bluuebunny/crossref_metadata_2025 huggingface dataset:
Failure frequency of fixed mandibular retainers after pre-treatment of the enamel surface with pumice versus sandblasting—a randomized controlled trial
Authors: Padula Tommaso , Wilhelmsson Teresia , Naoumova Julia
Published: April 2023

Background/Objectives

To compare retainer survival, periodontal health, and caries implications of fixed lower retainers bonded after pre-treatment of the enamel surface with either pumice or sandblasting.

Trial design

Two-arm parallel-group, two-center randomized controlled clinical trial.

Methods

One hundred sixty patients (101 females, 59 males, mean age: 17.9) requiring mandibular retainers were consecutively recruited. Patients were randomly allocated to have pre-treatment of the enamel surface with either pumice (n = 80) or sandblasting (n = 80). The primary outcome was retainer survival at 3 (T1) and 12 months (T2) control. Secondary outcomes were carious lesions and periodontal health: plaque index (PI), gingival index (GI), calculus index (CI), and probing depth (PD). The randomization sequence was generated using an online randomization and allocation concealment was secured by contacting the sequence generator for treatment assignment. Blinding was not possible at T0 due to the nature of the intervention. Statistical analyses were carried out using the t-test, Fisher’s exact test, repeated measure analysis of variance, and log rank test.

Results

Overall, the risk of bonding failure at T1 was 6.7 per cent and at T2 6.9 per cent. There were no statistically significant differences in failure rate between the two groups, neither at T1 (P = 1.000) nor at T2 (P = 0.360). No statistically significant differences were found for the intercanine periodontal indices GI, PI, CI, PD, and caries between the two groups at T0 and T1. At T2, significantly more gingivitis and plaque were seen in the sandblasting group (P = 0.05 and P = 0.047, respectively) compared with the pumice group. Calculus increased during the follow-up period in both groups (P ≤ 0.001) as well as plaque levels (P ≤ 0.001 and P = 0.025, respectively). No harm was reported.

Conclusions

Enamel sandblasting prior to bonding mandibular retainers is not better at preventing bonding failure.

Registration

275767 (https://www.researchweb.org/is/sverige).
Population genomics reveals demographic history and selection signatures of hazelnut (Corylus)
Authors: Yang Zhen , Ma Wenxu , Wang Lujun , Yang Xiaohong , Zhao Tiantian , Liang Lisong , Wang Guixi , Ma Qinghua
Published: April 2023

Hazelnut (Corylus spp.) is known as one of the four famous tree nuts in the world due to its pleasant taste and nutritional benefits. However, hazelnut promotion worldwide is increasingly challenged by global climate change, limiting its production to a few regions. Focusing on the eurytopic Section Phyllochlamys, we conducted whole-genome resequencing of 125 diverse accessions from five geo-ecological zones in Eurasia to elucidate the genomic basis of adaptation and improvement. Population structure inference outlined five distinct genetic lineages corresponding to climate conditions and breeding background, and highlighted the differentiation between European and Asian lineages. Demographic dynamics and ecological niche modeling revealed that Pleistocene climatic oscillations dominantly shaped the extant genetic patterns, and multiple environmental factors have contributed to the lineage divergence. Whole-genome scans identified 279, 111, and 164 selective sweeps that underlie local adaptation in Corylus heterophylla, Corylus kweichowensis, and Corylus yunnanensis, respectively. Relevant positively selected genes were mainly involved in regulating signaling pathways, growth and development, and stress resistance. The improvement signatures of hybrid hazelnut were concentrated in 312 and 316 selected genes, when compared to C. heterophylla and Corylus avellana, respectively, including those that regulate protein polymerization, photosynthesis, and response to water deprivation. Among these loci, 22 candidate genes were highly associated with the regulation of biological quality. Our study provides insights into evolutionary processes and the molecular basis of how sibling species adapt to contrasting environments, and offers valuable resources for future climate-resilient breeding.
Subtle, hidden, and far-off: The intertextuality of the Yogasūtras
Authors: Forman Jed
Published: April 2023

Modern scholarship discusses ‘Buddhist influences’ on the Patañjali’s Yogasūtras (YS). Indeed, Patañjali borrowed key Buddhist concepts, particularly from Yogācāra. But this borrowing does not evince that the YS is just ‘crypto-Buddhism’. In fact, during the first millennium CE, the YS was equally influential on Buddhist thinkers. I make this argument by focusing on YS 3.25, which discusses the yogic ability to see subtle (sūkṣma), hidden (vyavahita), and far-off (viprakṛṣṭa) objects. Tracing textual occurrences of these three words, I use this stable mimetic trope to demonstrate the influence of YS on Buddhist, Nyāya, and Vaiśeṣika writings. This influence is all the more interesting given that Buddhists explicitly disagree with many of the theoretical suppositions latent in YS 3.25. I demonstrate that despite this theoretical disagreement, Buddhists make ample use of YS 3.25. This paper thus complicates any clear direction of influence between Buddhist and Hindu traditions, and further questions the cogency of strict delineations between different philosophical schools. I also offer the method used in this paper as a novel approach to textual exegesis. By focusing on stable textual memes and tracing their occurrences across sources, we gain a powerful method to more deeply plumb India's rich intertextual intellectual history.
What should students be able to do? Helping students recognize professional skills in our courses
Authors: Yahnke Christopher J , Lanier Hayley , Flaherty Elizabeth A , Varner Johanna , Munroe Karen , Duggan Jennifer M , Erb Liesl , Dizney Laurie , Connors Patrice K
Published: April 2023

