bluuebunny/crossref_metadata_2025 huggingface dataset:
Should we still monitor QTc duration in frail older patients on low-dose haloperidol? A prospective observational cohort study
Authors: Castro Ellen , Körver Frank , Merry Audrey , van Moorsel Fieke , Hazebroek Mark , Smid Machiel , Ploux Sylvain , Bordachar Pierre , Prinzen Frits , Sipers Walther , Strik Marc
Published: March 2020

Background

Haloperidol at high dosage is associated with QTc prolongation and polymorphic ventricular arrhythmia but the effects of low-dose haloperidol remain unknown.

Objective

To evaluate the effects of low-dose haloperidol on QTc-duration in frail hospitalized elderly patients with delirium.

Methods

A prospective observational study including hospitalized patients aged ≥70 years with Groningen Frailty Index-score > 3. We included 150 patients who received haloperidol and 150 age- and frailty-matched control patients. Serial ECG recordings were performed at hospital admission and during hospitalization. QT-interval was corrected according to Framingham (QTc). Patients were grouped according to baseline QTc in normal (nQTc), borderline (bQTc) or abnormal (aQTc). Primary outcome was change in QTc-duration between first and second ECG. Potentially dangerous QTc was defined as QTc >500 ms or an increase of >50 ms.

Results

Patients in the haloperidol group (48% male, mean age 85y, nQT n = 98, bQT n = 31, aQT n = 20) received an average dose of 1.5 mg haloperidol per 24 hours. QTc decreased in patients with borderline (mean − 15 ± 29 ms, P < 0.05) or abnormal (−19 ± 27 ms, P < 0.05) QTc at baseline, no patients developed dangerous QTc-duration. In the control group (41% male, mean age 84y, nQT n = 99 bQT n = 29, aQT n = 22) QTc decreased to a similar extent (bQT −7 ± 16 ms, aQTc −23 ± 20 ms).

Conclusion

A trend to QTc shortening was seen, especially in patients with borderline or abnormal QTc at baseline, regardless of haloperidol use. These findings suggest that ECG monitoring of frail elderly patients who receive low-dose haloperidol, may not be necessary.
Burden of Peripheral Artery Disease on Mortality and Incident Cardiovascular Events
Authors: Unkart Jonathan T , Allison Matthew A , Araneta Maria Rosario G , Ix Joachim H , Matsushita Kunihiro , Criqui Michael H
Published: March 2020

Using data from the Multi-Ethnic Study of Atherosclerosis (United States, 2000–2015), 6,527 racially/ethnically diverse adults (mean age, 62 (standard deviation, 10) years) free of known cardiovascular (CVD) had ankle brachial index (ABI) assessment of their bilateral dorsalis pedis/posterior tibial arteries (4 vessels total) and were followed for total mortality and incident CVD events/mortality. Individuals were classified into categories of 0-, 1-, 2-, 3- or 4-vessel peripheral artery disease (PAD) (ABI of ≤0.9). There were 1,202 deaths (18%), 656 incident CVD events (10%), and 282 CVD deaths (4.3%). Of the 6,527 individuals, 5,711 (87.5%) had 0-, 460 (7.0%) had 1-, 218 (3.3%) had 2-, 69 (1.1%) had 3-, and 69 (1.1%) had 4-vessel PAD, respectively. In multivariable Cox models, higher number of vessels with PAD was associated with higher risk of mortality (P for trend <0.001), CVD events (P for trend = 0.002), and CVD mortality (P for trend = 0.001). Compared with individuals who had 0-vessel disease, hazard ratios for mortality were 1.29 (95% confidence interval (CI): 1.06, 1.59) for 1-, 1.45 (95% CI: 1.14, 1.86) for 2-, 1.58 (95% CI: 1.13, 2.21) for 3-, and 2.15 (95% CI: 1.58, 2.94) for 4-vessel disease. A similar pattern was seen for CVD events/mortality. These results suggest the importance of accounting for ABI values of all 4 leg arteries in clinical practice and research.
Multipopulation harmony search algorithm for the detection of high-order SNP interactions
Authors: Tuo Shouheng , Liu Haiyan , Chen Hao
Published: March 2020

Motivation

Recently, multiobjective swarm intelligence optimization (SIO) algorithms have attracted considerable attention as disease model-free methods for detecting high-order single nucleotide polymorphism (SNP) interactions. However, a strict Pareto optimal set may filter out some of the SNP combinations associated with disease status. Furthermore, the lack of heuristic factors for finding SNP interactions and the preference for discrimination approaches to disease models are considerable challenges for SIO.

 

In this study, we propose a multipopulation harmony search (HS) algorithm dedicated to the detection of high-order SNP interactions (MP-HS-DHSI). This method consists of three stages. In the first stage, HS with multipopulation (multiharmony memories) is used to discover a set of candidate high-order SNP combinations having an association with disease status. In HS, multiple criteria [Bayesian network-based K2-score, Jensen–Shannon divergence, likelihood ratio and normalized distance with joint entropy (ND-JE)] are adopted by four harmony memories to improve the ability to discriminate diverse disease models. A novel evaluation criterion named ND-JE is proposed to guide HS to explore clues for high-order SNP interactions. In the second and third stages, the G-test statistical method and multifactor dimensionality reduction are employed to verify the authenticity of the candidate solutions, respectively.

