurrence of multiple procedures. We performed a retrospective analysis of surgically treated pediatric (1 month–18 years) patients for acute osteomyelitis and septic arthritis at a tertiary children’s hospital from 2003–2017. The cohort was divided into single-procedure and multiple-procedure groups. A total of 753 patients were studied with a mean age of 7.05 years (2.4 months–17.9 years). We identified 645/753 (85.6%) patients who were treated with a single-procedure and 108/753 (14.4%) patients who required multiple- procedures. The lower extremity (hip, knee, tibia, and femur) was most commonly involved. The epidemiologic trend runs almost parallel between two groups with a peak in 2009. The odds ratio for multiple-procedures was 2.0 [95% confidence interval (CI), 1.2–3.1; P = 0.002] with dual infection (osteomyelitis + septic arthritis), 2.6 (95% CI, 1.6–4.4; P = 0.001) with high-risk conditions and 4.6 (95% CI, 3.0–7.1; P < 0.001) if MRSA was present. MRSA significantly predicts the requirement of additional operative procedures for the treatment of osteoarticular infections in children. Besides clinical deterioration and other markers, the presence of MRSA can be a considerable indicator for a planned secondary-procedure. Level III retrospective cohort study.
Artificial Intelligence-enabled, Real-time Intraoperative Ultrasound Imaging of Neural Structures Within the Psoas
Authors: Carson Tyler , Ghoshal Goutam , Cornwall George Bryan , Tobias Richard , Schwartz David G. , Foley Kevin T.
Published: October 2020

Study Design.

Experimental in-vivo animal study.

Objective.

The aim of this study was to evaluate an Artificial Intelligence (AI)-enabled ultrasound imaging system's ability to detect, segment, classify, and display neural and other structures during trans-psoas spine surgery.

Summary of Background Data.

Current methodologies for intraoperatively localizing and visualizing neural structures within the psoas are limited and can impact the safety of lateral lumbar interbody fusion (LLIF). Ultrasound technology, enhanced with AI-derived neural detection algorithms, could prove useful for this task.

Methods.

The study was conducted using an in vivo porcine model (50 subjects). Image processing and machine learning algorithms were developed to detect neural and other anatomic structures within and adjacent to the psoas muscle while using an ultrasound imaging system during lateral lumbar spine surgery (SonoVision,™ Tissue Differentiation Intelligence, USA). The imaging system's ability to detect and classify the anatomic structures was assessed with subsequent tissue dissection. Dice coefficients were calculated to quantify the performance of the image segmentation.

Results.

The AI-trained ultrasound system detected, segmented, classified, and displayed nerve, psoas muscle, and vertebral body surface with high sensitivity and specificity. The mean Dice coefficient score for each tissue type was >80%, indicating that the detected region and ground truth were >80% similar to each other. The mean specificity of nerve detection was 92%; for bone and muscle, it was >95%. The accuracy of nerve detection was >95%.

Conclusion.

This study demonstrates that a combination of AI-derived image processing and machine learning algorithms can be developed to enable real-time ultrasonic detection, segmentation, classification, and display of critical anatomic structures, including neural tissue, during spine surgery. AI-enhanced ultrasound imaging can provide a visual map of important anatomy in and adjacent to the psoas, thereby providing the surgeon with critical information intended to increase the safety of LLIF surgery.

Level of Evidence: N/A
Diagnostic Accuracy of Thresholds Less Than or Equal to 8 mA in Pedicle Screw Testing During Lumbar Spine Procedures to Predict New Postoperative Lower Extremity Neurological Deficits
Authors: Melachuri Samyuktha R. , Melachuri Manasa K. , Anetakis Katherine , Crammond Donald J. , Balzer Jeffrey R. , Thirumala Parthasarathy D.
Published: October 2020

Study Design.

Retrospective observational study.

Objective.

It has been shown that pedicle screw stimulation thresholds less than or equal to 8 mA yield a very high diagnostic accuracy of detecting misplaced screws in spinal surgery. In our study, we determined clinical implications of low stimulation thresholds.

Summary of Background Data.

Posterior lumbar spinal fusions (PSF), using pedicle screws, are performed to treat many spinal pathologies, but misplaced pedicle screws can result in new postoperative neurological deficits.

Methods.

Patients with pedicle screw stimulation testing who underwent PSF between 2010 and 2012 at the University of Pittsburgh Medical Center (UPMC) were included in the study. We evaluated the sensitivity, specificity, and diagnostic odds ratio (DOR) to determine how effectively low pedicle screw responses predict new postoperative lower extremity neurological deficits.