While the traditional goals of undergraduate courses are often content-based, the development of career-readiness and professional skills, such as those listed by the National Association of Colleges and Employers, are increasingly recognized as important learning outcomes. As Mammalogy courses embrace more hands-on learning activities, they provide the opportunity to embed these professional skills, which are directly relevant to many careers in science. For example, many Mammalogy courses may include projects that incorporate experimental design and data analysis that focus on quantitative literacy, in addition to technical skills including small mammal trapping and handling, or preparing voucher specimens, that focus on problem-solving and attention to detail. Here, we review the professional skills that can be developed through a Mammalogy course and evaluate evidence-based approaches to build those skills into our courses. One approach, using Course-based Undergraduate Research Experiences (CUREs), provides opportunities for both student skill development and instructor research program development. Because they invite students to participate in authentic scientific inquiry—from study design and data collection, to analysis and reporting of results—students participating in CUREs reported significant gains in their comfort with several important professional skills, including conducting field procedures, formulating and analyzing data, normalizing failure, and attempting new procedures on their own. Finally, we review the literature to demonstrate how active learning approaches inherent in CUREs can help students to build familiarity with technologies and techniques for collecting and assessing data from wild mammal populations, as well as to build important professional skills such as teamwork, leadership, problem-solving, and written and oral communication.
The Bipartisan Infrastructure Law and the Forest Service: Insights for Local Job Creation and Equity from the American Recovery and Reinvestment Act
Authors: Charnley Susan , Davis Emily Jane , Schelhas John
Published: April 2023

The USDA Forest Service received $5.447 billion in funding from the Bipartisan Infrastructure Law of 2021, providing substantial funding to support implementation of the agency’s 2022 Wildfire Crisis Strategy between fiscal years 2022 and 2026. This article examines how the agency might enhance local job creation and equity while conducting wildfire risk reduction and ecosystem restoration under the strategy using these funds. It does this by drawing on five key findings from a socioeconomic assessment of the American Recovery and Reinvestment Act of 2009 (ARRA) that are applicable today. The ARRA provided the Forest Service with $1.15 billion for wildfire, restoration, and infrastructure projects to foster job creation in counties most affected by the economic recession of 2007–2009. In addition to insights from the ARRA, we highlight the importance of considering job quality, the meaning of equity in local job creation, and characteristics of today’s forest management businesses and workforces.
Proton beam therapy for gliomas: a multicenter prospective registry study from all proton beam facilities in Japan
Authors: Mori Takashi , Mizumoto Masashi , Maebayashi Katsuya , Nishioka Kentaro , Arakawa Yoshiki , Kurozumi Kazuhiko , Yasuda Koichi , Sumiya Taisuke , Tamamura Hiroyasu , Sato Yoshitaka , Waki Takahiro , Takagi Masaru , Takada Yu , Okimoto Tomoaki , Murakami Masao , Kikuchi Yasuhiro , Okada Kazufumi , Ito Yoichi M , Akimoto Tetsuo , Aoyama Hidefumi
Published: April 2023

We reviewed the outcomes of glioma patients enrolled in a prospective observational registry study of proton beam therapy (PBT) in Japan. The inclusion criteria were glioma patients registered in the Electronic Data Capture system, the Proton-net, between May 2016 and July 2019. Data on patient characteristics, treatments, late adverse events, survival status, recurrence and secondary tumors were extracted and statistically analyzed. The primary endpoint was the overall survival (OS) rate, and the secondary endpoints were the progression-free survival (PFS) rate and cumulative local recurrence rate (cLRR). Of the 65 primary brain tumor patients registered, 29 glioma patients from eight of 19 PBT facilities met the inclusion criteria. There were 19 glioblastoma patients, eight of other malignant gliomas, and two of low-grade gliomas. For glioblastomas, with a median follow-up period of 16 months, the median survival time was 21.2 months and the OS at 1, 2, 3 and 4 years were 77.4%, 44.9%, 23.9% and 23.9%, respectively. The median PFS period was 10.1 months, the 1, 2, 3 and 4-year PFS were 32.4%, 19.4%, 9.7% and 9.7%, respectively. The 1, 2, 3 and 4-year cLRR were 56.1%, 68.8%, 78.4 and 78.4%, respectively. Grade 3 brain necrosis was observed in two patients. No secondary tumor was observed. This is the first report on the current status of PBT for gliomas in Japan. For glioblastomas, the outcomes of PBT are estimated to be equivalent to historical data of photon therapy. The results of a prospective comparative evaluation of PBT and photon therapy are awaited.
Unravelling interlanguage facts via explainable machine learning
Authors: Berti Barbara , Esuli Andrea , Sebastiani Fabrizio
Published: April 2023