Results

We compared MP-HS-DHSI with four state-of-the-art SIO algorithms for detecting high-order SNP interactions for 20 simulation disease models and a real dataset of age-related macular degeneration. The experimental results revealed that our proposed method can accelerate the search speed efficiently and enhance the discrimination ability of diverse epistasis models.

Availability and implementation

https://github.com/shouhengtuo/MP-HS-DHSI.

Supplementary information

Supplementary data are available at Bioinformatics online.
CARTR Plus: the creation of an ART registry in Canada
Authors: Lanes A , Fell DB , Teitelbaum M , Sprague AE , Johnson M , Wang H , Elliott M , Guo Y , Meng L , Yuzpe A , Bissonnette F , Leveille MC , Walker MC
Published: March 2020

STUDY QUESTION

What is the status of fertility treatment and birth outcomes documented over the first 6 years of the Canadian Assisted Reproductive Technologies Register (CARTR) Plus registry?

SUMMARY ANSWER

The CARTR Plus registry is a robust database containing comprehensive Canadian fertility treatment data to assist with providing evidence-based rationale for clinical practice change.

WHAT IS KNOWN ALREADY

The rate of infertility is increasing globally and having data on fertility treatment cycles and outcomes at a population level is important for accurately documenting and effecting changes in clinical practice.

STUDY DESIGN, SIZE, DURATION

This is a descriptive manuscript of 183 739 fertility treatment cycles from 36 Canadian clinics over 6 years from the CARTR Plus registry.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Canadian ART treatment cycles from 2013 through 2018 were included. This manuscript described trends in type of fertility treatment cycles, pregnancy rates, multiple pregnancy rates, primary transfer rates and birth outcomes.

MAIN RESULTS AND THE ROLE OF CHANCE

Over the 6 years of the CARTR Plus registry, the number of treatment cycles performed ranged from less than 200 to greater than 1000 per clinic. Patient age and the underlying cause of infertility were two of the most variable characteristics across clinics. Similar clinical pregnancy rates were found among IVF and frozen embryo transfer (FET) cycles with own oocytes (38.9 and 39.7% per embryo transfer cycle, respectively). Fertility treatment cycles that used donor oocytes had a higher clinical pregnancy rate among IVF cycles compared with FET cycles (54.9 and 39.8% per embryo transfer cycle, respectively). The multiple pregnancy rate was 7.4% per ongoing clinical pregnancy in 2018, which reflected a decreasing trend across the study period. Between 2013 and 2017, there were 31 811 pregnancies that had live births from all ART treatment cycles, which corresponded to a live birth rate of 21.4% per cycle start and 89.1% of these pregnancies were singleton live births. The low multiple pregnancy rate and high singleton birth rate are associated with the increase in single embryo transfers.

LIMITATIONS, REASONS FOR CAUTION

There is potential for misclassification of data, which is present in all administrative health databases.

WIDER IMPLICATIONS OF THE FINDINGS

The CARTR Plus registry is a robust resource for ART data in Canada. It provides easily accessible aggregated data for Canadian fertility clinics, and it contains data that are internationally comparable.

STUDY FUNDING/COMPETING INTEREST(S)

There was no funding provided for this study. The authors have no competing interests to declare.
Norm Sabotage: Conceptual Reflection on a Phenomenon That Challenges Well-Established Norms
Authors: Schneiker Andrea
Published: March 2020

This article is concerned with conceptualizing those actors who seek to undo the collective normative standard that has already been achieved. I call these actors norm saboteurs. Unlike norm entrepreneurs, who promote a new norm, or norm antipreneurs, who resist a new norm, saboteurs seek to obstruct the implementation of an already accepted norm. They not only oppose a norm, but also seek to prevent others from maintaining the normative status quo, i.e., from implementing a norm. In order to do so, saboteurs can apply a variety of strategies, relying on persuasion, blocking or obfuscation. The analysis shows that norms assumed to be the most robust—those having achieved a taken-for-granted quality—can actually lack resilience. Actors that follow widely accepted norms might even be sanctioned by saboteurs for upholding the normative status quo.
Effects of heat stress on the gut health of poultry
Authors: Rostagno Marcos H
Published: March 2020

Stress is a biological adaptive response to restore homeostasis, and occurs in every animal production system, due to the multitude of stressors present in every farm. Heat stress is one of the most common environmental challenges to poultry worldwide. It has been extensively demonstrated that heat stress negatively impacts the health, welfare, and productivity of broilers and laying hens. However, basic mechanisms associated with the reported effects of heat stress are still not fully understood. The adaptive response of poultry to a heat stress situation is complex and intricate in nature, and it includes effects on the intestinal tract. This review offers an objective overview of the scientific evidence available on the effects of the heat stress response on different facets of the intestinal tract of poultry, including its physiology, integrity, immunology, and microbiota. Although a lot of knowledge has been generated, many gaps persist. The development of standardized models is crucial to be able to better compare and extrapolate results. By better understanding how the intestinal tract is affected in birds subjected to heat stress conditions, more targeted interventions can be developed and applied.
Improved simple T-cannula technique to facilitate surgery and daily skin care of growing pigs
Authors: Metzler-Zebeli Barbara U , Rosenfelder-Kuon Pia , Brehm Helga , Eklund Meike , Mosenthin Rainer
Published: March 2020

