bluuebunny/crossref_metadata_2025 huggingface dataset:
Emulating a target trial in case-control designs: an application to statins and colorectal cancer
Authors: Dickerman Barbra A , García-Albéniz Xabier , Logan Roger W , Denaxas Spiros , Hernán Miguel A
Published: July 2020

Background

Previous case-control studies have reported a strong association between statin use and lower cancer risk. It is unclear whether this association reflects a benefit of statins or is the result of design decisions that cannot be mapped to a (hypothetical) target trial (that would answer the question of interest).

Methods

We outlined the protocol of a target trial to estimate the effect of statins on colorectal cancer incidence among adults with low-density lipoprotein (LDL) cholesterol below 5 mmol/L. We then emulated the target trial using linked electronic health records of 752 469 eligible UK adults (CALIBER 1999–2016) under both a cohort design and a case-control sampling of the cohort. We used pooled logistic regression to estimate intention-to-treat and per-protocol effects of statins on colorectal cancer, with adjustment for baseline and time-varying risk factors via inverse-probability weighting. Finally, we compared our case-control effect estimates with those obtained using previous case-control procedures.

Results

Over the 6-year follow-up, 3596 individuals developed colorectal cancer. Estimated intention-to-treat and per-protocol hazard ratios were 1.00 (95% confidence interval [CI]: 0.87, 1.16) and 0.90 (95% CI: 0.71, 1.12), respectively. As expected, adequate case-control sampling yielded the same estimates. By contrast, previous case-control analytical approaches yielded estimates that appeared strongly protective (odds ratio 0.57, 95% CI: 0.36, 0.91, for ≥5 vs. <5 years of statin use).

Conclusions

Our study demonstrates how to explicitly emulate a target trial using case-control data to reduce discrepancies between observational and randomized trial evidence. This approach may inform future case-control analyses for comparative effectiveness research.
The influence of age and environmental conditions on supplement intake by beef cattle winter grazing northern mixed-grass rangelands
Authors: Wyffels Samuel A , Dafoe Julia M , Parsons Cory T , Boss Darrin L , DelCurto Timothy , Bowman Janice G P
Published: July 2020

This study evaluated the influence of cow age and temperature adjusted for wind chill (Twindchill) on supplement intake behavior of beef cattle winter grazing northern mixed grass prairie rangelands. A commercial herd of 272 (year 1) and 302 (year 2) bred cows (Angus, Simmental × Angus) ranging in age from 1- to 12-yr-old grazed a 329-ha rangeland pasture (~1.5 ha animal unit monthˉ 1) from November to January. Cows were grouped into seven age classes (1 yr old, 2 yr old, 3 yr old, 4 yr old, 5 yr old, 6 yr old, and ≥ 7 yr old) and were provided free-choice access to a 30% CP self-fed canola meal-based pelleted supplement with 25% salt to limit intake. The target daily intake was 0.91 kg cowˉ 1 dˉ 1. Supplement was provided in a SmartFeed Pro self-feeder system to measure individual animal supplement intake and behavior. An Onset HOBO U30-NRC Weather Station was placed near the supplement feeders to collect weather data for the entirety of the grazing period. Average daily supplement intake and the coefficient variation in supplement intake displayed a Twindchill × cow age × year interaction (P ≤ 0.02). There was a negative linear effect of age on supplement intake (kg cowˉ 1 dˉ 1) for days with below average Twindchill conditions in both years (P < 0.01). There was also negative linear effect of age on supplement intake (g kg of BWˉ 1 dˉ 1) at average Twindchill in year 1 and below average Twindchill in year 2 (P < 0.01). Cow age had a quadratic effect on supplement intake for days with below average Twindchill in year 1 (P = 0.02); however, this was a curvilinear response where yearlings and 2-yr-olds consumed more supplement per kilogram of BW than other age cattle (P < 0.01). Cow age had positive linear effects on variation in supplement intake at below average Twindchill conditions in both years (P < 0.01). Daily visits to the supplement feeders displayed a Twindchill × cow age interaction (P < 0.01), where there was a linear decrease in visits with increasing age at below average Twindchill conditions (P < 0.01). In summary, both cow age and the winter environmental conditions interacted to influence animal supplement intake behavior and, as a result, nutrient delivery efficacy in winter grazing beef cattle.
An Investigation of Human–Mosquito Contact Using Surveys and Its Application in Assessing Dengue Viral Transmission Risk
Authors: Thongsripong Panpim , Qu Zhuolin , Yukich Joshua O , Hyman James M , Wesson Dawn M
Published: July 2020

Aedes-borne viral diseases such as dengue fever are surging in incidence in recent years. To investigate viral transmission risks, the availability of local transmission parameters is essential. One of the most important factors directly determining infection risk is human–mosquito contact. Yet the contact rate is not often characterized, compared with other risk metrics such as vector density, because of the limited research tool options. In this study, human–mosquito contact was assessed in two study sites in the Southern United States using self-administered standardized survey instruments. The fraction of mosquito bites attributed to important vector species was estimated by human landing sampling. The survey participants reported a significantly higher outdoor mosquito bite exposure than indoor. The reported bite number was positively correlated with outdoor time during at-risk periods. There was also a significant effect of the study site on outdoor bite exposure, possibly due to the differing vector density. Thus, the levels of human–mosquito contact in this study were influenced both by the mosquito density and human behaviors. A dengue virus transmission model demonstrated that the observed difference in the contact rates results in differential virus transmission risks. Our findings highlight the practicality of using surveys to investigate human–mosquito contact in a setting where bite exposure levels differ substantially, and serve as a basis for further evaluations. This study underscores a new avenue that can be used in combination with other field methods to understand how changes in human behavior may influence mosquito bite exposure which drives mosquito-borne virus transmission.
Stressors, Repetitive Negative Thinking, and Insomnia Symptoms in Adolescents Beginning High School
Authors: Brodar Kaitlyn E , La Greca Annette M , Hysing Mari , Llabre Maria M
Published: July 2020