Native language identification (NLI) is the task of training (via supervised machine learning) a classifier that guesses the native language of the author of a text. This task has been extensively researched in the last decade, and the performance of NLI systems has steadily improved over the years. We focus on a different facet of the NLI task, i.e. that of analysing the internals of an NLI classifier trained by an explainable machine learning (EML) algorithm, in order to obtain explanations of its classification decisions, with the ultimate goal of gaining insight into which linguistic phenomena ‘give a speaker’s native language away’. We use this perspective in order to tackle both NLI and a (much less researched) companion task, i.e. guessing whether a text has been written by a native or a non-native speaker. Using three datasets of different provenance (two datasets of English learners’ essays and a dataset of social media posts), we investigate which kind of linguistic traits (lexical, morphological, syntactic, and statistical) are most effective for solving our two tasks, namely, are most indicative of a speaker’s L1; our experiments indicate that the most discriminative features are the lexical ones, followed by the morphological, syntactic, and statistical features, in this order. We also present two case studies, one on Italian and one on Spanish learners of English, in which we analyse individual linguistic traits that the classifiers have singled out as most important for spotting these L1s; we show that the traits identified as most discriminative well align with our intuition, i.e. represent typical patterns of language misuse, underuse, or overuse, by speakers of the given L1. Overall, our study shows that the use of EML can be a valuable tool for the scholar who investigates interlanguage facts and language transfer.
Neurosurgical Consultation Referral from the Forces: Regarding 328 Patients Referred to the Department of Neurosurgery, Sainte Anne Military Hospital, France
Authors: Marotte Louis , Marsaa Hélène , Robin Nicolas , Sellier Aurore , Beucler Nathan , Thefenne Laurent , Dagain Arnaud , Joubert Christophe
Published: April 2023

Introduction

There are little data regarding elective referral to the military specialist, especially considering common pathologies such as spinal diseases, which, in the French forces, involve military neurosurgeons. An overview of the management of the military patient referred to neurosurgery consultation, especially considering spinal diseases that both constitute an operational healthissue in the forces and appear of special interest. The objective was to describe the reasons, demographics, and care pathways, addressed to the neurosurgeon.

Materials and methods

This retrospective, single-center study focused on all military patients referred for neurosurgery consultation at Sainte Anne Military Hospital in Toulon. Extracted data included demographic characteristics, army, unit, military specialty, the reason for referral, the diagnosis by the neurosurgeon, treatment, and outcome.

Results

From January 2018 to December 2019, 352 patients were referred for neurosurgical consultation by the unit general practitioner. Spinal disease (n = 297, 91%) was the most frequent reason. Lumbar degenerative disk disease accounted for 20% of consultations, regardless of the patient’s unit or specialty. Most of the patients seen in consultation received nonsurgical management (n = 271, 82.6%). These patients mainly presented with cervical or lumbar degenerative disk disease (n = 99, 36.5%) or cervical or lumbar herniated discs (n = 57, 21.0%). Ninety-eight patients (29.9%) were referred exclusively for medical fitness assessment. Few patients experienced full resolution of their presenting complaint after management (n = 9, 2.8%).

Conclusions

This descriptive study demonstrates the predominance of degenerative spinal diseases in military patients referred to neurosurgery. It reflects the importance of the medical and military competence required to maintain operational capability upstream and downstream of war traumatology. The description of the care pathways invites us to define more proactive multidisciplinary pathways for the management of these diseases in the armed forces.
Syndromic Panel Testing Among Patients With Infectious Diarrhea: The Challenge of Interpreting Clostridioides difficile Positivity on a Multiplex Molecular Panel
Authors: Pender Melissa , Throneberry S Kyle , Grisel Nancy , Leung Daniel T , Lopansri Bert K
Published: April 2023

Background

Including Clostridioides difficile (CD) in gastrointestinal multiplex molecular panels (GIPCR) presents a diagnostic challenge. Incidental detection by polymerase chain reaction (PCR) without consideration of pretest probability (PTP) may inadvertently delay diagnoses of other treatable causes of diarrhea and lead to prescription of unnecessary antibiotics.