In order to further increase the stability of the cannula behind the ribs and to facilitate cannula exteriorization in growing pigs, the present study aimed to evaluate whether elongation of the cannula flange could increase the stability of the cannula behind the ribs and to develop a tool to improve the exteriorization of the cannula through the ribs. Moreover, it was assessed whether a special skin protection paste and soft polyurethane foam material used in daily skin care could prevent erythema around the fistula. The feasibility of both, the modified simple T-cannula and daily skin care procedure, was evaluated in a digestibility experiment. Simple T-cannulae were made of high-molecular-weight polyethylene and inserted into the distal ileum of eight growing pigs (average body weight at surgery 30 kg). Modifications in the cannula design included a longer flange (11 cm) that was narrowed from the center to the ends and a bending of the flange to adapt it to the curve of the costal arch. In order to reduce the damage to the thread on the outer cannula barrel during surgery, a special surgical plug in conjunction with a screw thread on the inside of the barrel was developed. With respect to the daily cleaning of the fistula, a special skin protection paste was applied on the skin around the fistula to create a waterproof film that entirely sealed the skin. Additionally, foam material was inserted between the retaining ring and the skin to absorb the leaking digesta. Monitoring of the pigs throughout the trial showed that modifications in cannula design proved to be useful as they facilitated exteriorization of the cannula through the ribs and stability of the cannula behind the ribs. Moreover, the use of the skin protection paste and foam material during postsurgical treatment of growing pigs effectively prevented skin irritation around the flank area.
Mosquito Community Composition, Seasonal Distributions, and Trap Bias in Northeastern Florida
Authors: Giordano Bryan V , Bartlett Suzanne K , Falcon Drake A , Lucas Raymond P , Tressler Miranda J , Campbell Lindsay P
Published: March 2020

Mosquito control agencies monitor mosquito diversity and abundance through a variety of trap types. Although various long-term ecological data sets exist, little work has been done to address the sampling effort required to capture mosquito community diversity by trap type and few spatiotemporal distributions of vector species have been described. Here, we describe the seasonal distributions of vector species of importance, assess trapping effort needed to capture the diversity of the mosquito community, and use a partial redundancy analysis to identify trap bias from four commonly deployed adult mosquito traps in Volusia County, Florida. Collections were made with American Biophysics Corporation (ABC) light traps, Biogents Sentinel (BGS) traps, chicken coop exit traps, and gravid traps. We collected a total of 238,301 adult female mosquitoes belonging to 11 genera and 36 species, 12 of which we deemed to be vector species of epidemiological importance. We found that ABC traps not only yielded the greatest abundance and diversity but also captured several nonvector species. BGS and gravid traps yielded the highest proportions of vector species; exit traps recorded the lowest abundances and species richness. Wintertime abundances of several species demonstrated a need for year-round surveillance in the study area; partial redundancy analysis revealed that trap type explained a significant proportion of the variance in our data set, with certain vector species associated with specific trap types. Increased awareness regarding the amount of trapping effort needed to detect vector species diversity will help to optimize efforts in the field, leading to more effective resource allocation.
Rapid Tree Diameter Computation with Terrestrial Stereoscopic Photogrammetry
Authors: Eliopoulos Nicholas J , Shen Yezhi , Nguyen Minh Luong , Arora Vaastav , Zhang Yuxin , Shao Guofan , Woeste Keith , Lu Yung-Hsiang
Published: March 2020

Forest inventorying is time-consuming and expensive. Recent research involving photogrammetry promises to reduce the cost of inventorying. Existing photogrammetry methods require substantial data-processing time, however. Our aim was to reduce data-acquisition and processing times while obtaining relatively accurate diameter estimates compared to manual and other digital measurements. We developed an algorithm to identify the ground and measure diameter at breast height (dbh) or any height along a stem from the recorded video footage of trees taken with a stereo camera. Footage acquisition time, dbh root mean square error, and mean absolute error were used as comparison metrics with other methods. The time to perform three recordings for 40 trees was about 30 minutes. We recorded data at 1 m, 3 m, and 5 m from the trunk, and our dbh root mean square errors were 1.28 cm (0.50 in.), 1.47 cm (0.58 in.), and 2.57 cm (1.01 in.), respectively, using manual measures as the control. This terrestrial stereoscopic photogrammetric method is much more efficient computationally than popular terrestrial structure-from-motion photogrammetry and substantially lowers time, costs, and complexity for data acquisition and processing compared with terrestrial laser scanning.
Timber Use, Processing Capacity, and Capability within the USDA Forest Service, Rocky Mountain Region Timber-Processing Area
Authors: Simmons Eric A , Morgan Todd A , Hayes Steven W , Ng Kawa , Berg Erik C
Published: March 2020

Over the past two decades, more than half a million acres of forested land has experienced extensive insect- and disease-caused tree mortality within the USDA Forest Service Rocky Mountain Region 2 (R2) of the National Forest System. To plan for timber harvest treatments needed to restore forest health, managers need information on forest product facility capacity and capability to profitably process timber of various size classes. To answer this need, the authors summarized timber harvest volumes by state and county group, identified facilities in the R2 area, quantified timber-processing capacities and size class capabilities, and analyzed the geographic variability of timber flows from county of harvest to mill. Results showed that nearly 285.5 million board feet Scribner of timber flowed from the study area to 101 processors throughout the R2 timber-processing area. Approximately 70 percent of annual milling capacity can profitably process trees ≧10 in. dbh, whereas just 8 percent can process timber <7 in. dbh. When planning forest-management activities, land managers should balance the need to remove small and/or dead trees with the local industry’s ability to profitably use that material.
Effects of warming on soil respiration during the non-growing seasons in a semiarid temperate steppe
Authors: Miao Yuan , Liu Mengzhou , Xuan Juan , Xu Wei , Wang Shilin , Miao Renhui , Wang Dong , Wu Wei , Liu Yinzhan , Han Shijie
Published: March 2020

Aims

The response pattern of terrestrial soil respiration to warming during non-growing seasons is a poorly understood phenomenon, though many believe that these warming effects are potentially significant. This study was conducted in a semiarid temperate steppe to examine the effects of warming during the non-growing seasons on soil respiration and the underlying mechanisms associated therewith.

