bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction
Authors: McIntosh Mark A.
Published: March 2021

The divine ideas tradition is introduced, not primarily in terms of its philosophical characteristics, but as a theological concept widely employed for most of the history of Christian thought as a way of understanding the communion among creatures and between creatures and God. Contemporary denials and distortions of truth are contrasted with the reverence for truth at the heart of the divine ideas tradition, especially with the tradition’s acknowledgment of the sovereign majesty of beauty, goodness, and truth as created expressions of the divine meaning. The material claims of the divine ideas teaching are explored in terms of the polarity of stances among divine ideas exponents, both with regard to the metaphysical and noetic significance of the ideas. As well, the divine ideas tradition is shown to provide a mode of contemplative understanding that opens doctrine to the mystery to which doctrine directs believers.
The Saving Word of All Things
Authors: McIntosh Mark A.
Published: March 2021

The presence of the divine ideas in the eternal Word permits mystical theologians to consider the cosmic implications of the Incarnation, and also provides a unique mode of understanding the soteriological significance of Christ’s death and resurrection—in which the world’s false construction of creatures is undone and the divine truth of every creature is vindicated. Pseudo-Dionysius, Aquinas, and Catherine of Siena emphasize the Trinitarian matrix of the divine ideas, bringing to light the divine love and delight in all creatures as the motivation for salvation. Maximus and Hadewijch point to the saving encounter between a person’s earthly self, suffering the distortions of sin, and their true identity in God, made possible in Christ. Eriugena, Aquinas, and Bonaventure all employ the divine ideas teaching in order to reflect upon the power of the Word incarnate to re-create the creatures according to God’s eternal knowing and loving of them.
Kant’s Case for Transcendental Idealism and Empirical Realism
Authors: Jauernig Anja
Published: March 2021

The foundational structure of, and Kant’s arguments for his transcendental idealism and empirical realism are analyzed. Special attention is paid to the ‘master argument’ in the Transcendental Aesthetic for the thesis that space and time are transcendentally ideal and nothing but forms of sensibility. A reconstruction of the master argument is provided, and each of its premises is examined in detail, including the especially important premise that we have an a priori intuition of space and time.
Mitochondrial heat-shock cognate protein 70 contributes to auxin-mediated embryo development
Authors: Li Guichen , Li Zitong , Yang Zeyun , Leshem Yehoram , Shen Yuequan , Men Shuzhen
Published: March 2021

In Arabidopsis thaliana, mitochondrial-localized heat-shock cognate protein 70-1 (mtHSC70-1) plays an important role in vegetativegrowth. However, whether mtHSC70-1 affects reproductive growth remains unknown. Here, we found that the mtHSC70-1 gene was expressed in the provascular cells of the embryo proper from the early heart stage onward during embryogenesis. Phenotypic analyses of mthsc70-1 mutants revealed that mtHSC70 deficiency leads to defective embryo development and that this effect is mediated by auxin. In addition to a dwarf phenotype, the mthsc70-1 mutant displayed defects in flower morphology, anther development, and embryogenesis. At early developmental stages, the mthsc70-1 embryos exhibited abnormal cell divisions in both embryo proper and suspensor cells. From heart stage onward, they displayed an abnormal shape such as with no or very small cotyledon protrusions, had aberrant number of cotyledons, or were twisted. These embryo defects were associated with reduced or ectopic expression of auxin responsive reporter DR5rev:GFP. Consistently, the expression of auxin biosynthesis and polar auxin transport genes were markedly altered in mthsc70-1. On the other hand, mitochondrial retrograde regulation (MRR) was enhanced in mthsc70-1. Treatment of wild-type plants with an inhibitor that activates mitochondrial retrograde signaling reduced the expression level of auxin biosynthesis and polar auxin transport genes and induced phenotypes similar to those of mthsc70-1. Taken together, our data reveal that loss of function of mtHSC70-1 induces MRR, which inhibits auxin biosynthesis and polar auxin transport, leading to abnormal auxin gradients and defective embryo development.
In People With COPD, There Is Limited Evidence That Exercise Training Reduces Sedentary Time, and Behavior Change Techniques Are Poorly Reported: Systematic Review and Meta-Analysis
Authors: Coll Fiona , Cavalheri Vinicius , Gucciardi Daniel F , Wulff Sheldon , Hill Kylie
Published: March 2021

Objective

In people with chronic obstructive pulmonary disease (COPD), the authors sought to explore (1) the effect of any intervention on the time spent in sedentary behavior and, (2) which behavior change techniques (BCTs) have shown promise in achieving this lifestyle target.

Methods

Five electronic databases were searched on January 7, 2021. Studies were included if they (1) recruited people with stable COPD, (2) applied an intervention ≥4 weeks, and (3) measure sedentary time (ST) before and after the intervention period using wearable technology or via self-reports of television viewing. The primary analyses were restricted to data reported in randomized controlled trials (RCTs). All BCTs described during the intervention periods were mapped using an established taxonomy.