Objective

Although the first year of high school may represent a particularly stressful time for adolescents, no research addresses how stressors are related to insomnia symptoms during this time. Thus, we examined how stress relates to concurrent and prospective insomnia symptoms in adolescents beginning high school (Aim 1). Additionally, we assessed repetitive negative thinking (RNT) as a mediator (Aim 2). We also evaluated whether the pattern of associations differed for boys and girls (Aim 3).

Methods

Adolescents (N = 502; M age = 14.22 years; 58.2% girls; 91.2% Hispanic/Latinx) completed questionnaires about stressors related to beginning high school (e.g., school performance, peer pressure), family support, RNT, and insomnia symptoms at the beginning and end of their first year of high school. Multiple group structural equation models assessed relationships between these variables and evaluated differences between boys and girls.

Results

School/leisure conflict and low family support were directly associated with insomnia symptoms at both times, and RNT mediated these relationships in both boys and girls. In girls, peer pressure and low family support were indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT. In boys, school performance was indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT.

Conclusions

Stressful experiences at the beginning of high school negatively affect sleep in adolescents both in the short and long term. Pediatric psychologists should educate adolescents and their parents about the risk of sleep problems during this time period and provide strategies for stress management and for proper sleep hygiene.
Gastric perforation resulting into pneumoperitoneum in a neonate: a case report
Authors: Lodhia Jay , Msuya David , Philemon Rune , Sadiq Adnan , Mremi Alex
Published: July 2020

Gastric perforation in a neonate is a rare surgical emergency in routine practice. The causes and predisposing factors for gastric perforation in a neonate vary from traumatic to benign conditions like inflammatory processes. Early detection, intensive care, stabilization and prompt surgery yield positive outcome. Early diagnosis is important for better prognosis. Simple investigation such as plain abdominal X-ray can adequately lead to the diagnosis by showing pneumoperinoneum. We present a 3-day-old neonate; born at term who presented with abdominal distension and vomiting. Plain abdominal X-ray revealed pneumoperitoneum. Emergency laparotomy was performed where a gastric perforation was found measuring 0.5 by 0.5 cm located on the anterior aspect of the stomach body near the pylorus. The baby underwent successful surgical intervention and recovered well.
Untangled Branches: the Edenic Tree(s) and the Multivocal WAW
Authors: Makowiecki Mark
Published: July 2020

This narratological study of Genesis 2–3 examines whether the principal trees in the Garden of Eden—the tree of life and the tree of the knowledge of good and evil—are two in number or one and the same. While the answer to this question seems self-evident, namely, that the Edenic trees are two, the woman’s description of the forbidden tree as if it were an amalgam of both makes this conclusion uncertain. This ambiguity creates a certain tension in the text; a tension which commentators have been trying perennially to resolve. Yet rather than join the long list of attempts to eliminate this tension, this article explores its role as a narrative feature and is thus able to show how conflicting details function cooperatively within the text. This leads to the conclusion that the principal tree(s) in the Garden of Eden should not be understood as one or two in number but as one and two in number.
Complex variability of Kepler AGN revealed by recurrence analysis
Authors: Phillipson R A , Boyd P T , Smale A P , Vogeley M S
Published: July 2020

The advent of new time domain surveys and the imminent increase in astronomical data expose the shortcomings of traditional time series analysis (such as power spectra analysis) in characterizing the abundantly varied, complex, and stochastic light curves of Active Galactic Nuclei (AGNs). Recent applications of novel methods from non-linear dynamics have shown promise in characterizing higher modes of variability and time-scales in AGN. Recurrence analysis in particular can provide complementary information about characteristic time-scales revealed by other methods, as well as probe the nature of the underlying physics in these objects. Recurrence analysis was developed to study dynamical trajectories in phase space, which can be constructed from 1D time series such as light curves. We apply the methods of recurrence analysis to two optical light curves of Kepler-monitored AGN. We confirm the detection and period of an optical quasi-periodic oscillation in one AGN, and confirm multiple other time-scales recovered from other methods ranging from 5 to 60 d in both objects. We detect regions in the light curves that deviate from regularity, provide evidence of determinism and non-linearity in the mechanisms underlying one light curve (KIC 9650712), and determine realizations of a linear stochastic process describe the dominant variability in the other light curve (Zwicky 229–015). We discuss possible underlying processes driving the dynamics of the light curves and their diverse classes of variability.
The EBLM project – VII. Spin–orbit alignment for the circumbinary planet host EBLM J0608-59 A/TOI-1338 A
Authors: Kunovac Hodžić Vedad , Triaud Amaury H M J , Martin David V , Fabrycky Daniel C , Cegla Heather M , Collier Cameron Andrew , Gill Samuel , Hellier Coel , Kostov Veselin B , Maxted Pierre F L , Orosz Jerome A , Pepe Francesco , Pollacco Don , Queloz Didier , Ségransan Damien , Udry Stéphane , Welsh William F
Published: July 2020