Methods

This experiment was conducted in a semiarid temperate grassland and included 10 paired control and experimental plots. Experimental warming was achieved with open top chambers (OTCs) in October 2014. Soil respiration, soil temperature and soil moisture were measured several times monthly from November 2014 to April 2015 and from November 2015 to April 2016. Microbial biomass carbon (MBC), microbial biomass nitrogen (MBN) and available nitrogen content of soil were measured from 0 to 20 cm soil depth. Repeated measurement ANOVAs and paired-sample t tests were conducted to document the effect of warming, and the interactions between warming and time on the above variables. Simple regressions were employed to detect the underlying causality for the observed effects.

Important Findings

Soil respiration rate was 0.24 µmol m−2 s−1 in the control plots during the non-growing seasons, which was roughly 14.4% of total soil carbon flux observed during growing seasons. Across the two non-growing seasons, warming treatment significantly increased soil temperature and soil respiration by 1.48°C (P < 0.001) and 42.1% (P < 0.01), respectively, when compared with control plots. Warming slightly, but did not significantly decrease soil moisture by 0.66% in the non-growing seasons from 2015 to 2016. In the non-growing seasons 2015–16, experimental warming significantly elevated MBC and MBN by 19.72% and 20.99% (both P < 0.05), respectively. In addition, soil respiration responses to warming were regulated by changes in soil temperate, MBC and MBN. These findings indicate that changes in non-growing season soil respiration impact other components in the carbon cycle. Additionally, these findings facilitate projections regarding climate change–terrestrial carbon cycling.
Urinary bladder-containing incarcerated inguinoscrotal hernia: a case report
Authors: Karanikas Michael , Kofina Konstantinia , Foutzitzi Soultana , Deftereos Savas , Effraemidou Eleni , Lyratzopoulos Nikolaos , Polychronidis Alexandros
Published: March 2020

Inguinoscrotal hernia containing the urinary bladder is a rare entity found in 1–4% of inguinal hernias, while patients rarely present symptoms of urinary dysfunction. We present the case of a 79-year-old Caucasian male with acute renal dysfunction and incarcerated inguinoscrotal hernia containing the entire urinary bladder. The patient presented in the surgical emergency department due to an incarcerated right inguinoscrotal hernia and deteriorated renal function. Preoperatively, ultrasound imaging was performed, which showed the presence of the whole bladder in the hernia sac. The bladder was repositioned to its anatomic position and hernia was repaired through a modified Lichtenstein technique. In patients with inguinoscrotal hernia and acute urinary tract symptoms, surgeons should be aware of the possibility of inguinal bladder hernia. Preoperative imaging can help in preventing intraoperative bladder damage.
How the Implementation of a Battlefield Clinical Practice Guideline Affects Documentation Practice and Informs Future Research Initiatives: Spinal Injuries and Cervical Collars
Authors: Graham Brock , Johnson Grant M , Gurney Jennifer M , Shackelford Stacy A , Howard Jeffrey T , Janak Jud C
Published: March 2020

Introduction

In 2010, the Joint Trauma System published a clinical practice guideline (CPG) for providing care to patients with suspicion of spinal cord injury. The CPG advocated for liberal use of cervical collars and adequate documentation of the practice. This performance improvement project examined C-spine CPG adherence in both the prehospital and military treatment facility (MTF) settings. Understanding challenges in CPG adherence facilitates evaluation of future CPGs and their success at implantation of the clinical guidance.

Materials and Methods

The Department of Defense Trauma Registry was used to identify US Military casualties meeting the criteria for cervical collar placement between January 1, 2007 and December 31, 2018. Criteria for cervical collar placement were defined as any patient who experienced a mechanism of injury relating to an explosion, fall, or motor-vehicle-related injury. Any patients with an AIS severity score greater than 1 to the head or having any ICD injury codes related to either upper spinal cord or head injury were also considered for inclusion. Adherence of cervical collar placement was defined by documented ICD codes or prehospital documentation of cervical collar placement as captured in the registry.

Results

A total of 14,837 patients were identified for possible cervical collar placement and 3,317 had verifiable documentation of having a C-collar placed. Documented C-collar placement was higher after the publication of the clinical practice guideline in 2010 (29% vs. 15%, p < 0.0001). CPG publication was associated with cervical collar application (odds ratio: 2.50, 95% CI: 2.29–2.72).

