bluuebunny/crossref_metadata_2025 huggingface dataset:
Urine Drug Screening in the Era of Designer Benzodiazepines: Comparison of Three Immunoassay Platforms, LC–QTOF-MS and LC–MS-MS
Authors: Puzyrenko Andrii , Wang Dan , Schneider Randy , Wallace Greg , Schreiber Sara , Brandt Kristen , Gunsolus Ian L
Published: September 2021

This study investigated the presence of designer benzodiazepines in 35 urine specimens obtained from emergency department patients undergoing urine drug screening. All specimens showed apparent false-positive benzodiazepine screening results (i.e., confirmatory testing using a 19-component liquid chromatography–tandem mass spectrometry (LC–MS-MS) panel showed no prescribed benzodiazepines at detectable levels). The primary aims were to identify the possible presence of designer benzodiazepines, characterize the reactivity of commercially available screening immunoassays with designer benzodiazepines and evaluate the risk of inappropriately ruling out designer benzodiazepine use when utilizing common urine drug screening and confirmatory tests. Specimens were obtained from emergency departments of a single US Health system. Following clinically ordered drug screening using Abbott ARCHITECT c assays and laboratory-developed LC–MS-MS confirmatory testing, additional characterization was performed for investigative purposes. Specifically, urine specimens were screened using two additional assays (Roche cobas c502 and Siemens Dimension Vista) and LC–quadrupole time-of-flight mass spectrometry (LC–QTOF-MS) to identify presumptively positive species, including benzodiazepines and non-benzodiazepines. Finally, targeted, qualitative LC–MS-MS was performed to confirm the presence of 12 designer benzodiazepines. Following benzodiazepine detection using the Abbott ARCHITECT, benzodiazepines were subsequently detected in 28/35 and 35/35 urine specimens using Siemens and Roche assays, respectively. LC–QTOF-MS showed the presumptive presence of at least one non-Food and Drug Administration (FDA)-approved benzodiazepine in 30/35 specimens: flubromazolam (12/35), flualprazolam (11/35), flubromazepam (2/35), clonazolam (4/35), etizolam (9/35), metizolam (5/35), nitrazepam (1/35) and pyrazolam (1/35). Two or three designer benzodiazepines were detected concurrently in 13/35 specimens. Qualitative LC–MS-MS confirmed the presence of at least one designer benzodiazepine or metabolite in 23/35 specimens, with three specimens unavailable for confirmatory testing. Urine benzodiazepine screening assays from three manufacturers were cross-reactive with multiple non-US FDA-approved benzodiazepines. Clinical and forensic toxicology laboratories using traditionally designed LC–MS-MS panels may fail to confirm the presence of non-US FDA-approved benzodiazepines detected by screening assays, risking inappropriate interpretation of screening results as false positives.
Mammography Screening and Research Evidence: The Swedish Contribution
Authors: Duffy Stephen W
Published: September 2021

Sweden has made a contribution to mammography screening research considerably disproportionate to its size. With 0.13% of the world’s population, Sweden contributed almost half of the randomized trial evidence on mammography screening. In addition to the fundamental efficacy of screening in preventing deaths from breast cancer, Swedish researchers have produced a considerable volume of research evaluating mammography screening in the routine healthcare services setting and illuminating issues of breast cancer progression and natural history. The basic result that screening prevents deaths from breast cancer has informed policy and led to substantial preservation of life internationally.
Bayesian phylogenetic analysis of linguistic data using BEAST
Authors: Hoffmann Konstantin , Bouckaert Remco , Greenhill Simon J , Kühnert Denise
Published: September 2021

Bayesian phylogenetic methods provide a set of tools to efficiently evaluate large linguistic datasets by reconstructing phylogenies—family trees—that represent the history of language families. These methods provide a powerful way to test hypotheses about prehistory, regarding the subgrouping, origins, expansion, and timing of the languages and their speakers. Through phylogenetics, we gain insights into the process of language evolution in general and into how fast individual features change in particular. This article introduces Bayesian phylogenetics as applied to languages. We describe substitution models for cognate evolution, molecular clock models for the evolutionary rate along the branches of a tree, and tree generating processes suitable for linguistic data. We explain how to find the best-suited model using path sampling or nested sampling. The theoretical background of these models is supplemented by a practical tutorial describing how to set up a Bayesian phylogenetic analysis using the software tool BEAST2.
Multiple Introductions of SARS-CoV-2 C.37 Lambda lineage in the Southern Brazilian region
Authors: Arantes Ighor Gomes , Salvato Richard Steiner , Gregianini Tatiana Schäffer , Martins Leticia Garay , Barth Afonso Luís , Martins Andreza Francisco , Paixão Anna Carolina Dias , Appolinario Luciana , Lopes Renata Serrano , da Fonseca Mendonça Ana Carolina , da Rocha Alice Sampaio Barreto , Venas Taina Moreira Martins , Pereira Elisa Cavalcante , Siqueira Marilda Mendonça , Resende Paola Cristina
Published: September 2021

Deemed a variant of concern by the World Health Organization on 15 June, the Lambda variant of SARS-CoV-2 is a growing epidemiological threat in several South American countries, and initial results suggest it exhibits increased infectivity and immune escape qualities. Here, we present evidence of its multiple introductions in Brazil.
Bone Morphogenetic Protein-2 Rapidly Heals Two Distinct Critical Sized Segmental Diaphyseal Bone Defects in a Porcine Model
Authors: McKinley Todd O , Childress Paul , Jewell Emily , Griffin Kaitlyn S , Wininger Austin E , Tucker Aamir , Gremah Adam , Savaglio Michael K , Warden Stuart J , Fuchs Robyn K , Natoli Roman M , Shively Karl D , Anglen Jeffrey O , Gabriel Chu Tien-Min , Kacena Melissa A
Published: September 2021

Introduction

Segmental bone defects (SBDs) are devastating injuries sustained by warfighters and are difficult to heal. Preclinical models that accurately simulate human conditions are necessary to investigate therapies to treat SBDs. We have developed two novel porcine SBD models that take advantage of similarities in bone healing and immunologic response to injury between pigs and humans. The purpose of this study was to investigate the efficacy of Bone Morphogenetic Protein-2 (BMP-2) to heal a critical sized defect (CSD) in two novel porcine SBD models.