A dozen short-period detached binaries are known to host transiting circumbinary planets. In all circumbinary systems so far, the planetary and binary orbits are aligned within a couple of degrees. However, the obliquity of the primary star, which is an important tracer of their formation, evolution, and tidal history, has only been measured in one circumbinary system until now. EBLM J0608-59/TOI-1338 is a low-mass eclipsing binary system with a recently discovered circumbinary planet identified by TESS. Here, we perform high-resolution spectroscopy during primary eclipse to measure the projected stellar obliquity of the primary component. The obliquity is low, and thus the primary star is aligned with the binary and planetary orbits with a projected spin–orbit angle β = 2${_{.}^{\circ}}$8 ± 17${_{.}^{\circ}}$1. The rotation period of 18.1 ± 1.6 d implied by our measurement of vsin i⋆ suggests that the primary has not yet pseudo-synchronized with the binary orbit, but is consistent with gyrochronology and weak tidal interaction with the binary companion. Our result, combined with the known coplanarity of the binary and planet orbits, is suggestive of formation from a single disc. Finally, we considered whether the spectrum of the faint secondary star could affect our measurements. We show through simulations that the effect is negligible for our system, but can lead to strong biases in vsin i⋆ and β for higher flux ratios. We encourage future studies in eclipse spectroscopy test the assumption of a dark secondary for flux ratios ≳1 ppt.
The Molecular Machinery of Gametogenesis inGeodiaDemosponges (Porifera): Evolutionary Origins of a Conserved Toolkit across Animals
Authors: Koutsouveli Vasiliki , Cárdenas Paco , Santodomingo Nadiezhda , Marina Anabel , Morato Esperanza , Rapp Hans Tore , Riesgo Ana
Published: July 2020

All animals are capable of undergoing gametogenesis. The ability of forming haploid cells from diploid cells through meiosis and recombination appeared early in eukaryotes, whereas further gamete differentiation is mostly a metazoan signature. Morphologically, the gametogenic process presents many similarities across animal taxa, but little is known about its conservation at the molecular level. Porifera are the earliest divergent animals and therefore are an ideal phylum to understand evolution of the gametogenic toolkits. Although sponge gametogenesis is well known at the histological level, the molecular toolkits for gamete production are largely unknown. Our goal was to identify the genes and their expression levels which regulate oogenesis and spermatogenesis in five gonochoristic and oviparous species of the genus Geodia, using both RNAseq and proteomic analyses. In the early stages of both female and male gametogenesis, genes involved in germ cell fate and cell-renewal were upregulated. Then, molecular signals involved in retinoic acid pathway could trigger the meiotic processes. During later stages of oogenesis, female sponges expressed genes involved in cell growth, vitellogenesis, and extracellular matrix reassembly, which are conserved elements of oocyte maturation in Metazoa. Likewise, in spermatogenesis, genes regulating the whole meiotic cycle, chromatin compaction, and flagellum axoneme formation, that are common across Metazoa were overexpressed in the sponges. Finally, molecular signals possibly related to sperm capacitation were identified during late stages of spermatogenesis for the first time in Porifera. In conclusion, the activated molecular toolkit during gametogenesis in sponges was remarkably similar to that deployed during gametogenesis in vertebrates.
Prone Positioning of Patients With Acute Respiratory Distress Syndrome Related to COVID-19: A Rehabilitation-Based Prone Team
Authors: Ng Jillian A , Miccile Lauren A , Iracheta Christine , Berndt Carolyn , Detwiller Meredith , Yuse Carolyn , Tolland Joseph
Published: July 2020

Objective

Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 require prone positioning, which poses a challenge to the intensive care unit staff at Brigham and Women’s Hospital.

Methods

A prone team service of physical therapists and occupational therapists with critical care experience was established to assist with increasing demands for prone positioning of patients who were mechanically ventilated. The goals of the rehabilitation-based prone team were to provide support to nursing and respiratory therapy; create a consistent, efficient process; and ensure patient and staff safety.

Results

The service evolved over 7 weeks, expanding to 24-hour coverage and adding responsibilities to support the staff as patient volume grew. The volume of requests to the rehabilitation-based prone team generally increased to week 4 and has, since then, declined. Key points for successful implementation included identification of rehabilitation therapists with intensive care unit experience and leadership qualities, multidisciplinary collaboration, availability of needed positioning devices and supplies to protect the integument, and well-defined roles of all disciplines participating in position change process.

Conclusion

The description of the development, operations, evolution, and utilization of a rehabilitation therapist prone team acts as a guide for future development and implementation.

Impact

This case report is one of the first reports of a rehabilitation-based prone team established to assist with positioning patients in prone as an intervention for ARDS related to coronavirus disease 2019 and will help guide other institutions.
The COVID-19 Global Rheumatology Alliance: evaluating the rapid design and implementation of an international registry against best practice
Authors: Liew Jean W , Bhana Suleman , Costello Wendy , Hausmann Jonathan S , Machado Pedro M , Robinson Philip C , Sirotich Emily , Sufka Paul , Wallace Zachary S , Yazdany Jinoos , Grainger Rebecca ,   for the COVID-19 Global Rheumatology Alliance
Published: July 2020

Objectives

As the coronavirus disease 2019 pandemic developed there was a paucity of data relevant to people living with rheumatic disease. This led to the development of a global, online registry to meet these information needs. This manuscript provides a detailed description of the coronavirus disease 2019 Global Rheumatology Alliance registry development, governance structure, and data collection, and insights into new ways of rapidly establishing global research collaborations to meet urgent research needs.