Results.

One thousand one hundred seventy nine eligible patients underwent 8584 pedicle screw stimulations with lower extremity somatosensory evoked potentials (LE SSEP) monitoring for lumbar fusion surgery. One hundred twenty one of these patients had 187 pedicle screws with a stimulation response at a threshold less than or equal to 8 mA. Smoking had a significant correlation to pedicle screw stimulation less than or equal to 8 mA (P = 0.012). A threshold of less than or equal to 8 mA had a sensitivity/specificity of 0.32/0.90 with DOR of 4.34 [1.83, 10.27] and an area under the ROC curve (AUC) of 0.61 [0.49, 0.74]. Patients with screw thresholds less than or equal to 8 mA and abnormal baselines had a DOR of 9.8 [95% CI: 2.13–45.17] and an AUC of 0.73 [95% CI: 0.50–0.95].

Conclusion.

Patients with pedicle screw stimulation thresholds less than or equal to 8 mA are 4.34 times more likely to have neurological clinical manifestations. Smoking and LE deficits were shown to be significantly correlated with pedicle screw stimulation thresholds less than or equal to 8 mA. Low stimulation thresholds result in a high specificity of 90%. Pedicle screw stimulation less than or equal to 8 mA can serve as an accurate rule in test for postoperative neurological deficit, warranting reevaluation of screw placement and/or replacement intraoperatively.

Level of Evidence: 3
The Impact of Anterior Spondylolisthesis and Kyphotic Alignment on Dynamic Changes in Spinal Cord Compression and Neurological Status in Cervical Spondylotic Myelopathy
Authors: Sakamoto Takuya , Funaba Masahiro , Imajo Yasuaki , Nagao Yuji , Suzuki Hidenori , Nishida Norihiro , Fujimoto Kazuhiro , Sakai Takashi
Published: October 2020

Study Design.

A retrospective study of prospectively collected data.

Objective.

This study aimed to examine how radiological parameters affect dynamic changes in the cross-sectional area of the spinal cord (CSA) in cervical spondylotic myelopathy (CSM) patients and how they correlate with the severity of myelopathy, by evaluating multi-modal spinal cord evoked potentials (SCEPs).

Summary of Background Data.

Appropriate assessments of dynamic factors should reveal hidden spinal cord compression and provide useful information for choosing surgical procedures.

Methods.

Seventy-nine CSM patients were enrolled. They were examined with kinematic CT myelography (CTM), and the spinal levels responsible for their CSM were determined via SCEP examinations. The C2–7 angle, C2–7 range of motion, and percentage of slip were measured on the midsagittal view during flexion and extension, and the CSA was measured on the axial view in each neck position using kinematic CTM. The patients who exhibited the smallest CSA values during extension and flexion were classified into Groups E and F, respectively.

Results.

Fifty-two (65.8%) and 27 (34.2%) cases were included in Groups E and F, respectively. The preoperative JOA score did not differ significantly between the groups; however, the preoperative lower-limb JOA score of Group F was significantly lower than that of Group E (2.24 ± 0.82 vs. 2.83 ± 1.09, P = 0.016). In the multiple logistic regression analysis, a small C2–7 angle during extension (β = 5°, odds ratio: 0.69, 95% confidence interval [CI]: 0.54–0.90) and the slip percentage during flexion (β = 5%, odds ratio: 1.42, 95% CI: 1.09–1.85) were identified as significant predictors of belonging to Group F.

Conclusion.

Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2–7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column.

Level of Evidence: 4
Accuracy of EOS Imaging Technology in Comparison to Computed Tomography in the Assessment of Vertebral Rotational Orientation in Instrumented Spines in Adolescent Idiopathic Scoliosis
Authors: Jiang Fan , Simões Leonardo , Ouellet Jean , Saran Neil
Published: October 2020

Study Design.

Retrospective radiographic reliability study.

Objective.

The aim of this study was to assess the validity of EOS 3D imaging technology in the determination of vertebral rotations in the spine of patients with previous instrumentation.

Summary of Background Data.

There is a lack of evidence on the accuracy of vertebral rotational measurement using EOS 3D morphological analysis in the instrumented spine.

Methods.