Materials and Methods

Two CSDs were performed in Yucatan Minipigs including a 25.0-mm SBD treated with intramedullary nailing (IMN) and a 40.0-mm SBD treated with dual plating (ORIF). In control animals, the defect was filled with a custom spacer and a bovine collagen sponge impregnated with saline (IMN25 Cont, n = 8; ORIF40 Cont, n = 4). In experimental animals, the SBD was filled with a custom spacer and a bovine collage sponge impregnated with human recombinant BMP-2 (IMN25 BMP, n = 8; ORIF40 BMP, n = 4). Healing was quantified using monthly modified Radiographic Union Score for Tibia Fractures (mRUST) scores, postmortem CT scanning, and torsion testing.

Results

BMP-2 restored bone healing in all eight IMN25 BMP specimens and three of four ORIF40 BMP specimens. None of the IMN25 Cont or ORIF40 Cont specimens healed. mRUST scores at the time of sacrifice increased from 9.2 (±2.4) in IMN25 Cont to 15.1 (±1.0) in IMN25 BMP specimens (P < .0001). mRUST scores increased from 8.2 (±1.1) in ORIF40 Cont to 14.3 (±1.0) in ORIF40 BMP specimens (P < .01). CT scans confirmed all BMP-2 specimens had healed and none of the control specimens had healed in both IMN and ORIF groups. BMP-2 restored 114% and 93% of intact torsional stiffness in IMN25 BMP and ORIF40 BMP specimens.

Conclusions

We have developed two porcine CSD models, including fixation with IMN and with dual-plate fixation. Porcine models are particularly relevant for SBD research as the porcine immunologic response to injury closely mimics the human response. BMP-2 restored healing in both CSD models, and the effects were evident within the first month after injury. These findings support the use of both porcine CSD models to investigate new therapies to heal SBDs.
A Retrospective Study of Foot Biomechanics and Injury History in Varsity Football Athletes at the U.S. Naval Academy
Authors: Windsor Jennifer , Jeffries Joshua , Sorensen Jeff , Bach Kelly , Benedek Evan , Bicher Jessica , Pasquina Paul
Published: September 2021

Introduction

The six-item Foot Posture Index (FPI-6) was previously developed as an assessment tool to measure the posture of the foot across multiple segments and planes. It was derived from a criterion-based observational assessment of six components of each foot during static standing. The association between abnormal foot posture and musculoskeletal injuries remains unclear and is in of need further exploration.

Hypothesis/Purpose

The purpose of this study was to assess the association between foot biomechanics and self-reported history of musculoskeletal pain or injury.

Study Design

Retrospective, cross-sectional study of collegiate football players at the U.S. Naval Academy.

Materials and Methods

For each athlete, data were recorded on height, weight, self-reported history of pain or injury, and foot posture, which was measured using a FPI-6 with each item measuring the degree of pronation/supination. The primary outcome was each athlete’s maximum deviation from neutral posture across the six-item index (FPImax). The prespecified primary analysis used generalized linear models to measure the association between FPImax and self-report history of pain or injury. Exploratory analyses measured the association using penalized regression (L1-norm) and a type of tree-based ensemble known as extreme gradient boosting (XGBoost).

Results

Data were collected on 101 athletes, 99 of whom had sufficient body mass index (BMI) data to be included for analysis. Among the 99 athletes, higher FPImax was associated with a prior history of musculoskeletal pain (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.97 to 1.35), although the sample size was too small for the association to be significant with 95% CI (P = .107). FPImax was not associated with a history of knee injury/pain (OR 0.98, 95% CI 0.83 to 1.15, P = .792), nor with a history of ankle/foot injury or pain (OR 1.04, 95% CI 0.90 to 1.21, P = .599). From the L1-penalized model, the FPI components with the strongest linear associations were the L6, R2, R1-squared, and FPImax. From the XGBoost model, the most important variables were FPItotal, BMI, R1, and R2.

Conclusions

The U.S. Naval Academy football players whose foot postures deviated from neutral were more likely to have reported a previous history of musculoskeletal pain. However, this deviation from normal was not strongly associated with a specific history of pain or injury to the knee, ankle, or foot.