Results

Of the 1142 records identified, 8 were RCTs, of which 6 had exercise training as the intervention. Random effects meta-analysis of data from 4 of these 6 trials that implemented exercise training showed no clear effect on ST (mean difference, −3.4 minutes; 95% CI, −27.9–21.0 minutes). Commonly mapped BCTs in the majority of studies included action planning and instruction on how to perform the behavior. Of all the BCTs mapped, 25% were reported with sufficient information to be graded “beyond reasonable doubt.”

Conclusion

Despite robust evidence that exercise training improves functional outcomes and reduces dyspnea, this intervention does not seem to translate into behavior change. The primary analysis demonstrated that, in adults with COPD, the effect of exercise training on ST was, at best, uncertain. The BCTs embedded within the interventions were often poorly reported. Future RCTs are required that appropriately report BCT and ST to improve the precision of our estimate of the effect exercise training may have on ST, and BCTs used during intervention periods need to be reported with greater specificity.

Impact

In people with COPD, there is currently limited evidence to suggest that exercise training will reduce sedentary behavior. To move this area of research forward, BCTs embedded within these interventions need to be described with greater precision.

Lay Summary

In people with COPD, interventions such as exercise training do not seem to produce a reduction in sedentary behavior (ie, time spent sitting or lying down) during daily life. The techniques used to help people change their sedentary behavior were poorly reported, so we do not know what exactly was done and therefore cannot know what may have worked well.
The Fideicommissary Substitution and the Fiducia: Québécois Echoes in the Civil Code of Romania
Authors: Murphy Anthony , Duţă Cristina
Published: March 2021

The current Civil Code of Romania took inspiration from the Civil Code of Quebec in lifting the prohibition on fideicommissary substitutions. In doing so, it also made explicit reference to fiduciary duties when regulating the obligations incumbent on the first beneficiary. This particular provision divided the local literature with some authors embracing the transplant and others criticizing it. Our article argues that the fideicommissary substitution and the fiducia are essentially two sides of the same coin, with said transplant being a welcome development in the Romanian law of succession.
25‐Hydroxycholesterol metabolism is altered by lung inflammation, and its local administration modulates lung inflammation in mice
Authors: Bottemanne Pauline , Paquot Adrien , Ameraoui Hafsa , Guillemot‐Legris Owein , Alhouayek Mireille , Muccioli Giulio G.
Published: March 2021

Inflammation is a critical component of many lung diseases including asthma and acute lung injury (ALI). Using high‐performance liquid chromatography–mass spectrometry, we quantified the levels of oxysterols in two different murine models of lung diseases. These are lipid mediators derived from cholesterol and known to modulate immunity and inflammation. Interestingly, 25‐hydroxycholesterol (25‐OHC) was the only oxysterol with altered levels during lung inflammation, and its levels were differently affected according to the model. Therefore, we sought to assess how this oxysterol would affect lung inflammatory responses. In a model of lipopolysaccharide (LPS)‐induced acute lung inflammation, 25‐OHC levels were increased, and most of the hallmarks of the model (eg, leukocyte recruitment, mRNA expression, and secretion of inflammatory cytokines) were decreased following its intratracheal administration. We also found that, when administered in the lung, 25‐OHC is metabolized locally into 25‐hydroxycholesterol‐3‐sulfate and 7α,25‐dihydroxycholesterol. Their administration in the lungs did not recapitulate all the effects of 25‐OHC. Conversely, in a model of allergic asthma induced by intranasal administration of house dust mites (HDM), 25‐OHC levels were decreased, and when intranasally administered, this oxysterol worsened the hallmarks of the model (eg, leukocyte recruitment, tissue remodeling [epithelium thickening and peribranchial fibrosis], and cytokine expression) and induced changes in leukotriene levels. Ex vivo, we found that 25‐OHC decreases LPS‐induced primary alveolar macrophage activation while having no effect on neutrophil activation. Its sulfated metabolite, 25‐hydroxycholesterol‐3‐sulfate, decreased neutrophil, but not macrophage activation. Taken together, our data support a differential role of 25‐OHC in ALI and allergic inflammation models.
Medical Students as Essential Frontline Researchers During the COVID-19 Pandemic
Authors: Alshak Mark N. , Li Han A. , Wehmeyer Graham T.
Published: March 2021