Methods

We conducted a retrospective study to determine the frequency at which clinicians characterize PTP and disease severity in adult patients who test positive for CD by GIPCR. We organized subjects into cohorts based on the status of their CD PCR, glutamate dehydrogenase enzyme immunoassay (GDH), and toxin A/B detection, as well as by high, moderate, or low CD PTP. We used multivariable regression models to describe predictors of toxin positivity.

Results

We identified 483 patients with positive CD PCR targets. Only 22% were positive for both GDH and CD toxin. Among patients with a low PTP for CDI, 11% demonstrated a positive CD toxin result compared to 63% of patients with a high PTP. A low clinician PTP for CD infection (CDI) correlated with a negative CD toxin result compared to cases of moderate-to-high PTP for CDI (odds ratio, 0.19 [95% confidence interval, .10–.36]). Up to 64% of patients with negative GDH and CD toxin received CD treatment. Only receipt of prior antibiotics, fever, and a moderate-to-high clinician PTP were statistically significant predictors of toxin positivity.

Conclusions

Patients with a positive CD PCR were likely to receive treatment regardless of PTP or CD toxin results. We recommend that CD positivity on GIPCR be interpreted with caution, particularly in the setting of a low PTP.
Approaching COVID-19 as an Environmental Ethical Problem: A Perspective from African Relational Animal Ethics
Authors: Chemhuru Munamato
Published: April 2023

After the discovery of the origins of the new coronavirus disease 2019 (COVID-19) to be possibly wet markets in Wuhan, China, the normative questions of what ought to be the ethical relations between human beings and non-human animals have started to attract renewed interest among environmentalists. Although these are not new questions in environmental philosophy, the impact of COVID-19 across the world is challenging human beings to seriously reconsider some of these often-neglected questions. In this article, I examine COVID-19 as essentially an environmental ethical challenge. Specifically, I consider the extent to which the relationships between human and non-human animals can effectively impact the health and lives of humanity and the environment at large. I then provide some alternative ways by which human beings ought to re-think their relationships with non-human animals to avoid future catastrophes like COVID-19. I argue that the African view of animal ethics could at least provide a valuable lens through which to view correct relations between human beings and non-human animals. Ultimately, I set forth and defend an African environmental ethic for the right relations between human beings and animals and to show how such an ethic better places humanity in confronting future zoonoses.
Responding to the Injustice of Climate Change
Authors: Dwyer James
Published: April 2023

Climate change continues to have profound impacts on people’s health, lives and life prospects. For the most part, people who are at highest risk from the impacts of climate change have contributed very little to the problem. This is the crux of the injustice. After I discuss the risks and contributions associated with the injustice of climate change, I turn to the issue of responsiveness: of why and how people should respond to this injustice. I avoid discussions of legal liability and focus more attention on the need to take political action to change social structures and habits. However, I realize how political engagement can prove to be ineffective, burdensome and dangerous. So in the last section, I say more about the reasons and changes that limit the effectiveness of political engagement. I suggest how we might change both the perception and practice of politics. At the end, I note two issues that I have not addressed in this limited article.
Beliefs of rheumatologists and general practitioners on urate lowering therapy: a cross-sectional study
Authors: Veenstra Frouwke , Vriezekolk Johanna E , van den Bemt Bart J F , Schers Henk J , Sloot Bart , van den Ende Cornelia H M , van Herwaarden Noortje , Flendrie Marcel
Published: April 2023

Objective

To describe beliefs of physicians and patients in primary and secondary care about urate-lowering therapy (ULT), to examine differences in physicians’ medication beliefs and to examine the association of physicians’ medication beliefs with the prescribed dosage of ULT, gout outcomes and patients’ medication beliefs.

Methods

We conducted a cross-sectional study among rheumatologists and general practitioners (GPs) and their patients using ULT in The Netherlands. All participants filled out the Beliefs About Medication Questionnaire (BMQ). Demographics of physicians were collected through questionnaires. Patient and disease characteristics were collected through questionnaires and electronic medical records. Differences between rheumatologists and GPs in the BMQ subscales Necessity and Concern and the necessity–concern difference (NCD) score were analysed by two-sample t-tests. Multilevel analyses were performed to examine the association of physicians’ BMQ scores with the prescribed dosage of ULT, gout outcomes (number of gout flares, serum urate) and patients’ BMQ scores.

Results

A total of 28 rheumatologists, 443 rheumatology patients, 45 GPs and 294 GP patients were included. The mean NCD scores were 7.1 (s.d. 3.6), 4.0 (s.d. 4.0), and 4.2 (s.d. 5.0) for rheumatologists, GPs and patients, respectively. Rheumatologists scored higher on necessity beliefs [mean difference 1.4 (95% CI 0.0, 2.8)] and lower on concern beliefs [mean difference −1.7 (95% CI −2.7, −0.7)] compared with GPs. No associations between physicians’ beliefs and prescribed dosage of ULT, gout outcomes or patients’ beliefs were found.