Conclusion

Application of cervical collars has increased significantly, since the initial publication of the spine injury CPG. Current gaps include valid and reliable identification of patients warranting specific clinical interventions and documentation of patient care. Currently, lack of documentation is reported as nonadherence, but it remains unknown if these missing clinical data accurately portray nonadherence or adherence with lack of documentation. Future research and resources would benefit and expand the results collected in this paper, and cement the importance of CPG publication and adherence.
First Inventory of Fungi in Symptomless and Symptomatic Chinese Mesona Indicates Phytopathological Threat
Authors: Hsieh Chung-Wei , Chuang Ying-Ying , Lee Ming-Zhe , Kirschner Roland
Published: March 2020

Chinese mesona (Platostoma palustre) plays an important role as special crop in Southeast Asia and Taiwan for the production of herbal tea, grass jelly, and further processed food. In order to assess the potential threat of fungi to Chinese mesona, we surveyed isolates from symptomless plants in the area of mesona production, as well as from leaf spots of potted plants in a garden shop and a plantation in a botanical garden in Taiwan. From leaves, stems, and roots of 15 symptomless plants sampled at five collection events over two years, 154 isolates from 810 surface-sterilized plant fragments were obtained and identified based on DNA sequence data of the internal transcribed spacer region, and partially of the β-tubulin and histone H3 genes. The most common species belonged to the genera Cercospora, Colletotrichum, and Fusarium and were considered to be potential plant pathogens. Latent pathogenicity was confirmed by an infection experiment with an endophytic strain of Corynespora cassiicola. Observation of leaf spot disease associated with Cercospora kikuchii suggested pathogenicity of this fungus, which was also isolated as an endophyte from symptomless leaves. We hypothesize that the most common endophytic fungi are latent pathogens in the host and may cause plant disease when the host becomes weakened by senescence or changed cultivation condition. Leaf spots of plants in the botanical garden were associated with a species of Pseudocercospora, which was not found among the endophytic isolates and is newly described based on morphology and analysis of translation elongation factor 1 alpha gene sequences.
Genome Sequence of the Chestnut Blight Fungus Cryphonectria parasitica EP155: A Fundamental Resource for an Archetypical Invasive Plant Pathogen
Authors: Crouch Jo Anne , Dawe Angus , Aerts Andrea , Barry Kerrie , Churchill Alice C. L. , Grimwood Jane , Hillman Bradley I. , Milgroom Michael G. , Pangilinan Jasmyn , Smith Myron , Salamov Asaf , Schmutz Jeremy , Yadav Jagjit S. , Grigoriev Igor V. , Nuss Donald L.
Published: March 2020

Cryphonectria parasitica is the causal agent of chestnut blight, a fungal disease that almost entirely eliminated mature American chestnut from North America over a 50-year period. Here, we formally report the genome of C. parasitica EP155 using a Sanger shotgun sequencing approach. After finishing and integration with simple-sequence repeat markers, the assembly was 43.8 Mb in 26 scaffolds (L50 = 5; N50 = 4.0Mb). Eight chromosomes are predicted: five scaffolds have two telomeres and six scaffolds have one telomere sequence. In total, 11,609 gene models were predicted, of which 85% show similarities to other proteins. This genome resource has already increased the utility of a fundamental plant pathogen experimental system through new understanding of the fungal vegetative incompatibility system, with significant implications for enhancing mycovirus-based biological control.
Utilization of Health Care Resources by Long-term Care Residents as a Function of Pain Status
Authors: Guliani Harminder , Hadjistavropoulos Thomas , Jin Shan , Lix Lisa
Published: March 2020

Objective:

We estimated the association between the presence of pain and health care utilization among older adults residing in long-term care (LTC) facilities.

Materials and Methods:

Using administrative health data maintained by the Saskatchewan ministry of health and time-to-event analyses with multivariable frailty models, we tested for differences in health care use (hospitalization, physician and specialist visits, and prescription drug dispensations) as a function of pain status among LTC residents after admission to an LTC. Specifically, we contrasted LTC residents with daily pain or less than daily pain but with moderate or severe intensity (ie, clinically significant pain group; CSP) to residents with no pain or nondaily mild pain (NP/NDMP group).

Results:

Our cohort consisted of 24,870 Saskatchewan LTC residents between 2004 and 2015 with an average age of 85 years (63.2% female; 63.0% in urban facilities). Roughly one third had CSP at their LTC admission date. Health care use after admission to LTC was strongly associated with pain status, even after adjusting for residents’ demographic and facility characteristics, prior comorbidities and health care utilization 1 year before the study index date. In any given quarter, compared with NP/NDMP residents, those with CSP had an increased risk of hospitalization, specialist visit, follow-up general practitioner visit, and onset of polypharmacy (ie, 3 or more medication classes).

Discussion:

To our knowledge, this is the first large-scale project to examine the utilization of health care resources as a function of pain status among LTC facility residents. Improved pain management in LTC facilities could lead to reduced health care use.
Management of systemic sclerosis: the first five years
Authors: Roofeh David , Khanna Dinesh
Published: March 2020

Purpose of review

This review provides a risk-stratified and evidence-based management for subsets of systemic sclerosis (SSc) patients in the first five years from disease onset.

Recent findings

Cardiopulmonary disease remains the primary cause of mortality in SSc patients. Morbidity and mortality in SSc-associated pulmonary arterial hypertension have improved with combination treatment, in either an upfront or sequential treatment pattern. Traditional therapies for interstitial lung disease (SSc-ILD) have targeted those with clinically significant and progressive ILD with immunosuppression. New data suggest a possible paradigm shift, introducing immunosuppressive therapy to patients before they develop clinically significant or progressive ILD. The year 2019 saw the approval of the first FDA-approved therapy for SSc-associated interstitial lung disease, using an antifibrotic agent previously approved for idiopathic pulmonary fibrosis. To date, only autologous hematopoietic stem cell transplant has demonstrated a mortality benefit for SSc-ILD, albeit in a narrow spectrum of SSc-ILD patients.