As the coronavirus disease 2019 (COVID-19) pandemic hit the United States in March 2020, there was widespread disruption of clinical medical education: Hospital clerkships were suspended nationwide and students were moved out of the hospital and continued their studies remotely through virtual learning systems. Frustrated by not being able to directly care for patients, medical students across the country formed diverse volunteer initiatives to help frontline clinicians. In this article, the authors describe the essential role of medical students at Weill Cornell Medicine in quickly designing and building a large registry of COVID-19 patients who presented at 3 New York City hospitals. The Cornell COVID-19 Registry, which contains granular clinical information on more than 4,000 patients, informed hospital operations and guided clinical management during the first wave of the pandemic. One month after its creation, the registry led to the first published description of the clinical characteristics of a U.S.-based cohort of hospitalized COVID-19 patients. Using their experience as a model, the authors propose that students who cannot participate in their clinical clerkships because of the pandemic can augment their traditional medical education by contributing to COVID-19 research. In the case described in this article, students reviewed the management of COVID-19 patients, followed inpatients throughout their hospitalization (much like students would on clinical rotations), and refined their interpersonal skills through discussions with patients and patients’ families during follow-up calls. The authors conclude that medical students who are displaced from their hospital rotations can further their education and provide an invaluable contribution to the fight against COVID-19 by serving as essential frontline researchers.
Earthed Lightning: A Prescription for Poetry in Practice and Teaching
Authors: Sgro Gaetan
Published: March 2021

The author of this medical humanities article is a clinician-educator who finds himself relying more and more on poetry to make sense of the complexity, frustration, and wonder that attend the work of doctoring. Here, he posits that poems, in all their forms, are attempts at establishing order and meaning through meter, language, and sound, and that they may be particularly valuable for medical students and residents as they develop professional identities, habits of mind, and coping strategies. The author recalls that for Edward Hirsch, poetry is “a way of connecting—through the medium of language—more deeply with yourself even as you connect more deeply with others.” It is this purpose—to connect learners with themselves, their patients, and one another—that compels the author to read poems to teams of residents and medical students in lieu of traditional afternoon teaching rounds. In this article, the author artfully illustrates one such “Post-Call Poetry” session, quoting some of the poems he shares with learners. At the end of each 2-week rotation on the wards, few of the learners remark on the attending’s lessons on pathophysiology; however, nearly all of them, regardless of their background or career path, express appreciation for the poetry.
The RCA ReCAst: A Root Cause Analysis Simulation for the Interprofessional Clinical Learning Environment
Authors: Ziemba Justin B. , Berns Jeffrey S. , Huzinec Jill G. , Bammer Dina , Salva Catherine , Valentine Elizabeth , Myers Jennifer S.
Published: March 2021

Problem

The Accreditation Council for Graduate Medical Education calls for resident participation in real or simulated interprofessional analysis of a patient safety event. There are far more residents who must participate in these investigations than available institutional root cause analyses (RCAs) to accommodate them. To correct this imbalance, the authors developed an institutionally sponsored, interprofessional RCA simulation program and implemented it across all graduate medical education (GME) residency programs at the Hospital of the University of Pennsylvania.

Approach

The authors developed RCA simulations based upon authentic adverse events experienced at their institution. To provide relevance to all GME programs, RCA simulation cases varied widely and included examples of errors involving high-risk medications, communication, invasive procedures, and specimen labeling. Each simulation included residents and other health care professionals such as nurses or pharmacists whose disciplines were involved in the actual event. Participants adopted the role of RCA investigation team, and in small groups systematically progressed through the RCA process.

Outcomes

A total of 289 individuals from 18 residency programs participated in an RCA simulation in 2019–2020. This included 84 interns (29%), 123 residents (43%), 20 attending physicians (7%), and 62 (21%) other health care professionals. There was an increase in ability of GME trainees to correctly identify factors required for an RCA investigation (62% pre vs 80% post, P = .02) and an increase in intent to “always report” for each adverse event category (3% pre vs 37% post, P < .001) following the simulation.

Next Steps

The authors plan to expand the RCA simulation program to other GME clinical sites while striving to involve all GME learners in this educational experience at least once during training. Additionally, by collaborating with health system patient safety leaders, they will annually review all new RCAs to identify cases suitable for simulation adaptation.
Social and Behavioral Variables in the Electronic Health Record: A Path Forward to Increase Data Quality and Utility
Authors: Lasser Elyse C. , Kim Julia M. , Hatef Elham , Kharrazi Hadi , Marsteller Jill A. , DeCamp Lisa Ross
Published: March 2021

Purpose

Social and behavioral determinants of health (SBDH) are important factors that affect the health of individuals but are not routinely captured in a structured and systematic manner in electronic health records (EHRs). The purpose of this study is to generate recommendations for systematic implementation of SBDH data collection in EHRs through (1) reviewing SBDH conceptual and theoretical frameworks and (2) eliciting stakeholder perspectives on barriers to and facilitators of using SBDH information in the EHR and priorities for data collection.

Method

The authors reviewed SBDH frameworks to identify key social and behavioral variables and conducted focus groups and interviews with 17 clinicians and researchers at Johns Hopkins Health System between March and May 2018. Transcripts were coded and common themes were extracted to understand the barriers to and facilitators of accessing SBDH information.