Clinical Relevance

The information ascertained from this study could be used to better inform clinicians about the value of the FPI in predicting or mitigating injuries for varsity football athletes.
A combination of mRNA features influence the efficiency of leaderless mRNA translation initiation
Authors: Bharmal Mohammed-Husain M , Gega Alisa , Schrader Jared M
Published: September 2021

Bacterial translation is thought to initiate by base pairing of the 16S rRNA and the Shine–Dalgarno sequence in the mRNA’s 5′ untranslated region (UTR). However, transcriptomics has revealed that leaderless mRNAs, which completely lack any 5′ UTR, are broadly distributed across bacteria and can initiate translation in the absence of the Shine–Dalgarno sequence. To investigate the mechanism of leaderless mRNA translation initiation, synthetic in vivo translation reporters were designed that systematically tested the effects of start codon accessibility, leader length, and start codon identity on leaderless mRNA translation initiation. Using these data, a simple computational model was built based on the combinatorial relationship of these mRNA features that can accurately classify leaderless mRNAs and predict the translation initiation efficiency of leaderless mRNAs. Thus, start codon accessibility, leader length, and start codon identity combine to define leaderless mRNA translation initiation in bacteria.
Prime-Boost Vaccination With BNT162b2 Induces High Neutralizing Activity Against SARS-CoV-2 Variants in Naïve and COVID-19-Convalescent Individuals
Authors: Luczkowiak Joanna , Labiod Nuria , Rivas Gonzalo , Rolo Marta , Lasala Fátima , Lora-Tamayo Jaime , Mancheno-Losa Mikel , Rial David , Pérez-Rivilla Alfredo , Folgueira María D , Delgado Rafael
Published: September 2021

Background

The objective of this study was to investigate the neutralizing response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VoC) during coronavirus disease 2019 (COVID-19) convalescence and after vaccination.

Methods

COVID-19-convalescent and -naïve individuals were tested for neutralizing activity against SARS-CoV-2 VoC Alpha, Beta, Gamma, and Delta at 1 and 7 months postinfection and 4–6 weeks after BNT162b2 vaccination.

Results

Vaccination induced a high neutralizing response in naïve individuals. Interestingly, vaccination of convalescent patients induced a boosted response that was able to neutralize all VoC at high titers.

Conclusions

Vaccination with BNT162b2 induced high levels of neutralization against SARS-CoV-2 VoC in most patients; this is especially beneficial in COVID-19-convalescent individuals.
Structural Equation Model of Emotional Labor, Work–Home Interaction, and Well-Being
Authors: Ballentine Kess L , Woo Jihee
Published: September 2021

Social work best practices encourage empathy. However, empathy may both prevent and contribute to negative effects of work on worker well-being through emotional labor and spillover into home life. Theory and research suggest that work–family interaction (WFI) may mediate the relationship between emotional labor and worker well-being. The current work examines this framework using structural equation modeling. Authors hypothesized emotional labor to directly and indirectly relate to worker well-being through WFI. Data are from an online survey of 218 Pennsylvanian social workers. The structural equation model was a good fit: χ2(185) = 298.373, p < .001, comparative fit index = .940, Tucker–Lewis index = .926, root mean square error of approximation = .055, 90% confidence interval [0.044, 0.067], standardized root mean square residual = .050. Results show that emotional labor is directly associated with well-being. Negative WFI played a role in mediating the relationship between emotional labor and worker well-being. These results suggest that workplace policy and practice changes could improve worker well-being by adjusting both emotional labor and WFI.
Global phylogeny of the inquilinous gall wasp tribe Synergini (Hymenoptera: Cynipoidea: Cynipidae): first insights and establishment of a new cynipid tribe
Authors: Lobato-Vila Irene , Bae Jongmin , Roca-Cusachs Marcos , Kang Minjoon , Jung Sunghoon , Melika George , Pénzes Zsolt , Pujade-Villar Juli
Published: September 2021

Previous phylogenetic studies of the tribe Synergini were focused on Palaearctic material, in which the genus Synergus was recovered as monophyletic, despite evidence of non-monophyly when global sampling is considered. A global molecular phylogeny of Synergini, including sequenced material from Nearctic and Neotropical realms, is presented herein for the first time. We assembled DNA data for 120 specimens: 104 representing all genera belonging to Synergini, except for the rare monospecific genus Agastoroxenia (ingroup), and 16 belonging to five other tribes of Cynipidae (outgroup). We obtained sequences for four genes: cytochrome c oxidase subunit I (COI), cytochrome b (Cytb), 28S region D2 (28S D2) and 28S region D3 (28S D3). The evaluated analyses support the non-monophyly of both Saphonecrus and Synergus (with Nearctic and Neotropical Synergus resolved into three clades separated from the Palaearctic species), as well as the monophyly of the rest of the genera in Synergini. Furthermore, the results suggest that neither Saphonecrus s.s. nor Synergus s.s. are present in the New World. The future challenges to separate the clades of Saphonecrus and Synergus into new taxa are discussed. Lastly, Rhoophilus was shown to belong to a new tribe, Rhoophilini trib. nov., on the basis of molecular, morphological and biological data.
The role of the NP in primary care of adults with autism spectrum disorder
Authors: Robert Jacqueline , Duff Elsie
Published: September 2021

Adults with autism spectrum disorder have poorer physical and psychological health outcomes compared with individuals who are neurotypical and benefit from exceptional primary care. NPs are uniquely positioned to reform primary care and eliminate inequities, and can help influence practice standards and optimize care for these patients through education, advocacy, and health promotion.
The Effect of Morbid Obesity on Complications, Readmission, and Patient-Reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Claus Chad F. , Lawless Michael , Lytle Evan , Tong Doris , Bahoura Matthew , Garmo Lucas , Gabrail Joseph , Bono Peter , Kelkar Prashant , Richards Boyd , Carr Daniel A. , Houseman Clifford , Soo Teck M.
Published: September 2021

Study Design.

Retrospective review of prospectively collected data at a single institution.

Objective.