Methods

We use previously published recommendations for best practices for registry implementation and describe the development of the Global Rheumatology Alliance registry in terms of these steps. We identify how and why these steps were adapted or modified. In Phase 1 of registry development, the purpose of the registry and key stakeholders were identified on online platforms, Twitter and Slack. Phase 2 consisted of protocol and data collection form development, team building and the implementation of governance and policies.

Results

All key steps of the registry development best practices framework were met, though with the need for adaptation in some areas. Outputs of the registry, two months after initial conception, are also described.

Conclusion

The Global Rheumatology Alliance registry will provide highly useful, timely data to inform clinical care and identify further research priorities for people with rheumatic disease with coronavirus disease 2019. The formation of an international team, easily able to function in online environments and resulting in rapid deployment of a registry is a model that can be adapted for other disease states and future global collaborations.
The Effect of Regulatory Constraints on Fund Performance: New Evidence from UCITS Hedge Funds*
Authors: Joenväärä Juha , Kosowski Robert
Published: July 2020

This article examines the effect of regulatory constraints on fund performance and risk by comparing conventional and UCITS hedge funds. Using a matching estimator approach, we estimate the indirect cost of UCITS regulation to be between 1.06% and 4.05% per annum in terms of risk-adjusted returns. These performance differences are likely to stem from UCITS constraints such as those governing eligible assets, diversification, and short selling, and cannot be explained by differences in redemption terms or level of leverage. We confirm that our performance results are not driven by management company characteristics, fund manager characteristics, or unobserved confounder bias.
Black Swan versus Broad Idea
Authors: Wise Dan
Published: July 2020

This article seeks to highlight and discuss certain recent developments in the availability of free-standing freezing orders in the British Virgin Islands (BVI), in aid of main proceedings onshore. It also raises certain serious practical consequences of this development and considers possible future legislative steps that may be taken in the BVI. Given the frequency with which BVI vehicles appear as holding or receiving entities in asset recovery litigation, this recent development will have a considerable impact onshore, especially as it comes after 10 years of the ability to obtain free-standing freezing orders in aid of litigation onshore.
Facilitating Multiple Medical-Surgical Nursing Practicum Groups During Simulation Laboratory Days
Authors: Hansen Jamie , Holz Megan
Published: July 2020

This novel approach incorporates the facilitation of multiple clinical groups through a weekly simulation laboratory day during a medical-surgical nursing practicum rotation. Using a combination of nursing skills education practice stations, along with simulation learning experiences, 93 students from 12 clinical groups were able to rotate through two high-fidelity simulation learning experiences and one new skill station each week throughout the semester.
Self-injectable epinephrine: doctors’ attitude and patients’ adherence in real-life
Authors: Carrillo-Martin Ismael , Caminati Marco , Tanno Luciana K. , Gonzalez-Estrada Alexei
Published: July 2020

Purpose of review

Epinephrine is the only life-saving treatment of anaphylaxis. Prescription and administration rates of self-injectable epinephrine are generally low. It is unclear whether this is because of availability, low prescription rates, fear of using epinephrine, or a combination of these issues.

Recent findings

This review focuses on what self-injectable epinephrine devices (SIED), such as auto-injectors and prefilled syringes, are preferred by patients and healthcare professionals (HCP). Our findings suggest that a device's ease to use, proper and frequent training on its operability, and availability have an impact on preferences and adherence to treatment with SIEDs. After prescribing a patient with a SIED, clinicians should emphasize its use in anaphylaxis, educate patients/caregivers to identify anaphylaxis and on how to use the SIED, and encourage constant practicing with training devices.

Epinephrine is the sole recommended anaphylaxis treatment and SIEDs are of critical usefulness in the community setting. Further studying of these devices is needed to optimize education for HCPs and patients and their accessibility to SIEDs.
Comparison of Infrapatellar and Suprapatellar Approaches for Intramedullary Nail Fixation of Tibia Fractures
Authors: Metcalf Kathryn B. , Du Jerry Y. , Lapite Isaac O. , Wetzel Robert J. , Sontich John K. , Dachenhaus Elizabeth R. , Janes Jessica L. , Ochenjele George
Published: July 2020

Objective:

To assess clinical, radiographic, and functional outcomes after intramedullary nail (IMN) fixation of tibia fractures with an infrapatellar approach compared to a suprapatellar approach.

Design:

Retrospective chart review.

Setting:

Level 1 trauma center.

Patients/Participants:

Two hundred four patients with 208 tibia fractures treated with intramedullary nailing between 2008 and 2018.

Methods:

A retrospective chart review of tibia fractures was conducted. The clinical and functional outcomes of tibia fractures treated with IMN were compared between groups treated with an infrapatellar approach versus a suprapatellar approach. Multivariate models were created to control for confounding demographic, comorbidity, and injury-related confounders.

Main Outcome Measurements:

Outcome measures included nonunion, malunion, and infection. Subjective functional patient outcomes were assessed using pain interference and physical function Patient-Reported Outcome Measurements Systems scores.