Conclusion

Rheumatologists had higher necessity and lower ULT concern beliefs compared with GPs and patients. Physicians’ beliefs were not related to prescribed ULT dosage and patient outcomes. The role of physicians’ beliefs in gout management in patients using ULT seems limited. Future qualitative research can provide more insights into physicians’ views of gout management.
Et Tu, Brute? Unraveling the puzzle of deception and broken trust in close relations
Authors: Shulman David , Grayson Kent
Published: April 2023

Embeddedness theory and relational work theory propose that people in close social relations naturally have better information about partners, which helps safeguard and optimize their relationships. Yet, researchers have noted that despite access to better information, broken trust still occurs. Why? We identify two factors that systematically keep access to information from working as anticipated: detection errors, which prevent people from effectively accessing and processing information, and associational dilemmas, which hinder using the information to report and punish deception. We also consider how relational work can sustain or amplify these factors and foster relational matches that give the false impression of being based on shared meanings and understandings. For example, detection errors and associational dilemmas can place victims into illusory solidarity where, despite appearing close, they are stuck with opportunistic partners.
The availability of gonadotropin therapy from FDA-approved pharmacies for men with hypogonadism and infertility
Authors: Borgert Benjamin J , Bacchus Michael W , Hernandez Alexandra D , Potts Shelby N , Campbell Kevin J
Published: April 2023

Background

Recent changes to the Biologics Price Competition and Innovation Act of 2009 have created barriers to accessing therapy for men utilizing gonadotropins for hypogonadism and infertility.

Aim

In this study we sought to investigate ways to decrease disparities in the treatment of male hypogonadism by increasing access to gonadotropin therapy by identifying 503b outsourcing pharmacies which currently provide gonadotropin therapy.

Methods

A review of 503b compounding pharmacies was performed using the online published registry available from the US Food and Drug Administration (FDA). Each pharmacy was contacted regarding their ability to provide gonadotropin therapy. Pharmacies were also queried regarding the impact of FDA-related legal changes and cost considerations.

Outcomes

The study outcomes were the number and location of FDA-approved 503b compounding pharmacies supplying human chorionic gonadotrophin (hCG) and/or follicle-stimulating hormone (FSH) for the treatment of male hypogonadism and infertility.

Results

The 81 503b-compounding pharmacies approved by the FDA to produce hCG and FSH therapy were identified using the FDA registry. Seventy-five of the 81 pharmacies responded to the survey (response rate 92.6%). Of the contacted pharmacies, 5 provided hCG (6.67%). Of the pharmacies offering compounded hCG, 4 offered FSH. No additional pharmacies offered compounded FSH. Eight pharmacies had previously provided hCG and FSH. Six of the 8 pharmacies that stopped making hCG and FSH cited the 2020 FDA mandate as the reason for halting compounding services. Of the 75 pharmacies that responded, only 1 pharmacy provided the cost for FSH ($287 per 100-IU vial), and 3 pharmacies provided the cost for hCG ($50-$83 per 10 000-IU vial).

Clinical Implications

There are few FDA-approved outsourcing pharmacies currently providing male gonadotropin therapy, and increasing awareness of these pharmacies may decrease barriers to care for patients with male hypogonadism and infertility.

Strengths and Limitations

The strengths of this article are the clinical utility of the data presented, as this article may serve as a tool for clinicians to increase patient access to therapy. All FDA-approved 503b outsourcing pharmacies were contacted, and 92.6% participated in this project. Limitations of this article were the following: no non-FDA–approved compounding pharmacies such as 503a pharmacies were contacted, participant-reported outcomes were utilized, and only 3 contacted outsourcing pharmacies provided a cost for FSH or hCG, allowing for an unknown degree of cost variability between outsourcing pharmacies.

Conclusions

There currently exists limited access to FDA-approved compounded gonadotropin therapies for hypogonadism and male infertility, and these results demonstrate the barriers to hCG and FSH access and the need for additional treatment options for this vulnerable patient population.
The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life
Authors: Egami Susan , Highfield Martha E. Farrar
Published: April 2023

Background:

Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS).

Purpose:

To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL.

Methods:

Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit, for 3 weeks.

Results:

Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low (P = .003), while their low BO scores (P = .12) and moderate CS scores (P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased (P =.01). The hypothesis was partly supported.

Implications for Practice and Research:

Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.
NICU Visitation Time and Adherence to Safe Sleep Practices Among Mothers of Very Preterm Infants
Authors: Hwang Sunah S. , Weikel Blair W. , Palau Mauricio A. , Greenfield Jennifer C. , Klawetter Susanne , Neu Madalynn , Roybal Kristi L. , Scott Jessica , Shah Pari , Bourque Stephanie L.
Published: April 2023

Background:

Sleep-associated infant death is the leading cause of postneonatal mortality in the United States. Preterm infants are at higher risk for sleep-associated death, but maternal adherence to safe sleep practices is lower than for mothers of full-term infants. Data are lacking on whether maternal neonatal intensive care unit (NICU) visitation time impacts safe sleep compliance after hospital discharge.