To compare perioperative and clinical outcomes in morbidly obese patients who underwent minimally invasive transforaminal lumbar interbody fusion (MiTLIF).

Summary of Background Data.

Obesity remains a serious public health concern. Obese patients who undergo lumbar fusion have historically thought to be at higher risk for complications and fare worse regarding quality-of-life outcomes. However, recent literature may demonstrate comparable risk and outcomes in obese patients. An increasing number of patients are categorized as morbidly obese (body mass index [BMI] ≥ 40 kg/m2). Perioperative and patient-reported outcomes (PROs) are lacking in this patient population.

Methods.

The authors retrospectively reviewed a prospectively collected database of all morbidly obese and non-obese patients that underwent MiTLIF between 2015 and 2018 for degenerative conditions who had minimum 1-year follow-up for outcome assessment. An inverse propensity/probability of treatment weighting was utilized to create a synthetic weighted sample in which covariates were independent of obesity designation to adjust for imbalance between groups. Generalized estimating equations (GEE) was used to estimate the association of morbid obesity and complications and 1-year PROs.

Results.

A total of 292 patients were analyzed with 234 non-obese patients and 58 morbidly obese patients. Multivariate analysis failed to demonstrate any association between morbid obesity and achieving minimal clinically important difference (MCID) for Oswestry disability index (ODI), visual analog scale (VAS), or short form-12 (SF-12) physical component score. However, morbid obesity was associated with significant decrease in odds of achieving MCID for SF-12 mental component score (P = 0.001). Increased surgery duration was significantly associated with morbid obesity (P = 0.001). Morbid obesity exhibited no statistically significant association with postoperative complications, readmission, pseudarthrosis, or adjacent segment disease (ASD).

Conclusion.

Morbidly obese patients who undergo MiTLIF can achieve meaningful clinical improvement comparable to nonobese patients. Morbid obesity was associated with longer surgical times but was not associated with postoperative complications, readmission, or ASD.

Level of Evidence: 3
The Impact of Radiographic Lower Limb-Spinal Length Proportion on Whole-Body Sagittal Alignment
Authors: Hey Hwee Weng Dennis , Tan Kian Loong Melvin , Lau Eugene Tze-Chun , Ng Jordan Wei Peng , Liu Gabriel Ka-Po , Wong Hee-Kit
Published: September 2021

Study Design.

A radiographic comparative study.

Objective.

To investigate the influence of radiographic lower limb-spinal length proportion on sagittal radiographic parameters.

Summary of Background Data.

Although lordotic realignment of the lumbar spine is a well-established surgical strategy, its ideal target has not been fully understood. The widely used pelvic incidence-lumbar lordosis discrepancy (PI-LL) method to guide lordotic restoration of the lumber spine in the standing posture, may be further refined using the novel, radiographic lower limb-spinal length proportion parameter in selected subjects.

Methods.

A 100 healthy subjects were imaged in the standing posture using EOS imaging to obtain whole-body lateral radiographs for the measurement of sagittal radiographic parameters. Univariate analyses were performed to compare radiographic parameters between groups with different radiographic lower limb-spinal length proportion. Multivariate analyses were performed to identify the associations between lower limb-spinal length proportions and other radiographic parameters.

Results.

Regardless of lower limb-spinal length proportion (mean = 1.4), global lumbar angle (GLA) differed from spinal lordosis (SL), with the absolute means of SL and GLA larger and smaller than pelvic incidence (PI) respectively. Univariate analysis showed that patients with proportionately larger lower limb-spinal length proportion are more likely to have larger mean T1-slope, global thoracic angle (GTA), spinal kyphosis (SK), GLA, and SL. Multivariate analysis showed that a larger lower limb length-spinal length proportion is predictive of larger GLA is less than –47.69° (Odds Ratio (OR) 2.660, P = 0.026), and larger T1-slope of more than 18.84° (OR 3.695, P = 0.012).

Conclusion.

Larger radiographic lower limb-spinal length proportion results in naturally accentuated spinal curves. These patients balance with a larger lumbar lordosis that is closer to the PI and a higher T1-slope which should be considered for spinal realignment. SL differs from GLA and should be separately assessed.

Level of Evidence: 3
Delineation of Inner Annulus Fibrosus and Nucleus Pulposus on Routine T2-weighted MR Images
Authors: Eldaya Rami W. , Parsons Matthew S. , Rhea Lee , Sharma Aseem
Published: September 2021

Study Design.

Retrospective study of 150 IVDs.

Objective.

Assessment of costume algorithm ability to delineate the IAF and NP on routine T2 images.

Summary of Background Data.

Central hyperintense region on T2-weighted MR images of normal lumbar IVDs represents a combination of IAF and NP. Ability to identify NP as distinct from IAF can help improve our understanding of IVD morphology in-vivo.

Methods.

Sagittal T2-weighted TSE MR images of 150 lumbar IVDs from 25 patients were analyzed. MR images were processed using a custom algorithm that markedly increased the signal intensity of structures with inherent signal intensity within 2 defined intensity thresholds. Signal intensity and contrast-to- noise ratio between outer annulus fibrosus, IAF, and NP were assessed at baseline and after processing. To assess consistency of underlying T2 differences, similar analysis was done on 108 discs from 18 patients in whom additional sagittal T2-weighted STIR images were available.

Results.

Following image processing, apparent IAF and NP were rendered visible in 86% and 84.3% IVDs on T2-weighted TSE and STIR images respectively. While signal intensity of these 2 regions was inherently different (P< 0.001) before processing on TSE and STIR images, their visualization was facilitated by a significant increase (P<0.001) in contrast-to-noise ratio after processing. Nonvisualization of NP was associated with disc degeneration (P<0.001).