SSc is a highly heterogeneous autoimmune disease typified by varying clinical trajectories. Its management may be stratified within the first five years by subclassifying patients based on factors that have important prognostic significance: skin distribution and autoantibody status.
Image Distortion in Biplanar Slot Scanning: Patient-specific Factors
Authors: Welborn Michelle C. , Bouton Daniel , Baksh Nikolas , Degan Timothy , Sienko Susan
Published: March 2020

Background:

Error within imaging measurements can be due to processing, magnification, measurement performance, or patient-specific factors. Previous length measurement studies based on radiographs have shown good intraclass correlation coefficients (ICCs) on single images; but have not assessed interimage distortion. In our study, “image distortion in biplanar slot scanning: technology-specific factors” we determined that there is minimal image distortion due to the image acquisition when using biplanar slot scanning. In this study, we aim to determine the role of patient-specific factors in image distortion, specifically evaluating interimage distortion.

Methods:

Digital radiographs and biplanar slot scanner images were reviewed in 43 magnetically controlled growing rod (MCGR) patients. Fifty-five postoperative anteroposterior digital radiographs, 184 follow-up biplanar slot-scanner scanner posteroanterior and 76 biplanar slot-scanner scanner laterals were measured by 2 residents and 1 attending. The manufacturer reported average actuator diameter of 9.02 mm was used as our reference width.

Results:

Overall, within image interobserver ICC were moderate to excellent (0.635 to 0.983), but the interimage ICCs were poor (0.332). Digital radiographs consistently overestimated the MCGR actuator width (mean=9.655) and biplanar slot-scanner scanner images underestimated it (mean=8.935). The measurement range was large with biplanar slot-scanner scanner posteroanterior (up to 15%) and lateral (22%) measurements and with digital radiographs (39%). Patients with abnormal muscle tone had higher degrees of measurement variability.

Conclusions:

We found that neither biplanar slot scanning nor digital radiography was precise or accurate. Digital radiographs consistently overestimated MCGR actuator width and biplanar slot scanning underestimated it. The poor ICC’s within and between image subtypes and large standard error of measurement reflected a magnitude of distortion that needs to be accounted for when using length measurements clinically. Unlike the clinically insignificant error that we noted in our previous study “image distortion in biplanar slot scanning: technology-specific factors” (0.5% to 1.5% of the measurement), the error noted in this study (0.2% to 38.5% of the measurement) has the potential to be clinically significant. Patients who have abnormal muscle tone had larger measurement errors, likely stemming from motion during the slot scanning process.

Level of Evidence:

Level III.
C5 Palsy After Cervical Spine Decompression: Topographic Correlation With C6 Chassaignac Tubercle?
Authors: Rajabian Ali , Quraishi Nasir A.
Published: March 2020

Study Design.

Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens, which has not previously been reported.

Objective.

Our aim was to explore the possible topographic correlation of the C5 nerve root with regards to its course and regional relation to C6 Chassaignac tubercle.

Summary of Background Data.

C5 palsy is reported amongst the most frequent postoperative complications of cervical spinal procedures. We hypothesized that etiologic mechanisms proposed thus far in the current literature, although with some plausible explanation, still cannot explain why the C5 nerve root and not any other level suffer a postoperative palsy.

Methods.

Six fresh cadavers had extensive layer by layer dissection performed by two surgeons (one of whom has experience as an anatomy demonstrator and dissector). Roots of brachial plexus were exposed in relation to cervical transverse processes. Photographs were taken at each stage of the exposure.

Results.

We observed a close relation of the path of the C5 nerve root with the C6 tubercle bilaterally. Moreover, we noted a steeper descent of C5 in comparison with the other adjacent roots.

Conclusion.

Steeper angle of the C5 nerve root and close proximity to C6 Chassaignac tubercle may play a role in predisposing it to neuropraxia. Detailed anatomical photographs on fresh unprocessed cadaveric specimens are novel. Peculiar anatomical features and recent experimental evidence discussed do highlight a postganglionic extraforaminal etiology corresponding well to the demographic meta-analysis data on clinical features of postoperative C5 palsy. Exploring an alternative unified “neurophysiologic stress and critical tipping point” etiological model that encompasses current theories and correlates known metanalyses observations, we believe further studies would be prudent to ascertain/refute these findings.

Level of Evidence: 3
Cervical Canal Morphology: Effects of Neck Flexion in Normal Condition
Authors: Sudres Patrice , Evin Morgane , Arnoux Pierre-Jean , Callot Virginie
Published: March 2020

Study Design.

Continuous measurements and computation of absolute metrics of cervical subarachnoid space (CSS) and spinal cord (SC) geometries proposed are based on in vivo magnetic resonance imaging and 3D reconstruction.

Objective.

The aim of the study is to offer a new methodology to continuously characterize and to quantify the detailed morphology of the CSS and the cervical SC in 3D for healthy subjects in both neutral supine and flexion.

Summary of Background Data.

To the best of our knowledge, no study provides a morphological quantification by absolute indices based on the 3D reconstruction of SC and CSS thanks to in vivo magnetic resonance imaging. Moreover, no study provides a continuous description of the geometries.

Methods.

Absolute indices of SC (cross-sectional area, compression ratio, position in the canal, length) and of CSS (cross-sectional area, occupational ratio, lengths) were computed by measures from 3D semi-automatic reconstructions of high resolution in vivo magnetic resonance images (3D T2-SPACE sequence) on healthy subjects (N = 11) for two postures: supine neutral and flexion neck positions. The variability induced by the semi-automatic reconstruction and by the landmarks positioning were investigated by preliminary sensitivity analyses. Inter and intra-variability were also quantified on a randomly chosen part of our population (N = 5).