A retrospective review of 31 patients with adolescent idiopathic scoliosis (AIS) who underwent instrumented fusion and postoperative computed tomography (CT) scans of the spine was performed. Vertebral rotations of the apex vertebra, the uppermost (UIV) and lowermost (LIV) instrumented vertebra, the noninstrumented vertebra one level cranial to the UIV (UIV + 1) and one level caudal to LIV (LIV + 1) were determined using EOS 3D reconstruction. The vertebral rotation was also measured using reformatted CT axial images. Relative vertebral rotational difference (VRD) were calculated for UIV to apex, UIV + 1 to apex, LIV to apex, LIV + 1 to apex, UIV to LIV and UIV + 1 to LIV + 1. Paired t tests were used to compare the VRD measured using the two different imagining modalities. For values where P > 0.05, the Bland-Altman plot was used to assess the agreement between the measures. Interclass correlation (ICC) was used to determine interobserver and intraobserver reliabilities of EOS and CT measurements.

Results.

EOS analysis of relative VRD was found to be significantly different from that of CT for UIV to apex (P = 0.006) and UIV + 1 to apex (P = 0.003). No significant differences were found for LIV to apex (P = 0.06), LIV + 1 to apex (P = 0.06), UIV to LIV (P = 0.59) and UIV + 1 to LIV + 1 (P = 0.64). However, Bland-Altman plots showed that agreement was poor, and variance was beyond acceptable. ICC showed good interobserver and good to very good intraobserver reliability for EOS.

Conclusion.

EOS 3D morphological analysis of VRD in the instrumented levels of the spine demonstrated significant difference and unacceptable variance in comparison to CT measurement.

Level of Evidence: 4
Three-Dimensional Analysis of Preoperative and Postoperative Rib Cage Parameters by Simultaneous Biplanar Radiographic Scanning Technique in Adolescent Idiopathic Scoliosis
Authors: Machino Masaaki , Kawakami Noriaki , Ohara Tetsuya , Saito Toshiki , Tauchi Ryoji , Imagama Shiro
Published: October 2020

Study Design.

Prospective study.

Objective.

This study aimed to investigate the changes in rib cage deformity in adolescent idiopathic scoliosis (AIS) by comparing the preoperative and postoperative three-dimensional (3D) reconstruction images using simultaneous biplanar radiographic scanning technique (EOS) (EOS Imaging, Paris, France).

Summary of Background Data.

EOS data are limited for the analyses of preoperative and postoperative rib cage deformity.

Methods.

A total of 67 Lenke type 1 or 2 AIS patients who underwent surgery (59 females and 8 males) were enrolled in this study. The mean patient age was 14.4 years (range: 11–17 yr). In all patients, posterior corrective fusion was performed with a rod rotation maneuver based on segmental pedicle fixation. Spinal parameters (scoliosis and kyphosis) and rib cage parameters (max thickness, thoracic index (TI), rib hump (RH), surface spinal penetration index (sSPI), end thoracic hump ratio, vertebra-sternum angle, rib vertebral angle difference at the apex, and vertebral lateral decentering), were measured. 3D images were assessed preoperatively and postoperatively at 2-year follow-up.

Results.

Both main thoracic (MT) and proximal thoracic scoliosis were significantly corrected (51° to 15°, 30° to 17°, P < 0.0001). The rotation of MT apical vertebrae was also significantly corrected (12° to 5°, P < 0.0001). Thoracic kyphosis (T4-T12) significantly increased (13° to 18°, P < 0.0001). Besides, max thickness, TI, and RH demonstrated significant differences between preoperative and postoperative images (P < 0.01). T8–10 sSPI and end thoracic hump ratio decreased significantly postoperatively (P < 0.05). Although surgery significantly decreased vertebra-sternum angle (P < 0.0001), no significant difference was observed between the preoperative and postoperative rib vertebral angle difference (P = 0.32). Following the surgery, vertebral lateral decentering and rib cage volume were significantly increased (P < 0.0001).

Conclusions.

3D reconstruction of the rib cage using biplanar standing stereoradiography is useful to evaluate preoperative and postoperative rib cage deformity in patients with AIS.

Level of Evidence: 2
Anatomic Danger Zones of the Head and Neck
Authors: Talmor Guy , Trang Andy , Ahadiat Omeed , Paskhover Boris , Wysong Ashley
Published: October 2020

BACKGROUND

Dermatologic procedures require a detailed understanding of surface anatomy to avoid complications. The head and neck region has prominent danger zones including nerves and vasculature that may be at risk during cutaneous surgery. A thorough understanding of these danger zones can help avoid complications that may lead to functional or cosmetic impairment.

METHODS

The anatomic literature regarding the course of high-risk structures of the head and neck was reviewed. Structures deemed at risk during dermatologic procedures were included in the analysis. The final analysis focused on branches of the facial nerve, parotid duct, spinal accessory nerve, trigeminal nerve, and the lacrimal system. Anatomical information was compiled regarding each high-risk structure to develop a “danger zone” at which each respective structure is at risk.