Results

The authors found that although the frameworks agreed that SBDH affect health outcomes, the lack of model consensus complicates the development of specific recommendations for the prioritization of SBDH data collection. Study participants recognized the importance of SBDH information and individual health and agreed that patient-reported information should be captured, but clinicians and researchers cited different priorities for which variables are most important. For the few SBDH variables that are captured, participants reported that data were often incomplete, unclear, or inconsistent, affecting both researcher and clinician responses to SBDH barriers to health.

Conclusions

Health systems need to identify and prioritize the systematic implementation of collection of a high-impact but limited list of SBDH variables in the EHR. These variables should affect care and be amenable to change and collection should be integrated into clinical workflows. Improved data collection of SBDH variables can lead to a better understanding of how SBDH affect health outcomes and ways to better address underlying health disparities that need urgent action.
Does Pain Acceptance Buffer the Negative Effects of Catastrophizing on Function in Individuals With Chronic Pain?
Authors: Ferreira-Valente Alexandra , Solé Ester , Sánchez-Rodríguez Elisabet , Sharma Saurab , Pathak Anupa , Jensen Mark P. , Miró Jordi , de la Vega Rocío
Published: March 2021

Objectives:

Pain catastrophizing and pain acceptance are psychological factors that have been shown to be associated with pain-related outcomes and predict multidisciplinary pain treatment outcomes. However, they are rarely examined in the same study. This study aimed to: (1) assess the independent roles of pain catastrophizingand pain acceptance as predictors of pain intensity, pain interference, and depression; and (2) evaluate the potential moderating role of pain acceptance on the association between pain catastrophizing and both pain and function.

Materials and Methods:

A sample of 467 adults with chronic pain completed an online survey including measures of pain intensity, pain interference, depression, pain catastrophizing, and pain acceptance.

Results:

Pain catastrophizing and pain acceptance were independent predictors of pain interference. Only pain catastrophizing and the activity engagement domain of pain acceptance were independent predictors of pain intensity and depression. Activity engagement moderated the association between pain catastrophizing and depression, indicating a buffering effect on the negative effects of catastrophizing on depression. Pain willingness moderated the association between pain catastrophizing and pain interference, such that endorsing low pain willingness may override any negative effects of pain catastrophizing.

Discussion:

The findings suggest that pain catastrophizing and pain acceptance are independently important to adjustment to chronic pain. Research is needed to determine if treatments that target both for change are more effective than treatments that target only one.
Measurement Properties of the Brief Pain Inventory-Short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) in Pain-related Musculoskeletal Conditions
Authors: Jumbo Samuel U. , MacDermid Joy C. , Kalu Michael E. , Packham Tara L. , Athwal George S. , Faber Kenneth J.
Published: March 2021

Objective:

The objective of this study was to systematically locate, critically appraise, and summarize clinical measurement research addressing the use of Brief Pain Inventory-Short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) in pain-related musculoskeletal (MSK) conditions.

Materials and Methods:

We systematically searched 4 databases (Medline, CINAHL, EMBASE, and SCOPUS) and screened articles to identify those reporting the psychometric properties (eg, validity, reliability) and interpretability (eg, minimal clinically important difference) of BPI-SF and SF-MPQ-2 as evaluated in pain-related MSK conditions. Independently, 2 reviewers extracted data and assessed the quality of evidence with a structured quality appraisal tool and the updated COSMIN guidelines.

Results:

In all, 26 articles were included (BPI-SF, n=17; SF-MPQ-2, n=9). Both tools lack reporting on their cross-cultural validities and measurement error indices (eg, standard error of measurement). High-quality studies suggest the tools are internally consistent (α=0.83 to 0.96), and they associate modestly with similar outcomes (r=0.3 to 0.69). Strong evidence suggests the BPI-SF conforms to its 2-dimensional structure in MSK studies; the SF-MPQ-2 4-factor structure was not clearly established. Seven reports of high-to-moderate quality evidence were supportive of the BPI-SF known-group validity (n=2) and responsiveness (n=5). One report of high quality established the SF-MPQ-2 responsiveness.

Discussion:

Evidence of high-to-moderate quality supports the internal consistency, criterion-convergent validity, structural validity, and responsiveness of the BPI-SF and SF-MPQ-2 and establishes their use as generic multidimensional pain outcomes in MSK populations. However, more studies of high quality are still needed on their retest reliability, known-group validity, cross-cultural validity, interpretability properties, and measurement error indices in different MSK populations.
Periprosthetic early insufficiency fracture after total knee arthroplasty: a retrospective case series
Authors: Jabalameli Mahmoud , Abedi Majid , Yahyazadeh Hooman , Sobhan Mohammad Reza
Published: March 2021

Background:

Early periprosthetic insufficiency fracture after total knee arthroplasty (TKA) is a rare, yet serious debilitating condition. Identification of the risk factors predisposing patients to this fracture is crucial to reduce its incidence. We aimed to investigate if patients who experienced early periprosthetic insufficiency fracture after TKA shared any specific characteristics.