Results.

The length and cross-sectional area of SC are significantly different (P < 0.05) in flexion compared with neutral neck position. Spinal cord stays centered in the canal for both postures. However, the cross-sectional area of CSS is submitted to low variation after C3 vertebra for both postures. Occupational ratio (OR) and compression ratio (CR) after C3 are significantly lower in flexion.

Conclusion.

This study presented interpretations of morphological measures: (1) left–right stability (described by the Left–Right eccentricity index) ensured by the denticulate ligaments and the nerve roots attached to the dural sheaths, (2) a Poisson effect of the SC was partially notified through its axial (antero-posterior [AP] diameter, OR, CR) and its longitudinal geometrical descriptions (length of spinal cord [LSC]). Such morphological data can be useful for geometrical finite element modeling and could now be used to compare with injured or symptomatic subjects.

Level of Evidence: 3
Identification of Predictive Factors for Mechanical Complications After Adult Spinal Deformity Surgery
Authors: Kawabata Atsuyuki , Yoshii Toshitaka , Sakai Kenichiro , Hirai Takashi , Yuasa Masato , Inose Hiroyuki , Utagawa Kurando , Hashimoto Jun , Matsukura Yu , Tomori Masaki , Torigoe Ichiro , Kusano Kazuo , Otani Kazuyuki , Mizuno Koichi , Satoshi Sumiya , Kazuyuki Fukushima , Tomizawa Shoji , Arai Yoshiyasu , Shindo Shigeo , Okawa Atsushi
Published: March 2020

Study Design.

A retrospective multicenter observational study.

Objective.

To investigate correction surgeries that were performed in relatively aged patients in terms of mechanical complications (MCs) and their predictive factors.

Summary of Background Data.

The risk factors associated with MCs have not yet been well examined, especially in aged populations.

Methods.

We retrospectively reviewed 230 surgically treated ASD patients with an average age of 72.2 years. Twenty-eight patients with ASD caused by vertebral fractures were excluded. The minimum follow-up was 2 years. Postoperative MCs were defined as proximal junction kyphosis, distal junction kyphosis, pseudoarthrosis, rod breakage, and vertebral fractures. We divided all the ASD patients into two groups: patients with MC (the MC (+) group) and patients without MC (the MC (−) group). Radiographic parameters were evaluated before and immediately after surgery. The SRS-Schwab ASD classification and global alignment and proportion (GAP) score were also evaluated.

Results.

Of the 202 patients, 91 (45.0%) had MCs. The age at surgery was significantly higher in the MC (+) group than in the MC (−) group. Regarding radiographic parameters, postoperative global tilt (GT), pre- and postoperative thoracolumbar kyphosis (TLK), and postoperative thoracic kyphosis were significantly higher in the MC (+) group than in the MC (−) group. Other parameters, such as the proposed ideal alignment target of PI-LL<10, did not significantly affect MC rates. The GAP score was high in both groups and not significantly related to a higher rate of MC. Forward stepwise logistic regression indicated that the age at surgery, postoperative GT, and preoperative TLK were significant risk factors for MCs.

Conclusion.

Older age, higher postoperative GT, and higher pre and postoperative TLK can be risk factors for MCs. The GAP score was high in both groups and not significantly related to a higher rate of MC.

Level of Evidence: 4
Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace
Authors: Dolan Lori A. , Donzelli Sabrina , Zaina Fabio , Weinstein Stuart L. , Negrini Stefano
Published: March 2020

Study Design.

Comparative effectiveness study

Objective.

To evaluate factors leading to higher percentage of brace failures in a cohort of North American patients with adolescent idiopathic scoliosis relative to their peers in Italy.

Summary of Background Data.

Studies of bracing in United States have shown worse outcomes than studies from European centers, possibly due to sample characteristics or treatment approaches.

Methods.

Sample: Braced patients, aged 10 to 15, Risser <3, Cobb 20°- to 40°, observed to Cobb ≥40° and/or ≥Risser 4 selected from prospective databases. Comparators: Bracing per Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) (TLSO) and Italian Scientific Spine Institute (ISICO) protocol (SPoRT braces with or without SEAS exercises). Baseline characteristics (sex, age, BMI, Risser, Cobb, curve type) and average hours of brace wear/day. Differences in programs (e.g., SEAS, type of brace, weaning protocol) were captured by a variable named “SITE.” Outcome: Treatment failure (Cobb ≥40 before Risser 4). Statistics: Comparison of baseline characteristics, analyses of risk factors, treatment components, and outcomes within and between cohorts using logistic regression.

Results.

A total of 157 BrAIST and 81 ISICO subjects were included. Cohorts were similar at baseline but differed significantly in terms of average hours of brace wear: 18.31 in the ISICO versus 11.76 in the BrAIST cohort. Twelve percent of the ISICO and 39% of the BrAIST cohort had failed treatment. Age, Risser, Cobb, and a thoracic apex predicted failure in both groups. SITE was related to failure (odds ratio [OR] = 0.19), indicating lower odds of failure with ISICO versus BrAIST approach. With both SITE and wear time in the model, SITE loose significance. In the final model, the adjusted odds of failure were higher in boys (OR = 3.34), and those with lowest BMI (OR = 9.83); the odds increased with the Cobb angle (OR = 1.23), and decreased with age (OR = 0.41) and hours of wear (OR = 0.86).