RESULTS

The danger zone for each structure was compiled based on the review of the literature and depicted in the figures.

CONCLUSION

With careful attention to anatomy and the meticulous surgical technique, there is great potential for reduction in surgical injury to danger zones of the head and neck.
Roles of Type 2 Immune Response–Initiating Cytokines and Detection of Type 2 Innate Lymphoid Cells in Mouse Models of Allergic Conjunctivitis
Authors: Asada Yosuke
Published: October 2020

Allergic conjunctivitis is one the most common global diseases and affects many people worldwide. It has been reported that 15% to 20% of the total population in Japan suffers from allergic conjunctival disease. Although TH2 cytokines suchs as interleukin (IL)-4, IL-5, and IL-13 have long been known as causes of allergic conjunctivitis, new cytokines involved in allergic diseases have been identified since 2000. The discovery of type 2 immune response–initiating cytokines, such as IL-25, IL-33, and thymic stromal lymphopoietin, and type 2 innate lymphoid cells has suggested that allergic diseases can arise from not only T cells but also barrier function disruption. In this article, we summarize the results of experiments in mouse models of ragweed-induced experimental allergic conjunctivitis and papain-soaked contact lens–induced conjunctivitis.
Serum interleukin-18 levels are associated with non-dipping pattern in newly diagnosed hypertensive patients
Authors: Güntürk Ertuğrul Emre , Güntürk İnayet , Topuz Ayşe Nur , Akkaya Hasan , Topuz Mustafa
Published: October 2020

Background

Interleukin-18 (IL-18), a pro-inflammatory cytokine, increases inflammation in the endothelium. Increased inflammation plays an important role in the development of hypertension (HT). IL-18 level is higher in hypertensives than normotensives.

Objective

To investigate the relationship between IL-18 level and diurnal blood pressure (BP) variations in newly diagnosed HT patients.

Methods

This prospective study included 130 subjects referred to outpatient cardiology clinic with an initial diagnosis of HT. The patients were classified as dipper HT (n = 40), non-dipper HT (n = 50), and normotensive (control, n = 40) according to 24-hour ambulatory BP monitoring. All subjects underwent blood sampling after 12 hours of fasting and transthoracic echocardiography.

Results

The serum IL-18 level was significantly higher in the patient group compared with the controls (195.17 ± 93.00 mg/dl vs. 140.75 ± 71.11 mg/dl, P < 0.01) and also in the non-dipper group than in the dipper group (217.3 ± 96.90 mg/dl, 167.5 ± 80.79 mg/dl, P = 0.011). IL-18 level was positively correlated both the night-time SBP and DBP levels (r = 0.29, P = 0.02 and r = 0.34, P < 0.01, respectively). On multivariate linear regression analysis, left atrium diameter, left ventricular mass index, and serum IL-18 level were independent predictors of non-dipping pattern in newly diagnosed HT patients.

Conclusion

Higher IL-18 level was particularly associated with an increase in the night-time BP levels. IL-18 can be used as a predictor for non-dipper HT in newly diagnosed HT patients.
Cognitive Dysfunction in Older Breast Cancer Survivors
Authors: Crouch Adele , Champion Victoria , Von Ah Diane
Published: October 2020

Background

Approximately 60% of the more than 3.8 million breast cancer survivors (BCSs) living in the United States are 60 years or older. Breast cancer survivors experience many symptoms including cognitive dysfunction; however, little is known regarding how age affects these symptoms.

Objective

This integrative review was conducted to synthesize the literature on cognitive dysfunction in older BCSs. The purpose was to (1) describe the prevalence of objective and subjective cognitive dysfunctions and (2) examine factors associated with cognitive dysfunction in older BCSs.

Methods

Whittemore and Knafl’s integrative review methodology was used to examine cognitive dysfunction in BCSs 60 years or older.

Results

Twelve quantitative studies were included. Up to 41% of older BCSs experienced cognitive dysfunction on neuropsychological examination, and up to 64% reported cognitive dysfunction on subjective measures pretreatment. Approximately half of older BCSs experienced cognitive decline from pretreatment to posttreatment regardless of cognitive measure. The domains most impacted were memory, executive functioning, and processing speed. Objective and subjective cognitive dysfunctions were associated with age, comorbidities, chemotherapy receipt, sleep, neuropsychological symptom cluster, frailty, and quality of life.

Conclusions

Cognitive dysfunction among older BCSs was common both prior to and following treatment. Cognitive dysfunction was associated with multiple factors that are compounded in the aging population and could be detrimental to quality of life and independent living.