Results:

There were 101 patients treated with infrapatellar nailing (49%) and 107 patients treated with suprapatellar nailing (51%). On multivariate analysis, suprapatellar nailing was independently associated with decreased risk of malunion (adjusted odds ratio, 0.165; 95% confidence interval, 0.054–0.501; P = 0.001) and decreased risk of postoperative knee pain (adjusted odds ratio, 0.272; 95% confidence interval, 0.083–0.891; P = 0.032). There was no difference in the rate of nonunion (P = 0.44), infection (P = 0.45), or Patient-Reported Outcome Measurements Systems pain interference or physical function scores.

Conclusions:

Suprapatellar IMN fixation of tibial shaft fractures is independently associated with lower risk of malunion and postoperative knee pain compared to the infrapatellar approach. However, there are no functional differences between approaches.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Factors Related to Postoperative Osteochondritis Dissecans of the Lateral Femoral Condyle After Meniscal Surgery in Juvenile Patients With a Discoid Lateral Meniscus
Authors: Hashimoto Yusuke , Nishino Kazuya , Reid John B. , Yamasaki Shinya , Takigami Junsei , Tomihara Tomohiro , Takahashi Shinji , Shimada Nagakazu , Nakamura Hiroaki
Published: July 2020

Purpose:

The purpose was to assess the incidence of postoperative osteochondritis dissecans (OCD) and the related epidemiologic factors following meniscal surgery for juvenile discoid lateral meniscus (DLM).

Methods:

The study was a retrospective review of 103 knees in 89 patients with a mean age of 12.1 years who underwent arthroscopic meniscal surgery for DLM. Mean follow-up was 4.2 years. The surgical procedures were either saucerization, saucerization with repair or subtotal meniscectomy, depending on the type of DLM tear. Postoperative OCD lesions were identified radiographically. Age, sex, weight, Lysholm score, Tegner activity scale, exercise frequency, and surgical procedure were compared between the postoperative OCD diagnosis group and non-OCD control group.

Results:

Postoperative OCD was diagnosed in 8/103 (7.8%) knees following DLM surgery. The incidence of postoperative OCD was significantly greater for patients age less than 10 years old, and male sex, low weight, Lysholm score, Tegner activity scale preinjury and after returning to sports, and exercise frequency per week on univariate analyses. On multivariate analyses, postoperative OCD occurred more commonly with subtotal meniscectomy than with saucerization or saucerization with repair, and in patients less than 11 years of age. Receiver operating characteristic curve analysis revealed a cutoff value of age at surgery of 10 years.

Conclusions:

Subtotal meniscectomy and patients younger than 10 years at the time of surgery are at greater risk for postoperative OCD. To decrease this risk, if possible, we recommend performing saucerization or saucerization with repair in patients undergoing surgery for DLM.

Level of Evidence:

Level III—retrospective comparative study.
Surgical Management of Thoracolumbar Burst Fractures
Authors: Morrissey Patrick B. , Shafi Karim A. , Wagner Scott C. , Butler Joseph S. , Kaye Ian D. , Sebastian Arjun S. , Schroeder Gregory D. , Kepler Christopher K. , Aarabi Bizhan , Oner Fetullah C. , Vaccaro Alexander R.
Published: July 2020

The management of thoracolumbar burst fractures is controversial with no universally accepted treatment algorithm. Several classification and scoring systems have been developed to assist in surgical decision-making. The most widely accepted are the Thoracolumbar Injury Classification and Severity Score (TLICS) and AOSpine Thoracolumbar Injury Classification Score (TL AOSIS) with both systems designed to provide a simple objective scoring criteria to guide the surgical or nonsurgical management of complex injury patterns. When used in the evaluation and treatment of thoracolumbar burst fractures, both of these systems result in safe and consistent patient care. However, there are important differences between the 2 systems, specifically in the evaluation of the complete burst fractures (AOSIS A4) and patients with transient neurological deficits (AOSIS N1). In these circumstances, the AOSpine system may more accurately capture and characterize injury severity, providing the most refined guidance for optimal treatment. With respect to surgical approach, these systems provide a framework for decision-making based on patient neurology and the status of the posterior tension band. Here we propose an operative treatment algorithm based on these fracture characteristics as well as the level of injury.
Duration of Symptoms Does Not Affect Clinical Outcome After Lumbar Arthrodesis
Authors: Sayari Arash J. , Harada Garrett K. , Basques Bryce A. , Louie Philip K. , Gandhi Sapan D. , Banks Landan , Sung Audrey S. , Nolte Michael T. , Gosse Jessica , An Howard S.
Published: July 2020

Study Design:

Retrospective cohort study at a single institution.

Objective:

To examine the effect of symptom duration on clinical outcomes after posterolateral lumbar fusion.

Summary of Background Data:

Nonoperative measures are generally exhausted before patients are indicated for surgical intervention, leaving patients with their symptomatology for varying lengths of time. It is unclear at what point in time surgical intervention may become less efficacious at alleviating preoperative symptoms.

Materials and Methods:

Consecutive patients who underwent primary elective open posterior lumbar spinal fusion at a single academic institution were included. Patient and operative characteristics were compared between symptom duration groups (group 1: <12 mo of pain, group 2: ≥12 mo of pain). Preoperative and final postoperative visual analog scale back/leg pain, and Oswestry Disability Index, were collected. Preoperative, immediate postoperative, and final radiographs were assessed to measure lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and the PI-LL difference was calculated.