Methods:

In a retrospective study, the characteristic features of 17 patients with early periprosthetic insufficiency fracture were reviewed. The index TKA was performed using a medial parapatellar approach and a cemented posterior-stabilized prosthesis. The demographic characteristics of the patients, including body mass index (BMI), preoperative alignment deformity, and postfracture bone mineral density (BMD), were evaluated.

Results:

The study population included 14 women and three men with the mean age of 71.4±7.2 yr. All patients returned with sudden sharp knee pain and inability to walk after the surgery. The mean time from surgery to the diagnosis of fracture was 23±13.3 days. Preoperative varus and valgus deformities were detected in 16 (94.1%) and one (5.9%) patient, respectively. The fracture occurred in the lateral condyle in all patients with varus deformity and the medial condyle in the patient with valgus deformity. All patients were identified with osteoporosis based on the post-fracture BMD evaluation. Thirteen (76.4%) patients were categorized as obese, and four patients as overweight. The size of the femoral condyle was small in the majority of patients.

Conclusions:

Severe knee deformity, osteoporosis, high BMI, and small size of the femoral condyle were the main risk factors of early periprosthetic insufficiency fracture.

Level of Evidence:

Level IV.
Patients’ perceptions of receiving orthopaedic care during a pandemic: a patient survey
Authors: Comadoll Shea , Reams Megan , Only Arthur J. , Cunningham Brian P.
Published: March 2021

Background:

Coronavirus 2019 (COVID-19) has had a great effect on the health care landscape, including altering the availability and methods of orthopaedic care. There is little information regarding patients’ perceptions of orthopaedic care during the pandemic. This study was designed to assess patient concerns surrounding orthopaedic care and determine what areas can be addressed to optimize orthopaedic care during this pandemic.

Methods:

In the spring of 2020, during this study that was exempt from institutional review board (IRB) approval, a survey designed to evaluate the attitudes and beliefs from healthcare consumers about receiving care during the COVID-19 pandemic was sent to a group of panelists via email.

Results:

Three hundred sixty-six (31%) out of 1,200 individuals completed the survey. The majority of participants expressed they would feel comfortable receiving care in orthopaedic clinics (48% immediately, 36% in 1 to 3 mo) in the immediate or near future. Participants reported they were more comfortable seeking orthopaedic care at an orthopedic urgent care facility (8% not comfortable) versus an emergency room (41% not comfortable). When thinking about receiving care at orthopaedic clinics, participants were most concerned about the risks of getting sick from other patients (18% extremely, 26% very). Seventeen percent of respondents reported that despite having orthopaedic concerns, they delayed seeking care due to COVID-19. One-third of respondents expressed a desire to know what precautions were in place to ensure safety.

Conclusions:

Patients remained interested in receiving orthopaedic care in the midst of a pandemic. As a result, physicians need to ensure that they effectively communicate what safety precautions are in place and what additional infection prevention measures are available.

Level of Evidence:

Level IV.
Internal hemipelvectomy for primary pelvic tumors, first experience in Peru: a case series
Authors: Bilbao-Calsine Marco , Guerra-Canchari Pedro , Brañez-Condorena Ana , Layme Josue
Published: March 2021

Internal hemipelvectomy (IH) is a newer surgical choice for pelvic tumors. It involves resection of the tumor, reconstruction of the pelvis without sacrificing the neurovascular structures, and preservation of the lower limb. We aimed to describe first experience with IH in primary pelvic tumors in Peru. Four patients aged 17 to 49 years old at the time of diagnosis were included. 75% were chondrosarcomas, and 25% were chondroblastomas. The IH types were 50% type II, 25% type I-A, and 25% type III. The neoplasm sizes differed from 5cm to more than 20 cm. Postoperative complications were right hip arthrosis, transient urinary incontinence, and abdominal eventration. Fifty percent had local recurrence, with a recurrence mean time of 24 months. As a first attempt at this technique in Peru, IH had promising results with a 100% overall survival at 30 months. However, more studies are required to analyze the factors associated with a high rate of recurrence (50%).
Outcomes of Patellar Tendon Imbrication With Distal Femoral Extension Osteotomy for Treatment of Crouch Gait
Authors: Hyer Lauren C. , Carpenter Ashley M. , Saraswat Prabhav , Davids Jon R. , Westberry David E.
Published: March 2021

Background:

Crouch gait is a frequent gait abnormality observed in children with cerebral palsy. Distal femoral extension osteotomy (DFEO) with the tightening of the extensor mechanism is a common treatment strategy to address the pathologic knee flexion contracture and patella alta. The goal of this study was to review the results of a patellar tendon imbrication (PTI) strategy to address quadriceps insufficiency in the setting of children undergoing DFEO.