Implications to Practice

Early assessment and intervention by healthcare providers, including nurses, for cognitive dysfunction in older BCSs are essential. Future research should focus on evidence-based interventions for cognitive dysfunction incorporating the unique needs of older BCSs.
The Sensitivity and Specificity of Parental Report of Concern for Identifying Language Disorder in Children With Craniosynostosis
Authors: Kilcoyne Sarah , Rajan Sindhu Menon , Dalton Louise , Judge Andy , Overton Sarah , Wall Steven , Johnson David
Published: October 2020

Many factors that may co-occur with craniosynostosis, such as oral structural anomalies, hearing impairment, visual impairment, cognitive difficulties and psychosocial factors, may predispose this population to communication difficulties. At the Oxford Craniofacial Unit, children's speech, language and communication are regularly monitored in accordance with a systematic developmental screening protocol developed by the Speech and Language Therapists in the 4 United Kingdom (UK) Highly Specialized Craniofacial Centers. In addition to routine assessments, when parents attend routine multidisciplinary clinic appointments, they are asked about their child's communication development, and whether they have any concerns.

A retrospective review was undertaken of parental concerns about hearing, speech development, behavior, physical development, concentration, school and friendships as indicated by parents on the Oxford Craniofacial Unit Pre-Clinic Questionnaire. The areas of concern were then correlated with the results of a standardized, guided parent questionnaire about children's language development, (Children's Communication Checklist - 2 (CCC-2)), to determine whether parental concern alone is a reliable way of identifying whether patients require further assessment for Language Disorder associated with Craniosynostosis.

Participants were parents of 89 monolingual English-speaking children with craniosynostosis (62 male; 27 female), age range four to 13 years (mean age = 8 years 7 months), receiving active care at the Oxford Craniofacial Unit (June 2017-July 2018). Results of the pre-clinic questionnaire indicated that 6% of parents had concerns about their child's communication development. Results of the CCC-2 indicated that 29/89 (32.6%) of children required further assessment for Language Disorder associated with Craniosynostosis. When language difficulties were identified on the CCC-2, only 14% (n = 4/29) parents indicated concern on the pre clinic questionnaire. Results indicated that parental concern about behavior was the most important factor in identifying language disorder (P = 0.023).

Results reinforce that the pre-clinic questionnaire is useful for identifying areas of parental concern. Results also indicate that parental concern alone is not sufficient to identify language disorder, and that further, detailed assessment is warranted. The results are consistent with previously reported links between behavior and language in the general population.
The Effect on Patient Satisfaction of the Postoperative Nasal Topographic, Demographic, and Functional Results of Open and Closed Septorhinoplasty Techniques
Authors: Metin Mehmet , Avcu Mustafa
Published: October 2020

Aim:

To evaluate the contribution to patient satisfaction of the newly reshaped topographic anatomy of the nose, demographic, and functional results in the postoperative period of septorhinoplasty surgery.

Method:

A total of 370 patients applied with open and closed septorhinoplasty techniques for various reasons were grouped according to the postoperative Rhinoplasty Outcome Evaluation (ROE) Scale results; Group 1 (open rhinoplasty satisfied group, ROE ≥12 points, n:194), Group 2 (open rhinoplasty dissatisfied group, ROE <12 points, n:23), Group 3 (closed rhinoplasty satisfied group, ROE ≥12 points, n:137), Group 4 (closed rhinoplasty dissatisfied group, ROE <12 points, n:16). The groups were evaluated in respect of the effect on patient satisfaction of functional and demographic variables and satisfaction with the topographic outcome of the nose.

Results:

The effect of the topographic surgical results was evaluated on patient satisfaction. A correlation was determined between nasal topographic satisfaction and patient satisfaction (r:0.228, P = 0.009). In the subgroup analyses, the only factor among the topographic factors which had an effect on satisfaction was the nasal tip (r:0.187, P = 0.024). Although 30.7% (n:39) of patients dissatisfied with the surgery reported that they were not satisfied with the nasal base results, no correlation was determined between nasal base and satisfaction (r:0.091, P = 0.463). The strongest correlations of patient satisfaction were determined to be with subjective (NOSE score [r:0.530, P < 0.001]) and objective (high nasal resistance levels [r:0.579, P < 0.001]) functional results.

Conclusion:

The 2 basic components of postoperative satisfaction with SRP surgery were shown to be functional healing and cosmetic outcomes. Of the surgical topographic results, nasal tip and nasal base were the parts determined to require the most attention.