Results:

In total, 167 patients were included in group 1, whereas 359 patients were included in group 2. Baseline demographics and operative characteristics were similar between the 2 groups. Both groups had similar changes in sagittal parameters and had no significant difference in rates of complication, reoperation, discharge to rehabilitation facility, or early adjacent segment degeneration. Both groups demonstrated similar improvement in clinical outcome measures.

Conclusions:

Despite differences in symptom duration, patients who had pain for ≥12 months demonstrated similar improvement after posterolateral lumbar arthrodesis than those who had pain for <12 months. Extended effort of conservative treatments or delay of operative intervention does not appear to negatively impact the eventual outcome of surgery.

Level of Evidence:

Level III.
Effect of Massage With Lavender Oil on Postoperative Pain Level of Patients Who Underwent Gynecologic Surgery
Authors: Mizrak Sahin Berrak , Culha Ilkay , Gursoy Elif , Yalcin Omer Tarik
Published: July 2020

This was a randomized, placebo-controlled study. The sample consisted of 3 groups of patients: an experimental group, massage application with lavender oil (n = 15); a placebo group, massage application with ultrasound gel (n = 15); and a control group (n = 15). Massage application was performed 3 hours after analgesic application. Pain levels of the patients in the experiment and placebo groups were evaluated with a Verbal Rating Scale (VRS) at the 30th minute and the 3rd hour after the application. Similarly, the pain level of patients in the control group was also evaluated with the VRS at 3 hours after the initial analgesic administration and following the 30th minute and the 3rd hour. Generally, the VRS scores of the 3 groups did not show a significant difference in terms of group and time interaction (P = .221). However, there was a significant difference in VRS scores between the experimental and control groups at the 30th minute after the massage (P = .036). This difference was caused by the lower pain level of the group, which had massage with lavender (2.66 ± .89) compared with the control group (3.80 ± 1.01). According to the study results, while only hand massage application after gynecologic surgery was effective for a short period in decreasing postoperative pain, it was determined that massage application with lavender had a longer effect in decreasing postoperative pain. The results of this study showed that this inexpensive and easy-to-apply method can be safely performed by nurses on postoperative patients and can support pain management of patients in the first hours after gynecologic surgery.
Possible Influence of Upper Blepharoplasty on Intraocular Pressure
Authors: Osaki Tammy H. , Osaki Midori H. , Ohkawara Lilian E. , Osaki Teissy , Gameiro Gustavo R. , Melo Luiz Alberto S.
Published: July 2020

Purpose:

There is anecdotal evidence that upper blepharoplasty might lead to raised intraocular pressure (IOP). If this association is confirmed, then patients with glaucoma and glaucoma suspects could be at risk if they underwent this procedure with no appropriate follow up. Here, the authors aimed to determine whether there are significant changes in IOP after upper blepharoplasty.

Methods:

This prospective study evaluated the IOP at baseline and 1, 2, and 6 weeks after an upper blepharoplasty in individuals with mild to moderate dermatochalasis. Upper blepharoplasty might change the pressure exerted by the upper eyelid into the cornea, and this could affect the corneal surface and the IOP; thus, the corneal topography was also recorded before and at 6 weeks.

Results:

The IOP of 40 eyes was evaluated. The mean (±SD) preoperative IOP was 14.19 ± 2.12 mm Hg. A statistically significant increase in IOP was observed at 1 (15.15 ± 2.27 mm Hg, p = 0.009), 2 (15.57 ± 2.29 mm Hg, p < 0.0001), and 6 weeks (15.21 ± 2.60 mm Hg, p = 0.001) postoperatively. A statistically significant increase in steep K (preoperative: 44.66 ± 2.06, 6 weeks: 44.78 ± 2.28, p = 0.007) and corneal astigmatism was also observed (preoperative: 0.78 ± 0.43, 6 weeks: 0.89 ± 0.45, p = 0.006) at 6 weeks.

Conclusions:

Upper blepharoplasty resulted in a mild and statistically significant increase in intraocular pressure postoperatively. The authors’ results suggest that upper blepharoplasty should be carefully evaluated in glaucoma and glaucoma suspect patients.
Cost-Effectiveness of Thoracotomy Approach for the Implantation of a Centrifugal Left Ventricular Assist Device
Authors: Mahr Claudius , McGee Edwin , Cheung Anson , Mokadam Nahush A. , Strueber Martin , Slaughter Mark S. , Danter Matthew R. , Levy Wayne C. , Cheng Richard K. , Beckman Jennifer A. , May Damian M. , Ismyrloglou Eleni , Tsintzos Stelios I. , Silvestry Scott C.
Published: July 2020

This study reports the first analysis regarding cost-effectiveness of left ventricular assist device (LVAD) implantation via thoracotomy. Cost-effectiveness of LVADs implanted via the traditional surgical approach of sternotomy has been improved through the years because of technological advances, along with understanding the importance of patient selection and postimplant management have on positively affecting outcomes. Given the positive clinical outcomes of the thoracotomy approach, we seek to study the cost-effectiveness of a centrifugal LVAD via this less invasive approach. We developed a Markov model. Survival and quality of life inputs (QALY) for the LVAD arm were based on data from the LATERAL clinical trial. For the Medical Management arm, survival was derived from the Seattle Heart Failure Model. The heart transplant probability was derived from INTERMACS. Survival after heart transplantation used International Society for Heart and Lung Transplantation data. Cost inputs were calculated based on Medicare data and past literature. The incremental cost-effectiveness ratio was found to be $64,632 per quality adjusted life year and $57,891 per life year in the bridge to transplant indication. These results demonstrate further improvement in the overall cost-effectiveness of LVAD therapy and confirm implantation of LVADs via a less invasive approach as being cost-effective.
Routine Early 68Ga-DOTATATE Positron Emission Tomography Has Low Yield After Resection of Appendiceal Neuroendocrine Neoplasms
Authors: Chan David L. , Hoang Jeremy , Roach Paul J. , Arena Jennifer , Bailey Dale L. , Nevell David , Pavlakis Nick , Engel Alexander , Bernard Elizabeth J.
Published: July 2020