Methods:

After institutional review board approval, all patients with crouch gait treated at a single institution with DFEO and PTI were identified. Clinical, radiographic, and instrumented gait analysis data were analyzed preoperatively and at 1 year following surgery.

Results:

Twenty-eight patients (54 extremities) with a diagnosis of cerebral palsy and crouch gait were included. Significant improvements were appreciated in the degree of knee flexion contracture, quadriceps strength, knee extensor lag, and popliteal angle (P<0.01). Knee flexion at initial contact and during mid-stance improved significantly (P<0.0001), and knee moments in late stance were significantly reduced (P<0.01). The anterior pelvic tilt, however, significantly increased postoperatively (P<0.0001). Radiographic improvements were seen in the knee flexion angle and patellar station as assessed by the Koshino Sugimoto Index (P<0.0001). Four patients (14.2%) developed a recurrence of knee flexion contracture requiring further intervention.

Conclusions:

PTI is a simplified and safe technique to address quadriceps insufficiency when performing DFEO. The short-term results of patients who underwent DFEO with PTI demonstrated improvements in clinical, radiographic, and gait analysis variables of the knee. Investigating long-term outcomes, comparing techniques, and assessing quality of life measures are important next steps in research.

Level of Evidence:

Level IV—case series.
Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position
Authors: Baghdadi Soroush , Weltsch Daniel , Arkader Alexandre , Harwood Kathleen , Lawrence John T.R.
Published: March 2021

Background:

Operative treatment of medial epicondyle fractures can be performed in either a supine or prone position. In the supine position, fracture visualization is sometimes difficult due to the posterior position of the medial epicondyle. However, the prone position requires extensive patient repositioning but may improve visualization. The purpose of this study was to compare the results and complications between the supine and prone position when treating medial epicondyle fractures.

Methods:

In a retrospective chart review, patients below 18 who underwent open reduction and internal fixation of an acute medial epicondyle fracture from January 2011 to August 2019 were identified. Patients with <2 months follow-up and concomitant fractures were excluded. Surgical variables, outcomes, and complications were recorded and compared between the supine and prone positions.

Results:

Sixteen surgeons treated the 204 patients evaluated in this study. The mean age was 11.7 years. In all, 122 (60%) patients were treated in the supine position, and 82 (40%) in the prone position. The mean time in the room was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Tourniquet time was similar between groups (P=0.4). Displacement of the fracture on the first postoperative x-rays was 2.06 mm for the supine position and 1.1 mm for the prone position (P<0.001). We also found good interobserver and intraobserver reliability for the measurements. Five patients (2.5%) required reoperation due to stiffness, 2 patients due to nonunion, 1 patient due to tardy ulnar nerve palsy, and 53 (26%) had surgical hardware removal. The surgical position was not associated with complications or reoperation.

Conclusions:

While the prone position requires additional time in the operating room, presumably for positioning, the length of the surgical procedure itself does not differ between the 2 positions. Although the trend of the surgeons at our center is towards the prone position, with surgeons that try it usually doing all their subsequent cases that way, both positions provide excellent clinical outcomes with minimal complications.

Level of Evidence:

Therapeutic level III—retrospective cohort study.
Turkish Validity and Reliability Study of Scoliosis Research Society-30 Questionnaire in Adolescent Idiopathic Scoliosis Patients
Authors: Aksekili Mehmet Atif Erol , Demir Pervin , Iyigun Abdullah , Akcaalan Serhat , Korkmazer Selcuk , Tecimel Osman , Senkoylu Alpaslan
Published: March 2021

Study Design.

Methodological.

Objective.

Turkish validity and reliability study of Scoliosis Research Society-30 (SRS-30) questionnaire.

Summary of Background Data.

SRS-30 is the most current questionnaire of SRS, which is widely used in the evaluation of the treatment of patients with idiopathic scoliosis. There is no validity and reliability study for the Turkish language.

Methods.

All translation and cross-cultural adaptation stages of the SRS-30 English version to Turkish were implemented. SRS-30 Turkish and Short Form-36 questionnaires were administered to 96 patients with adolescent idiopathic scoliosis simultaneously. Two weeks later, the SRS-30-Turkish version was applied again. Internal validity was examined using the Rasch model, and external construct validity (convergent validity) was evaluated with the Spearman rho correlation test. Person Separation Index was used for reliability. The internal consistency was analyzed with Cronbach alpha. For test re-test reliability, intraclass correlation coefficient between the two measurements was calculated.

Results.

As a result of the Rasch analysis, it was observed that the Turkish version of SRS-30 has a multidimensional structure and the disordered threshold problem was observed in some items. Overall fit is provided for each of the four sub-dimensions of SRS-30 Turkish. There was no difference in the functioning of the items in terms of gender and age groups. The lowest Person Separation Index value was obtained with 0.539 in the satisfaction of the treatment sub-dimension. Cronbach alpha values were over 0.70 for all domains. The intraclass correlation coefficient value was found in satisfaction with management dimension (0.463) and above 0.60 in other dimensions.