Conclusion.

Inherent differences exist in signal intensities of normal NP and IAF on T2-weighted MR images. Accentuating these differences using image postprocessing techniques can render these 2 structures visible.
Cervical Myelopathy Screening with Machine Learning Algorithm Focusing on Finger Motion Using Noncontact Sensor
Authors: Koyama Takafumi , Fujita Koji , Watanabe Masaru , Kato Kaho , Sasaki Toru , Yoshii Toshitaka , Nimura Akimoto , Sugiura Yuta , Saito Hideo , Okawa Atsushi
Published: September 2021

Study Design.

Cross-sectional study.

Objective.

To develop a binary classification model for cervical myelopathy (CM) screening based on a machine learning algorithm using Leap Motion (Leap Motion, San Francisco, CA), a novel noncontact sensor device.

Summary of Background Data.

Progress of CM symptoms are gradual and cannot be easily identified by the patients themselves. Therefore, screening methods should be developed for patients of CM before deterioration of myelopathy. Although some studies have been conducted to objectively evaluate hand movements specific to myelopathy using cameras or wearable sensors, their methods are unsuitable for simple screening outside hospitals because of the difficulty in obtaining and installing their equipment and the long examination time.

Methods.

In total, 50 and 28 participants in the CM and control groups were recruited, respectively. The diagnosis of CM was made by spine surgeons. We developed a desktop system using Leap Motion that recorded 35 parameters of fingertip movements while participants gripped and released their fingers as rapidly as possible. A support vector machine was used to develop the binary classification model, and a multiple linear regression analysis was performed to create regression models to estimate the total Japanese Orthopaedic Association (JOA) score and the JOA score of the motor function of the upper extremity (MU-JOA score).

Results.

The binary classification model indexes were as follows: sensitivity, 84.0%; specificity, 60.7%; accuracy, 75.6%; area under the curve, 0.85. The Spearman rank correlation coefficient between the estimated score and the total JOA score was 0.44 and that between the estimated score and the MU-JOA score was 0.51.

Conclusion.

Our binary classification model using a machine learning algorithm and Leap Motion could classify CM with high sensitivity and would be useful for CM screening in daily life before consulting doctors and telemedicine.

Level of Evidence: 3
Clinical and Radiological Outcomes of Two Modified Open-door Laminoplasties Based on a Novel Paraspinal Approach for Treatment of Multilevel Cervical Spondylotic Myelopathy
Authors: Guo Qian , Xu Yong , Fang Zhong , Guan Hanfeng , Xiong Wei , Li Feng
Published: September 2021

Study Design.

A case–control study.

Objectives.

The aim of this study was to evaluate the outcomes of two modified laminoplasties (LPs) based on a novel paraspinal approach for treating multilevel cervical spondylotic myelopathy.

Summary of Background Data.

No laminoplasty through a natural intermuscular plane mimicking Wiltse approach to minimize intraoperative injury to extensor muscles has ever been developed and studied.

Methods.

Ninety-two patients were enrolled, including patients treated with either modified LP and patients treated with concurrent conventional LP. Operation time, blood loss, and complications were recorded. Clinical outcomes were evaluated by VAS, JOA scores, and recovery rate. Cervical sagittal alignment was measured on cervical radiographs. Spinal canal expansion was assessed on CT scans. Cross-sectional area (CSA) and atrophy rate (AR) of cervical deep extensors were evaluated on MRI.

Results.

The average follow-up duration was 33.05, 31.55, 33.02, and 32.52 months, respectively in each group. Compared to concurrent conventional procedure, unilateral muscle-preserving procedure displayed similar, whereas bilateral muscle-preserving procedure showed significantly increased operation time and blood loss; each modified procedure resulted in comparable and satisfied perioperative clinical scores, spinal canal expansion while achieving significantly lower axial pain incidence, better cervical lordosis maintenance, and better deep extensor preservation. AR of deep extensors on the open side was significantly lower than that on the hinge side. Bilateral paraspinal approach demonstrated significantly better muscle-preservation on the open side and increased operation duration, with similar clinical scores, axial pain incidence, cervical lordosis maintenance, and spinal canal expansion compared to unilateral paraspinal approach. Loss of cervical lordosis was strongly correlated with AR of deep extensors.

Conclusion.

Paraspinal approach is a good manner to protect deep extensor muscles; the two modified LPs have similar effects on clinical outcomes.

Level of Evidence: 3
Phase I/II Dose-Escalation Trial of 3-Fraction Stereotactic Radiosurgery for Resection Cavities From Large Brain Metastases
Authors: Rahimy Elham , Dudley Sara A. , von Eyben Rie , Pollom Erqi L. , Seiger Kira , Modlin Leslie , Wynne Jacob , Fujimoto Dylann , Jacobs Lisa R. , Chang Steven D. , Gibbs Iris C. , Hancock Steven L. , Adler John R. , Li Gordon , Choi Clara Y.H. , Soltys Scott G.
Published: September 2021

Objectives:

We investigated differences in quality of life (QoL) in patients enrolled on a phase I/II dose-escalation study of 3-fraction resection cavity stereotactic radiosurgery (SRS) for large brain metastases.