Objectives

Appendiceal neuroendocrine neoplasms (appNEN) generally carry a low recurrence risk. 68Ga-DOTATATE positron emission tomography (DOTA PET) is increasingly used as it is more sensitive than cross-sectional imaging. We hypothesize that early DOTA PET is unlikely to detect recurrent disease in patients with low-risk resected appNEN because of the delayed pattern of recurrence.

Methods

Retrospective study (dual review) of patients undergoing DOTA PET 0 to 18 months after resected appNEN. The primary outcome was the proportion of scans demonstrating residual disease.

Results

Forty-one patients were included (median age, 29 years; 63% female), most with small, low-grade appNEN. No scans (0%) showed residual/distant disease. Eight (20%) of 41 scans showed indeterminate findings requiring follow-up. Five (12%) scans were recommended for follow-up with modalities other than DOTA PET (vertebra, 3; thyroid; bone, 1 each). Three (7%) were recommended for follow-up with DOTA PET (all with indeterminate abdominal uptake). These 3 patients had no recurrent disease on follow-up.

Conclusions

The 68Ga-DOTATATE PET is of no value when performed in the first 18 months after resected appNEN. Although 20% of scans showed indeterminate findings, more than half did not require repeat DOTA PET. Despite advantages over cross-sectional imaging, DOTA PET is not recommended in staging after completely resected appNEN.
Comparison of [11C]-PBR28 Binding Between Persons Living With HIV and HIV-Uninfected Individuals
Authors: Boerwinkle Anna H. , Strain Jeremy F. , Burdo Tricia , Doyle John , Christensen Jon , Su Yi , Wisch Julie K. , Cooley Sarah A. , Vaida Florin , Smith Mandy D. , Jafri Hussain , Paul Robert H. , Benzinger Tammie L.S. , Ances Beau M.
Published: July 2020

Objective:

Despite combined antiretroviral therapy, neuroinflammation may persist in persons living with HIV (PLWH) and contribute to cognitive impairment in this population. Positron emission tomography (PET) imaging targeting 18 kDa translocator protein (TSPO) has been used to localize neuroinflammation. We aimed to use TSPO-PET imaging to evaluate neuroinflammation in PLWH.

Design:

Twenty-four virologically suppressed PLWH on combined antiretroviral therapy and 13 HIV-negative (HIV−) controls completed TSPO-PET imaging using the radiotracer [11C]PBR28. Because of tracer complexity and differing procedures used in previous studies, we employed an expansive methodological approach, using binding potential (BP) and standard uptake value ratio and multiple different reference regions to estimate [11C]PBR28 binding.

Methods:

[11C]PBR28 binding was measured in 30 cortical and subcortical regions and compared between PLWH and HIV− controls. Pearson correlation evaluated the association between [11C]PBR28 binding and cognition and clinical measures of HIV.

Results:

Analyses conducted using multiple reference regions and measures of tracer uptake revealed no significant differences between [11C]PBR28 binding in PLWH compared with HIV− controls. In addition, [11C]PBR28 binding in PLWH was not significantly associated with clinical measures of HIV or plasma biomarkers of inflammation. [11C]PBR28 binding was not significantly elevated in cognitively impaired PLWH compared with unimpaired PLWH, but there were inverse relationships between cognitive performance (executive and global function) and [11C]PBR28 binding in PLWH.

Conclusions:

Our results suggest that neuroinflammation may play a role in cognitive deficits, but overall neuroinflammatory levels as measured by TSPO-PET imaging in PLWH are not significantly different from those seen in HIV− controls.
Derivation and Validation of an HIV Risk Prediction Score Among Gay, Bisexual, and Other Men Who Have Sex With Men to Inform PrEP Initiation in an STD Clinic Setting
Authors: Tordoff Diana M. , Barbee Lindley A. , Khosropour Christine M. , Hughes James P. , Golden Matthew R.
Published: July 2020

Background:

Clinicians and health departments would ideally undertake targeted efforts to promote HIV pre-exposure prophylaxis (PrEP) and frequent HIV testing using data-based criteria to identify populations at elevated risk for HIV. We developed an HIV risk prediction score for men who have sex with men (MSM) to identify individuals at substantial risk for HIV acquisition.

Methods:

We created a retrospective cohort of MSM who tested HIV-negative at the sexually transmitted disease clinic in Seattle, WA, from 2001 to 2015, and identified seroconversions using HIV surveillance data. We split the cohort randomly 2:1 into derivation and validation data sets, and used Cox proportional hazards to estimate the hazard of acquiring HIV associated with behavioral and clinical predictors, and the Akaike information criterion to determine which variables to retain in our model.