Purpose:

For mothers of preterm infants, to investigate the association of time days per week spent in the NICU and adherence to safe sleep practices after discharge.

Methods:

A prospective observational study of 109 mothers with infants born at less than 32 weeks from 4 Colorado NICUs who completed a survey at 6 weeks after discharge about infant sleep practices. Maternal time spent in the NICU was defined as the average number of days spent in the NICU per week of infant hospitalization, as documented in the electronic medical record. Multivariable logistic regression models assessed the relationship between time in the NICU and safe sleep adherence. Covariates included maternal/infant characteristics significant at P < .2 level in bivariate analysis.

Results:

Predictors of compliance with all safe infant sleep practices included public/no insurance compared with private insurance (adjusted odds ratio [AOR] 0.29; 95% confidence interval [CI] 0.09-0.96), some college/associate-level education versus bachelor's degree (AOR 5.88; 95% CI 1.21-28.67), and depression/anxiety symptoms (AOR 0.37; 95% CI 0.14-0.97). NICU visitation days was not associated with adherence to safe sleep practices.

Implications for Practice and Research:

Maternal visitation days was not associated with adherence to safe infant sleep practices after discharge, highlighting the need to identify barriers and facilitators to engaging families about SUID risk-reducing behaviors.
Effect Of Unintended Tissue Injury On The Development Of Thigh Symptoms After Lateral Lumbar Interbody Fusion In Patients With Adult Spinal Deformity
Authors: Yamato Yu , Hasegawa Tomohiko , Yoshida Go , Banno Tomohiro , Oe Shin , Arima Hideyuki , Ide Koichiro , Yamada Tomohiro , Kurosu Kenta , Nakai Keiichi , Matsuyama Yukihiro
Published: April 2023

Study design.

Retrospective case series.

Objective.

This study aimed to investigate the effects of lateral lumbar interbody fusion (LLIF)-induced unintended tissue damage, including cage subsidence, cage malposition, and hematoma in the psoas major muscle, on the development of thigh symptoms.

Summary of Background Data.

Thigh symptoms are the most frequent complications after LLIF and are assumed to be caused by lumbar plexus compression and/or direct injury to the psoas major muscle. However, the causes and risk factors of thigh symptoms are yet to be fully understood.

Methods.

Adult patients with spinal deformity who underwent two-stage surgery using LLIF and a posterior open fusion for the first and second stages, respectively, were included. Computed tomography and magnetic resonance imaging were routinely performed after LLIF before posterior surgery to investigate cage subsidence, cage malposition, and hematoma in the psoas muscle. We evaluated the development of thigh symptoms after LLIF and examined the effects of tissue injury on the occurrence of thigh symptoms. The differences in demographics and surgical and tissue damage parameters were compared between the groups with and without thigh symptoms using unpaired t-tests and chi-square tests. Factors associated with the development of thigh symptoms and muscle weakness were also assessed using logistic regression analysis.

Results.

Overall, 130 patients (17 men and 113 women; mean age, 68.7 [range, 47–84]) were included. Thigh symptoms were observed in 52 (40.0%) patients, including muscle weakness and contralateral side symptoms in 20 (15.4%) and 9 (17.3%) patients, respectively. The factors significantly associated with thigh symptoms identified following multiple logistic regression analysis included hematoma (odds ratio 2.27, 95% confidence interval (CI) 1.03–5.01) and approach from the right side (odds ratio 2.64, 95% CI 1.21–5.75). The presence of cage malposition was the only significant factor associated with muscle weakness. (odds ratio 4.12, 95% CI 1.37–12.4).

Conclusions.

We found unintended tissue injury during LLIF was associated with thigh symptoms. We found that hematoma in the psoas major muscle and cage malposition were factors associated with thigh symptoms and muscle weakness, respectively.

Level of Evidence.

4
Minimum Clinically Important Difference in Patient-reported Outcome Measures in de novo Degenerative Lumbar Scoliosis
Authors: Yuan Lei , Li Weishi , Zeng Yan , Chen Zhongqiang
Published: April 2023

Study Design.

A retrospective analysis.

Objectives.

The objective of this study was to calculate the range of minimum clinically important difference threshold values using anchor-based and distribution-based methods for back pain, leg pain, the Oswestry Disability Index (ODI), and the Scoliosis Research Society 22R instrument (SRS-22R) in patients with de novo degenerative lumbar scoliosis (DNDLS) who underwent long-segment fusion surgery. Then, we sought to determine a statistically sound meaningful, minimum clinically important difference in patient-reported outcome measures (PROMs) and compare our results with previously reported values for other adult spine deformity (ASD) populations.