Conclusion.

Treatment at the ISICO resulted in a lower failure rate, primarily explained by longer average hours of brace wear.

Level of Evidence: 3
Anatomic Features of Head and Neck Keratinocyte Cancer in Virginia
Authors: Karlin Justin , Engelhard Stephanie , Russell Mark , Kirzhner Maria
Published: March 2020

BACKGROUND

Keratinocyte cancer (KC) patients benefit from early diagnosis. We describe here the anatomy of head/neck KCs to help guide screening efforts.

OBJECTIVE

To examine lesion frequency and anatomic distribution of head and neck KC.

METHODS

This retrospective cohort study of 4,770 consecutive pathology reports, 1998 to 2015, analyzes 5,463 head and neck KCs (3,664 basal cell carcinoma [BCC], 1,259 squamous cell carcinoma [SCC], and 540 SCC in situ) from 3,581 patients.

RESULTS

Basal cell carcinoma relative tumor density (RTD) was highest on the nose; SCC RTD was highest on the cheek. Basal cell carcinoma-to-SCC ratio was highest on eyelid and lowest on scalp. Temple, ear, and neck SCC predominated in men; nose and cheek SCC in women. Scalp, temple, and ear BCC showed male predominance, while cheek, nose, and chin predominated in women. Left-sided ear SCC in situ and BCC were more common than right-sided ear lesions.

CONCLUSION

This study demonstrates gender- and laterality-specific differences that comport with patterns of solar exposure.
Exercise training delays renal disorders with decreasing oxidative stress and increasing production of 20-hydroxyeicosatetraenoic acid in Dahl salt-sensitive rats
Authors: Ogawa Yoshiko , Takahashi Junta , Sakuyama Akihiro , Xu Lusi , Miura Takahiro , Muroya Yoshikazu , Ito Daisuke , Kohzuki Masahiro , Ito Osamu
Published: March 2020

Objective:

Exercise training has antihypertensive and renoprotective effects in humans and rats. However, the effects of exercise training on renal disorders that occur with salt-sensitive hypertension remains unclear. The study aim was to investigate the effects and mechanisms of exercise training on renal function in a rat model of salt-sensitive hypertension.

Methods:

Six-week-old male Dahl salt-sensitive rats were divided into normal-salt (0.6% NaCl) diet, high-salt (8% NaCl) diet, and high-salt diet with exercise training groups. The high-salt diet with exercise training group underwent daily treadmill running for 8 weeks.

Results:

The high-salt diet induced severe hypertension and renal dysfunction. Exercise training significantly improved high-salt diet-induced urinary protein, albumin, and l-type fatty acid-binding protein excretion, and glomerulosclerosis but not renal interstitial fibrosis without changing blood pressure. Exercise training significantly attenuated high-salt diet-induced oxidative stress in the kidneys and decreased high-salt diet-stimulated xanthine oxidoreductase activity but not nicotinamide adenine dinucleotide phosphate oxidase activity. The high-salt diet did not change urinary excretion of 20-hydroxyeicosatetraenoic acid and decreased cytochrome P450 4A protein expression in the kidneys. Exercise training increased urinary 20-hydoroxyeicosatetraenoic acid excretion and renal cytochrome P450 4A protein expression.

Conclusion:

Exercise training improved renal disorders without lowering blood pressure in Dahl salt-sensitive rats. Exercise training also decreased oxidative stress and increased 20-hydroxyeicosatetraenoic acid production in the kidneys. These results suggest that improvements in oxidative stress and 20-hydroxyeicosatetraenoic acid production may be potential mechanisms by which exercise training improved renal disorders in Dahl salt-sensitive rats.
Change in Lower Eyelid Contour Following Ectropion Repair With Lateral Tarsal Strip
Authors: Young William , Scofield-Kaplan Stacy M. , Levy R. Evan , Keenum Zachary , Mancini Ronald
Published: March 2020

Purpose:

To evaluate the change in lateral canthal angle (LCA), inferior ocular surface exposed (IOSE), lower eyelid curvature, and margin-to-reflex distance 2 in those undergoing lower eyelid ectropion repair using a lateral tarsal strip technique.

Methods:

This is an Institutional Review Board-approved retrospective analysis of patients undergoing lower eyelid ectropion repair. This study included all patients from 2012 to 2018 operated on by a single surgeon at the University of Texas Southwestern Medical Center. For each patient, LCA, IOSE, and eyelid curvature were measured on preoperative and postoperative photographs using NIH Image J photographic analysis. These measurements were compared using paired 1-tail t-tests for LCA and IOSE and paired 2-tail t-tests for eyelid curvature. This study was Health Insurance Portability and Accountability Act-compliant with protection of individually identifiable information.

Results:

Fifty-one patients with lower eyelid ectropion underwent lower eyelid ectropion repair using a lateral tarsal strip technique. Forty-three of the patients underwent a bilateral lower eyelid ectropion repair. There was no statistically significant difference in the LCA. There was a reduction in IOSE among both cohorts. The fourth degree polynomial trendlines generated to assess eyelid curvature demonstrated statistical significance, suggesting a flattening of eyelid curvature. margin-to-reflex distance 2 also had a statistically significant decrease postoperatively.

Conclusions:

Lower eyelid ectropion repair using a lateral tarsal strip approach causes a reduction in IOSE, a more gradual lower eyelid curvature, and a decrease in margin-to-reflex distance 2 without causing a statistically significant change in LCA.