Methods:

Eligible patients had 1 to 4 brain metastases, one of which was a resection cavity 4.2 to 33.5 cm3. European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires core-30 (QLQ-30) and brain cancer specific module (QLQ-BN20) were obtained before SRS and at each follow-up. Nine scales were analyzed (global health status; physical, social, and emotional functioning; motor dysfunction, communication deficit, fatigue, insomnia, and future uncertainty). QoL was assessed with mixed effects models. Differences ≥10 points with q-value (adjusted P-value to account for multiplicity of testing) <0.10 were considered significant.

Results:

Between 2009 and 2014, 50 enrolled patients completed 277 QoL questionnaires. Median questionnaire follow-up was 11.8 months. After SRS, insomnia demonstrated significant improvement (q=0.032, −17.7 points at 15 mo post-SRS), and future uncertainty demonstrated significant worsening (q=0.018, +9.9 points at 15 mo post-SRS). Following intracranial progression and salvage SRS, there were no significant QoL changes. The impact of salvage whole brain radiotherapy could not be assessed because of limited data (n=4 patients). In the 28% of patients that had adverse radiation effect, QoL had significant worsening in 3 metrics (physical functioning, q=0.024, emotional functioning q=0.001, and future uncertainty, q=0.004).

Conclusions:

For patients treated with 3-fraction SRS for large brain metastasis cavities, 8 of 9 QoL metrics were unchanged or improved after initial SRS. Intracranial tumor progression and salvage SRS did not impact QoL. Adverse radiation effect may be associated with at least short-term QoL impairments, but requires further investigation.
Optimizing Parameters for Smoke Evacuation
Authors: Ahluwalia Jusleen , de Golian Emily , Yuan Joyce , Brian Jiang Shang I.
Published: September 2021

BACKGROUND

Current literature lacks recommendations regarding the ideal organization of the smoke evacuation system to minimize inhalation of surgical smoke.

OBJECTIVE

This study determines optimal parameters of the smoke evacuation system with respect to the surgical field.

MATERIALS AND METHODS

This study was conducted in an outpatient surgical facility at a tertiary care center. After 30 seconds of continuous electrocautery of tissue, particulate measurements were recorded using the TSI DustTrak Aerosol Monitor 8520 (>2.5 μm particles) and the TSI P-Trak Ultrafine Particle Counter 8525 (<1 μm particles) while changing the angle and distance of the smoke evacuation system.

RESULTS

Particulate matter measurements were lower when suction angle was at 45° than at 90°. For both small-sized and large-sized particles, the lowest particulate matter was recorded when the evacuator was maintained at a 45° angle, 2 to 4 inches away from the cauterizing procedure. Particulate matters dramatically increased after increasing the distance of the smoke evacuator beyond 8 inches from the procedural site.

CONCLUSION

In an effort to reduce smoke inhalation, the authors recommend that smoke evacuation should be placed at a 45° suction angle, no further than 8 inches away from the surgical site, while preserving the surgeon's field of vision.
Intra-operative ventilator mechanical power as a predictor of postoperative pulmonary complications in surgical patients
Authors: Karalapillai Dharshi , Weinberg Laurence , Neto A Serpa , Peyton Philip , Ellard Louise , Hu Raymond , Pearce Brett , Tan Chong O. , Story David , O’Donnell Mark , Hamilton Patrick , Oughton Chad , Galtieri Jonathan , Wilson Anthony , Eastwood Glenn , Bellomo Rinaldo , Jones Daryl A.
Published: September 2021

BACKGROUND

Studies in critically ill patients suggest a relationship between mechanical power (an index of the energy delivered by the ventilator, which includes driving pressure, respiratory rate, tidal volume and inspiratory pressure) and complications.

OBJECTIVE

We aimed to assess the association between intra-operative mechanical power and postoperative pulmonary complications (PPCs).

DESIGN

Post hoc analysis of a large randomised clinical trial.

SETTING

University-affiliated academic tertiary hospital in Melbourne, Australia, from February 2015 to February 2019.

PATIENTS

Adult patients undergoing major noncardiothoracic, nonintracranial surgery.

INTERVENTION

Dynamic mechanical power was calculated using the power equation adjusted by the respiratory system compliance (C
RS). Multivariable models were used to assess the independent association between mechanical power and outcomes.

MAIN OUTCOME MEASURES

The primary outcome was the incidence of PPCs within the first seven postoperative days. The secondary outcome was the incidence of acute respiratory failure.

RESULTS

We studied 1156 patients (median age [IQR]: 64 [55 to 72] years, 59.5% men). Median mechanical power adjusted by C
RS was 0.32 [0.22 to 0.51] (J min−1)/(ml cmH2O−1). A higher mechanical power was also independently associated with increased risk of PPCs [odds ratio (OR 1.34, 95% CI, 1.17 to 1.52); P < 0.001) and acute respiratory failure (OR 1.40, 95% CI, 1.21 to 1.61; P < 0.001).

CONCLUSION

In patients receiving ventilation during major noncardiothoracic, nonintracranial surgery, exposure to a higher mechanical power was independently associated with an increased risk of PPCs and acute respiratory failure.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Registry no: 12614000790640.
Spinal Muscular Atrophy: A Potential Target for In Utero Therapy
Authors: Baptiste Caitlin , De Vivo Darryl C.
Published: September 2021

Spinal muscular atrophy (SMA) is a life-threatening autosomal recessive disease that leads to progressive muscle weakness and atrophy, respiratory insufficiency and scoliosis. SMA is currently the most common monogenic cause of infant mortality. Amazing advancements have been made in the therapeutic options available for these children since 2016. What has also become clear is that the earlier the treatment is administered, the better the clinical outcome. For several reasons, which we will review in this chapter, SMA may be an excellent disease candidate for in utero therapy.
Afterload-related cardiac performance predicts prognosis in critical ill patients with sepsis
Authors: Zhao Cong-Cong , Zhang Li-Ru , Liu Li-Xia , Sun Li-Xiao , Hu Zhen-Jie
Published: September 2021

To investigate the usefulness of afterload-related cardiac performance (ACP) for assessing cardiac impairment and predicting prognosis in septic patients.