Summary of the Background Data.

Minimum clinically important difference thresholds for back pain, leg pain, and the ODI and SRS-22R have not been widely described in patients with ASD.

Materials and Methods.

PROMs were obtained preoperatively and two years postoperatively in 128 patients with DNDLS. We applied different minimum clinically important difference calculation methods to the data, and the results were compared.

Results.

There was a statistically significant improvement in the two-year postoperative PROM scores compared with the preoperative scores. Different preoperative calculation methods yielded an ~10-fold range of values. Minimum clinically important difference values were established as 1.9 for back pain, 1.5 for leg pain, 18.9 for the ODI, 0.8 for SRS-22R pain, 0.5 for SRS-22R activity, 1.6 for SRS-22R appearance, 0.8 for SRS-22R mental, and 0.98 for the SRS-22R subtotal. Compared with the previously reported minimum clinically important differences in ASD, the values for back pain, ODI, and SRS-22R appearance were higher in patients with DNDLS.

Conclusions.

Sensitivity-based and specificity-based methods provide statistically sound minimum clinically important difference thresholds for the DNDLS population. The minimum clinically important difference thresholds for PROMs in patients with DNDLS were different from the threshold values previously reported for adult patients with spinal deformities.
Early Bacterial Coinfections in Patients Admitted to the ICU With COVID-19 or Influenza: A Retrospective Cohort Study
Authors: Bergmann Felix , Gabler Cornelia , Nussbaumer-Pröll Alina , Wölfl-Duchek Michael , Blaschke Amelie , Radtke Christine , Zeitlinger Markus , Jorda Anselm
Published: April 2023

IMPORTANCE:

Previous findings suggest that bacterial coinfections are less common in ICU patients with COVID-19 than with influenza, but evidence is limited.

OBJECTIVES:

This study aimed to compare the rate of early bacterial coinfections in ICU patients with COVID-19 or influenza.

DESIGN, SETTING AND PARTICIPANTS:

Retrospective propensity score matched cohort study. We included patients admitted to ICUs of a single academic center with COVID-19 or influenza (January 2015 to April 2022).

MAIN OUTCOMES AND MEASURES:

The primary outcome was early bacterial coinfection (i.e., positive blood or respiratory culture within 2 d of ICU admission) in the propensity score matched cohort. Key secondary outcomes included frequency of early microbiological testing, antibiotic use, and 30-day all-cause mortality.

RESULTS:

Out of 289 patients with COVID-19 and 39 patients with influenza, 117 (n = 78 vs 39) were included in the matched analysis. In the matched cohort, the rate of early bacterial coinfections was similar between COVID-19 and influenza (18/78 [23%] vs 8/39 [21%]; odds ratio, 1.16; 95% CI, 0.42–3.45; p = 0.82). The frequency of early microbiological testing and antibiotic use was similar between the two groups. Within the overall COVID-19 group, early bacterial coinfections were associated with a statistically significant increase in 30-day all-cause mortality (21/68 [30.9%] vs 40/221 [18.1%]; hazard ratio, 1.84; 95% CI, 1.01–3.32).

CONCLUSIONS AND RELEVANCE:

Our data suggest similar rates of early bacterial coinfections in ICU patients with COVID-19 and influenza. In addition, early bacterial coinfections were significantly associated with an increased 30-day mortality in patients with COVID-19.
Increased human neutrophil lipocalin and its clinical relevance in adult-onset Still's disease
Authors: Li Ji , Li Yingni , Li Ru , Ma Xiangbo , Shi Lianjie , Li Shengguang , Guo Qian , Jia Yuan , Li Zhanguo
Published: April 2023

Background:

Human neutrophil lipocalin (HNL) has been used extensively to differentiate acute bacterial infection from febrile diseases as a biomarker to reflect the activation of the neutrophil. The serum HNL levels in the adult-onset Still's disease (AOSD) patients with and without infection, as well as the healthy controls (HCs), were analyzed statistically in this study to evaluate the value of HNL for the diagnosis of AOSD.

Methods:

A total of 129 AOSD patients were enrolled, from whom blood samples were drawn and the AOSD diagnosis was confirmed through the review of the medical records, where the systemic score, demographic characteristics, clinical manifestations, and laboratory parameters were also collected for the patients; in addition, a total of 40 HCs were recruited among the blood donors from the healthcare center with the relevant information collected. The HNL test was done for the blood samples with the enzyme-linked immunosorbent assay and the analyses were done for the correlations of HNL with clinical manifestations and diagnostic effectiveness.