Results:

Among 16,448 MSM, 640 seroconverted over a 14.3-year follow-up period. The best prediction model included 13 variables and had an area under the receiver operating characteristic curve of 0.73 (95% confidence interval: 0.71 to 0.76), 76% sensitivity, and 63% specificity at a score cutoff ≥11. A simplified model restricted to 2011–2015 included 4 predictors [methamphetamine use, condomless receptive anal intercourse (CRAI), ≥10 partners, and current diagnosis or self-reported gonorrhea/syphilis in the past year]. This model, the Seattle PrEP Score, had an area under the receiver operating characteristic curve of 0.69 (95% confidence interval: 0.64 to 0.73), 62% sensitivity, and 70% specificity. One-year incidence was 0.5% for a score of 0, 0.7% for a score of 1, and 2.1% for scores ≥2.

Conclusions:

The Seattle PrEP Score was predictive of HIV acquisition and could help clinicians and public health agencies identify MSM who could benefit from PrEP and frequent HIV testing.
Hyaluronic Acid Injections to Correct Lips Deformity Following Surgical Removal of Permanent Implant
Authors: Rauso Raffaele , Federico Francesco , Zerbinati Nicola , De Cicco Davide , Nicoletti Giovanni Francesco , Tartaro Gianpaolo
Published: July 2020

One of the most attractive areas of the face are the lips, they are crucial for emotion and communication, both during animation and at rest. Throughout the years, several techniques to obtain permanent lip enhancement have been introduced, such as the use of nonresorbable fillers. The main problem related to permanent fillers is that undesirable results could not always be repaired; although lip sequelae can be addressed surgically, some surgeons will not perform this type of procedure due to its complexity and the lack of guidelines.

In this paper, the authors present a case of a labial incompetence developed after lips implant removal performed elsewhere; after clinical examination the patient was planned for surgery, although during preoperative instrumental examination (chest X-ray) a solitary pulmonary nodule was noted; further investigation performed with needle biopsy revealed a lung cancer. For this reason, the surgical procedure planned for lip restoration was not performed; however, the patient asked for a minimally invasive procedure, thus to improve, although temporarily, her lips appearance.

For the aforementioned reasons, the patient was treated just with hyaluronic acid injections achieving a pleasant result, solving also the labial incompetence at rest.

To the best of the author's knowledge, this paper represents the first one describing the use of hyaluronic acid injections to restore lip competence following surgical removal of permanent implant.
Co-Culture of Adipose-Derived Stem Cells and Chondrocytes With Transforming Growth Factor-Beta 3 Promotes Chondrogenic Differentiation
Authors: Ma Xiao-Fei , Ma Xiao-Bing , Qian Wen-Jiang , Zhao Hong-Yi , Ding Jin-Ping , Zhao Tian-Lan
Published: July 2020

Tissue engineering cartilage is a promising strategy to reconstruct the craniofacial cartilaginous defects. It demands plenty of chondrocytes to generate human-sized craniofacial frameworks. Partly replacement of chondrocytes by adipose-derived stem cells (ADSCs) can be an alternative strategy.

The study aimed at evaluating the chondrogenic outcome of ADSCs and chondrocytes in direct co-culture with transforming growth factor-beta (TGF-β3). Porcine ADSCs and chondrocytes were obtained from abdominal wall and external ears. Four groups: ADSCs or chondrocytes monocultured in medium added with TGF-β3; ADSCs and ACs co-cultured with or without TGF-β3. Cell growth rate was performed to evaluate the cell proliferation. Morphological, histologic and real-time polymerase chain reaction analysis were performed to characterize the chondrogenic outcome of pellets. ADSCs had favorable multi-lineage differentiation potential. Further, when ADSCs were co-cultured with chondrocytes in medium added with TGF-β3, the cell proliferation was promoted and the chondrogenic differentiation of ADSCs was enhanced. We demonstrate that pellet co-culture of ADSCs and chondrocyte with TGF-β3 could construct high quantity cartilages. It suggests that this strategy might be useful in future cartilage repair.
Prevalence of Frontal Sinus Aplasia in Jordanian Individuals
Authors: Al-Balas Hasan Ibrahim , Nuseir Amjad , Alzoubi Firas , Alomari Ahmad , Bani-Ata Majid , Almehzaa Sumaya , Aleshawi Abdelwahab
Published: July 2020

Our paper aims to investigate the prevalence of frontal sinus aplasia among Jordanian individuals and compare it with values from different populations. Retrospectively, the study was done for 167 of the paranasal sinuses coronal tomography (CT) for patients who attended the clinic from January 2019 to August 2019 in King Abdullah University Hospital Irbid, Jordan. The authors analyzed the multiplanar CT scans to perform our work. The authors excluded the following images from our study: patients younger than 18 years old, patients with history of skull base trauma that impaired visualization of the frontal sinus, and images with fibro-osseous lesions that impaired the visualization of the frontal sinus. The prevalence of bilateral frontal sinus aplasia is 4.2% among Jordanian individuals and 6.6% is the prevalence of unilateral frontal sinus aplasia. Both values are consistent with average values among different populations. Moreover, we noticed the higher prevalence in both the bilateral and unilateral frontal sinus aplasia in males compared to females. The prevalence of frontal sinus aplasia among Jordanian individuals is almost within the same values among different populations. These numbers regarding the bilateral and unilateral frontal sinus aplasia is crucial to push the surgeon to evaluate CT of the paranasal sinuses preoperatively and focus on the presence of frontal sinuses on CT images to prevent unwanted complications during sinus surgeries.