Adult patients with sepsis in the intensive care unit were included. Cardiac output, cardiac index, cardiac power index, and ACP were calculated at the time of admission (D0) and 48–72 h after admission (D3). They were correlated with Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores, then the prognostic values were analyzed.

A total of 41 patients with sepsis were selected. ACP showed a stronger negative correlation with Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores than cardiac output, cardiac index, and cardiac power index. ACP predicted 28-day mortality with an area under the curve of 0.775 and 0.976 on D0 and D3, respectively. In addition, most non-survivors had emergent cardiac impairment (ACP ≤ 80%) on D0, and cardiac function was deteriorated on D3. Survival analysis showed that the patients with a decreased ACP from D0 to D3 had the highest mortality. The decrease of ACP on D3 was an independent risk factor for mortality (hazard ratio, 11.89; P = .0028).

ACP can be used to assess the severity of cardiac impairment in sepsis. Continued decline of ACP during the first 3 days strongly suggests a poor prognosis.
The assessment of usability of pain medical device by physiatrists and physiotherapists
Authors: Kwak Hyunseok , Oh Hyunjung , Cha Byoungwoo , Kim Jong Moon
Published: September 2021

When developing a new medical device, it is essential to assess the usability of such a device through various stakeholders.

This study assessed the usability of pain medical devices through a Delphi survey administered to physiatrists and physiotherapists.

A Delphi survey was conducted on the problems and improvements in hardware and software for a panel consisting of 10 physiatrists and 10 physiotherapists. A total of 3 rounds of surveys were conducted, and the third round of survey was confirmed through a Likert scale (1 = strongly agree to 5 = strongly disagree).

The 2 groups generally had a common perception of the problems and improvements in pain medical devices. However, the physiatrist group mostly identified problems such as linking patient information, whereas the physiotherapist group deemed hardware problems such as device weight or connection cables as being more important (mean [standard deviation]; physiatrist, hardware 2.90 [0.93], software 2.28 [0.91] / physiotherapist, hardware 3.04 [0.84], software 3.03 [1.13]).

To date, analysis has not been conducted by dividing the focus of various stakeholders using pain medical devices. The difference in view of the usability of these 2 stakeholder groups should be considered when improving the hardware or software of pain medical devices in the future. Further research is warranted to investigate other stakeholders such as patients and device developers to improve the devices.
Cognitive decline according to amyloid uptake in patients with poststroke cognitive impairment
Authors: Yoon Bora , Yang Dong Won , Hong Yun-Jeong , Kim Taewon , Na Seunghee , Noh Sang-Mi , Park Hye Lim , Ku Bon D. , Yang Young Soon , Choi Hojin , Jang Jae-Won , Kim Seongheon , Kim Yerim , Shim YongSoo
Published: September 2021

Background and purpose:

Poststroke cognitive impairment (PSCI) is common, but the impact of β-amyloid (Aβ) on PSCI is uncertain. The proposed study will investigate amyloid pathology in participants with PSCI and how differently their cognition progress according to the amyloid pathology.

Methods:

This multicenter study was designed to be prospective and observational based on a projected cohort size of 196 participants with either newly developed cognitive impairment, or rapidly aggravated CI, within 3 months after acute cerebral infarction. They will undergo 18F-flutemetamol positron emission tomography at baseline and will be categorized as either amyloid-positive (A+) or amyloid-negative (A−) by visual rating. The primary outcome measures will be based on Korean Mini-Mental State Examination changes (baseline to 12 months) between the A+ and A− groups. The secondary outcome measures will be the dementia-conversion rate and changes in the Korean version of the Montreal Cognitive Assessment (baseline to 12 months) between the A+ and A− groups.

Conclusions:

This study will provide a broadened perspective on the impact of Aβ on the cause and outcomes of PSCI in clinical practice. Identifying amyloid pathology in patients with PSCI will help select patients who need more focused treatments such as acetylcholinesterase inhibitors

Trial registration:

Clinical Research Information Service identifier: KCT0005086
Hypothermia therapy for the treatment of acute myocardial infarction
Authors: Jiang Fen , Zeng Defei , Xing Kongyu , Yang Xiaoli
Published: September 2021

Background:

In patients with acute myocardial infarction (AMI) receiving percutaneous coronary intervention (PCI), the role of systemic therapeutic hypothermia remains controversial. We performed a protocol for systematic review and meta-analysis to investigate the effect of systemic therapeutic hypothermia in patients with AMI receiving PCI.

Methods:

This study will use the Cochrane Library, Web of Science, PubMed, Embase, Allied and Complementary Medicine Database, China Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Ongoing Clinical Trials Database. The search terms were hypothermia, cooling, myocardial infarction, myocardial ischemia and acute coronary syndrome. Quality assessment of the included studies was evaluated using the Cochrane risk of bias assessment tool. Statistical analyses were performed using RevMan 5.4 software.

Results:

The findings of this study will be submitted to peer-reviewed journals for publication.

Conclusion:

This systematic review will provide evidence to determine whether hypothermia therapy is an effective and safe intervention for patients with AMI receiving PCI.