Conclusion.

It was concluded that the SRS-30 Turkish questionnaire was valid and reliable in evaluating the treatment of patients with adolescent idiopathic scoliosis. Considering the studies related to SRS scales in the literature, especially those applied Rasch analysis, it is seen that the reply categories of the items should be reviewed.

Level of Evidence: 2
Fractional Curve in Adult Spinal Deformity
Authors: Plais Nicolas , Bao Hongda , Lafage Renaud , Kim Han Jo , Gupta Munish , Smith Justin S. , Shaffrey Christopher , Mundis Gregory , Burton Douglas , Ames Christopher , Klineberg Eric , Bess Shay , Hostin Richard A. , Schwab Frank , Lafage Virginie , ISSG
Published: March 2021

Study Design:

This was a retrospective review of the multicenter adult spine deformity database.

Objective:

The objective of this study was to investigate the role of the fractional curve (FC) on global coronal malalignment.

Summary of Background Data:

Despite being very common, the role of the coronal FC as either a driver or compensation for global coronal malalignment is not well documented

Materials and Methods:

Patients with the following characteristics were extracted from a prospective multicenter database: lumbar/thoracolumbar (TL) major coronal curve >15 degrees, apex at T11–L3, lower end vertebra at L3 or L4, above 45 years old, and FC >5 degrees. In addition to the classic radiographic parameters, baseline analysis included Cobb angle, pelvic obliquity (PO), fractional ratio (fractional Cobb/main Cobb), the sum of PO and FC, as well as the coronal Qiu classification. Curves distribution (TL vs. FC) were compared across the 3 Qui types, and the role of the FC was investigated.

Results:

A total of 404 patients (63 y old, 83.3% female) were included: 43 patients were classified as type B, 120 as type C, and 241 were coronally balanced (type A). Compared with the balanced patients, type C patients had similar major TL Cobb angles but significantly larger fractional Cobb angles (17.5 vs. 22.3 degrees, P<0.001). By opposition, type B patients had significantly larger major TL Cobb angles (49 vs. 41 degrees, P=0.001) but smaller fractional Cobb angles (P<0.001). PO>5 degrees in the same direction as FC was more common in type B patients (20%) than in type C patients (7.5%), which suggests the preferential role of pelvic compensation.

Conclusions:

Our findings challenge the idea that FC is only a compensatory curve below a main lumbar or TL curve. In type B patients, FC acts as a compensation mechanism but fails to maintain coronal alignment despite the presence of PO. In type C patients, however, the lumbosacral FC acts as a primary driver of coronal malalignment.

Level of Evidence:

Level III.
miR-206-G6PD axis regulates lipogenesis and cell growth in hepatocellular carcinoma cell
Authors: Wang Ao , Chen Bocen , Jian Shaoqin , Cai Wangwei , Xiao Man , Du Guankui
Published: March 2021

miR-206 plays an essential role in repressing the growth of multiple cancer cells. Glucose-6-phosphate dehydrogenase (G6PD) is the rate-limiting enzyme of the pentose phosphate pathway. However, it is mostly unknown whether G6PD is associated with miR-206-mediated growth repression of hepatocellular carcinoma (HCC) cells. In this study, we found that the expression of G6PD was upregulated in HCC patients and cell lines, whereas the expression of miR-206 was negatively associated with the clinical staging criterion of primary liver cancer. Overexpression of G6PD increased lipid accumulation and promoted cell proliferation. Conversely, inhibition of G6PD expression decreased lipid accumulation and suppressed cell proliferation. Moreover, miR-206 could directly bind to G6PD mRNA 3´-UTR and downregulate G6PD level. Overexpression of G6PD significantly attenuated the miR-206 mimic-mediated suppression of lipid accumulation and cell proliferation. In summary, the results demonstrated that miR-206 could inhibit lipid accumulation and growth of HCC cells by targeting G6PD, suggesting that the miR-206-G6PD axis may be a promising target for treating HCC.
Encephalitis Induced by Durvalumab During Treatment of Metastatic Small-Cell Lung Cancer: Illustrative Case and Review of the Literature
Authors: Shechtman Yelena , Shalata Walid , Khoury Rasha , Mahajna Ayed , Weller Boaz , Agbarya Abed
Published: March 2021