Results:

The serum HNL increased significantly in the patients with only AOSD as compared with that in the HCs (139.76 ± 8.99 ng/mL vs. 55.92 ± 6.12 ng/mL; P < 0.001). The serum HNL level was correlated with the white blood cell (WBC) count (r = 0.335, P < 0.001), neutrophil count (r = 0.334, P < 0.001), erythrocyte sedimentation rate (r = 0.241, P = 0.022), C-reactive protein (r = 0.442, P < 0.0001), and systemic score (r = 0.343, P < 0.0001) in the AOSD patients significantly. Patients with fever, leukocytosis ≥15,000/mm3, and myalgia in the HNL-positive group were observed relatively more than those in the HNL-negative group (P = 0.009, P = 0.023, and P = 0.007, respectively). HNL was a more sensitive indicator than ferritin and C-reactive protein (CRP) to differentiate the AOSD patients with a bacterial infection from AOSD-only patients, and the Youden index was 0.6 for HNL and 0.29 for CRP.

Conclusion:

Serum HNL can be used as a biomarker for the diagnosis of the AOSD, and HNL is also observed to be associated with the disease activity.
Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR)
Authors: Yang Fan , Lu Chaofan , Liu Huilan , Dou Lei , Wang Yanhong , Li Hongbin , Duan Xinwang , Wu Lijun , Wang Yongfu , Zhang Xiuying , Xu Jian , Su Jinmei , Xu Dong , Zhao Jiuliang , Wu Qingjun , Li Mengtao , Leng Xiaomei , Zeng Xiaofeng
Published: April 2023

Background:

The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.

Methods:

Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.

Results:

In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0–18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59–3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01–1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01–1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use.

Conclusions:

Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
Neoadjuvant Therapy Regimens for Hilar Cholangiocarcinoma Before Liver Transplant
Authors: Keltner Samuel J. , Hallemeier Christopher , Wang Kyle , Tao Randa , Shah Shimul , Heimbach Julie , Kharofa Jordan R.
Published: April 2023

Objectives:

Patients with unresectable hilar cholangiocarcinoma (hCCA) may be eligible for curative treatment through liver transplantation (LT). Neoadjuvant protocols often include radiotherapy (RT), however, there is no standard RT approach. The purpose of this study is to characterize practice patterns of RT use before transplantation for hCCA.

Methods:

A survey was administered to radiation oncologists practicing at LT centers identified through the U.S. Organ Procurement and Transplant Network and the International Cholangiocarcinoma Research Network. The survey consisted of 13 questions regarding RT details as well as approaches to systemic therapy. For cross-regimen comparison, the cumulative RT tumor dose was standardized using the EQD2 method.

Results:

Twenty-three centers utilizing neoadjuvant therapy for hCCA were identified. Most respondents (96%) use both chemotherapy and RT as part of their protocol. Elective nodal volumes commonly included the portal vein lymph nodes (91%) and celiac artery lymph nodes (70%). After an initial 45 Gy plan, a wide range of sequential boost regimens was used. The median cumulative dose including boosts to the gross disease was 58 Gy (EQD2) with a wide range of 40 to 110 Gy. Five (22%) include brachytherapy as part of their treatment plan. The majority (96%) used concurrent chemotherapy with fluoropyrimidines.

Conclusions:

These results suggest significant variability of neoadjuvant RT use for hCCA before LT. A wide range of doses and fractionation schemes are utilized with cumulative doses ranging from 40 to 110 Gy (EQD2). A further study evaluating the efficacy and toxicity of these various approaches is warranted to better inform best practices.
Evaluation of a Novel Graft-Holding Solution in Hair Transplantation: A Randomized Controlled Clinical Study
Authors: Zhou Yi , Zhang Jiaxian , Fan Zhexiang , Hu Zhiqi , Miao Yong
Published: April 2023

BACKGROUND

Hair transplantation has become a popular choice for alopecia treatment; however, postsurgical hair shedding still annoys both patients and surgeons.

OBJECTIVE

To explore the impact of graft-holding solution on postsurgical hair shedding and testify the protective efficacy of histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine (HTK-AD).

METHODS

There were 240 patients enrolled in the study, and the follicles were placed into either HTK-AD or Ringer solution (RS). Masson staining and live/dead staining were performed to evaluate graft morphology and apoptosis levels, respectively. The between-group comparison of postsurgical graft shedding, survival rate, complications, and patient satisfaction was performed.

RESULTS

Grafts in HTK-AD maintained organized dense collagen construction and higher cell viability, but those preserved in RS became soft, which hindered implantation. Histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine significantly reduced the incidence of postsurgical hair shedding (73.81% vs 95%), delayed shedding onset, and diminished shedding amount versus RS (p < .05) when ≥3,000 grafts were transplanted. The shedding duration was shortened, and hair regrowth started earlier in HTK-AD versus RS (p < .05); thus, satisfaction was increased. The final survival rate showed no difference between 2 groups.

CONCLUSION

Histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine is superior to RS for hair graft preservation because it improves graft viability and alleviates postsurgical shedding.