Registration number: 10.17605/OSF.IO/9XJSB.
CXCL10 and its related key genes as potential biomarkers for psoriasis
Authors: Zou Ailing , Jian Qichao
Published: September 2021

Although several studies have attempted to investigate the etiology of and mechanism underlying psoriasis, the precise molecular mechanism remains unclear. Our study aimed to explore the molecular mechanism underlying psoriasis based on bioinformatics.

GSE30999, GSE34248, GSE41662, and GSE50790 datasets were obtained from the Gene Expression Omnibus database. The Gene Expression Omnibus profiles were integrated to obtain differentially expressed genes in R software. Then a series of analyses was performed, such as Gene Ontology annotation, Kyoto Encyclopedia of Genes and Genomes pathway analysis, protein-protein interaction network analysis, among others. The key genes were obtained by CytoHubba, and validated by real-time quantitative polymerase chain reaction.

A total of 359 differentially expressed genes were identified between 270 paired lesional and non-lesional skin groups. The common enriched pathways were nucleotide-binding and oligomerization domain-like receptor signaling pathway, and cytokine-cytokine receptor interaction. Seven key genes were identified, including CXCL1, ISG15, CXCL10, STAT1, OASL, IFIT1, and IFIT3. These key genes were validated as upregulated in the 4 datasets and M5-induced HaCaT cells.

Our study identified 7 key genes, namely CXCL1, ISG15, CXCL10, STAT1, OASL, IFIT1, and IFIT3, and 2 mostly enriched pathways (nucleotide-binding and oligomerization domain-like receptor signaling pathway, and cytokine-cytokine receptor interaction) involved in psoriatic pathogenesis. More importantly, CXCL1, ISG15, STAT1, OASL, IFIT1, IFIT3, and especially CXCL10 may be potential biomarkers. Therefore, our findings may bring a new perspective to the molecular mechanism underlying psoriasis and suggest potential biomarkers.
Clinical outcome of neoadjuvant chemoradiation in rectal cancer treatment
Authors: Suwanthanma Weerapat , Kitudomrat Saowanee , Euanorasetr Chakrapan
Published: September 2021

To determine the clinical and pathological outcome of locally advanced rectal cancer patients treated with neoadjuvant chemoradiation (chemoradiotherapy [CRT]) followed by curative surgery and to identify predictive factors of pathological complete response (pCR).

Locally advanced rectal cancer patients undergoing CRT followed by curative surgery from January 2012 to December 2017 were included. Patient's demographic data, pretreatment tumor characteristics, type of CRT regimens, type of surgery, postoperative complications, pathological reports and follow up records were analyzed. Univariate and multivariate analyses were applied to identify predictive factors for pCR. Five-year disease free and overall survival were estimated by Kaplan–Meier method and compared between pCR and non-pCR groups.

A total of 85 patients were analyzed. Eighteen patients (21.1%) achieved pCR. The sphincter-saving surgery rate was 57.6%. After univariate analyses, tumor length >4 cm (P = .007) and positive lymph nodes (P = .040) were significantly associated with decreased rate of pCR. Complete clinical response was significantly associated with higher rate of pCR (P = .015). Multivariate analyses demonstrated that tumor length >4 cm (P = .010) was significantly associated with decreased rate of pCR. After a median follow-up of 65 months (IQR 34–79), the calculated 5-year overall survival and disease-free survival rates were 81.4% and 69.7%, respectively. Patients who achieved pCR tend to had longer 5-year disease-free survival (P = .355) and overall survival (P = .361) than those who did not.

Tumor length >4 cm was associated with decreased rate of pCR in locally advanced rectal cancer who had CRT followed by surgery. Longer waiting time or more intense adjuvant treatment may be considered to improved pCR and oncological outcomes.
Clinical usefulness of PET/MRI in differentiating anterior mediastinal masses
Authors: Sugawara Haruto , Ito Kimiteru , Watanabe Hirokazu , Morita Takahiro , Yatabe Yasushi , Watanabe Shun-ichi , Kusumoto Masahiko
Published: September 2021

Objectives

To investigate the clinical usefulness of 18F-fluorodeoxyglucose (FDG) PET/MRI in differentiating anterior mediastinal lesions, including small ones.

Material and methods

Among 96 patients who underwent 18F-FDG PET/MRI screening for anterior mediastinal lesions, we retrospectively reviewed images of 42 patients with histologically or clinically diagnosed thymic carcinomas, thymomas or anterior mediastinal cysts. MRI findings and maximum standardized uptake value (SUVmax) were compared among the three categories. In addition, small lesions measuring <3.0 cm which did not show very high signal intensity (isointense to water) on T2 weighted images (T2WI) were sub-analyzed.

Results

Significant differences in SUVmax were observed among anterior mediastinal cysts (P < 0.001, vs. thymomas and thymic carcinomas), thymomas (P = 0.032, vs. thymic carcinomas) and thymic carcinomas. Regarding the MRI findings, anterior mediastinal cysts showed higher T2WI signal intensity (P = 0.004 vs. thymomas and P = 0.042 vs. thymic carcinomas) and thymic carcinomas tended to show ill-defined contours (P = 0.024 vs. anterior mediastinal cysts and P = 0.036 vs. thymomas). SUVmax was also significantly higher in small thymic tumors than small anterior mediastinal cysts without very high T2WI signal intensity (P = 0.003).

Conclusion

18F-FDG PET/MRI is clinically useful in differentiating anterior mediastinal lesions, including those smaller than 3 cm.