The immune checkpoint inhibitors have improved the standards of care in cancer treatment and have dramatically improved patient prognoses. These new antibodies turned to be an integral part of the standard of care for metastatic small-cell lung cancer. Platinum-based chemotherapy combined with checkpoint inhibitors, resulted in statistically significant improvement of progression free survival and overall survival. Immune checkpoint inhibitors immune-related adverse events have been observed and reported as a consequence of administering these innovative treatment drugs. Neurological immune-related adverse events are rare complications; however, they can be potentially fatal, particularly encephalitis. This report describes a 66-year-old female who received Durvalumab for metastatic small-cell lung cancer. Following 3 cycles of treatment, she developed encephalitis.
Sphenoid Wing Dysplasia in the Absence of Neurofibromatosis: Diagnosis and Management of a Novel Phenotype
Authors: Zapatero Zachary D. , Kalmar Christopher L. , Kosyk Mychajlo S. , Carlson Anna R. , Bartlett Scott P.
Published: March 2021

Congenital sphenoid wing dysplasia is one of the major diagnostic criteria for neurofibromatosis type 1, and is often considered pathognomonic for the disease. Between 5% and 12% of neurofibromatosis type 1 cases have evidence of sphenoid wing dysplasia. Sequelae of this deficiency include slow expansion of the middle temporal fossa and progressive herniation of the temporal lobe into the orbital cavity, resulting in pulsatile exophthalmos. Herein, we report a patient with greater sphenoid wing agenesis and middle temporal fossa enlargement requiring transcranial orbital reconstruction in the absence of neurofibromatosis. To our knowledge, this represents a novel craniofacial phenotype of sphenoid wing agenesis in the absence of neurofibromatosis previously not described in the literature.
Early Recurrent Carpal Tunnel Syndrome in Patients with Mucopolysaccharidoses
Authors: Park Keon Min , Tai Chau , Rahgozar Paymon
Published: March 2021

Early-onset carpal tunnel syndrome (CTS) is a well-known manifestation of mucopolysaccharidoses (MPS) due to excessive deposition of glycosaminoglycans in soft tissues. Standard treatment has been carpal tunnel release surgery, with the conventional technique of dividing the transverse carpal ligament. With advancement of treatments for MPS, these patients now have a longer life expectancy and are presenting with recurrent CTS. Management of recurrent CTS in these patients is not well studied. Here, we report 2 cases of recurrent CTS in MPS patients after a carpal tunnel release operation. We describe the findings on repeat operations and propose a unique technique for treating CTS in MPS patients to minimize recurrence during the initial CTS surgery. Our method involves resection of a portion of the transverse carpal ligament and use of a hypothenar fat pad flap over the median nerve.
Descemet Membrane Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy: Initial Experiences
Authors: Mittal Vikas , Sehdev Nancy , Mittal Ruchi
Published: March 2021

Purpose:

To report our early experiences with Descemet membrane endothelial keratoplasty (DMEK) in congenital hereditary endothelial dystrophy (CHED).

Methods:

Retrospective analysis of medical records of eyes with CHED that underwent DMEK between January 1, 2018, and April 30, 2019, and had a minimum of 1-year follow-up.

Results:

Three eyes of 2 CHED patients (a 10-year-old girl and a 22-year-old man) were included. Both had decreased vision and hazy corneas from birth and underwent DMEK during the study period. Surgery was performed by a single surgeon and was uneventful in all 3 eyes. Within 1 month of surgery, the corneal edema cleared, and vision improved significantly. The mean decimal visual acuity improved from 0.15 ± 0.08 (baseline) to 0.33 ± 0.19 at 3 months. The mean central corneal thickness improved from 928 ± 2.3 μm (baseline) to 555.3 ± 25.8 μm at 3 months. The final visual outcome was less in 1 eye because of dense amblyopia. In all 3 eyes, a subtle stromal haze persisted even after resolution of edema. One eye had graft rejection 7 months after surgery because of discontinuation of medications, effectively managed by increasing the frequency of topical steroids.

Conclusions:

DMEK may be a viable option in phakic eyes with CHED.
Distributions of crystalline lens tilt and decentration and associated factors in age-related cataract
Authors: Chen Xiaoyun , Gu Xiaoxun , Wang Wei , Jin Guangming , Wang Lanhua , Zhang Enen , Xu Jingmin , Liu Zhenzhen , Luo Lixia , Liu Yizhi
Published: March 2021

Purpose:

To investigate the characteristics and factors associated with crystalline lens tilt and decentration measured by CASIA2 anterior segment optical coherence tomography.

Setting:

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Design:

Cross-sectional study.

Methods:

1097 eyes of 1097 patients who planned to undergo cataract surgery were enrolled. All patients underwent a general ophthalmologic examination. Lens thickness (LT), front curvature radius (FCR), back curvature radius, lens equator diameter (LED), tilt, and decentration of preoperative crystalline lenses were measured by CASIA2. Univariate and multivariate regression analyses were performed to evaluate the relationships between the tilt and decentration of crystalline lens with related factors.

Results:

The natural crystalline lenses showed a mean tilt of 5.16 degrees toward the inferotemporal direction and a mean decentration of 0.22 mm toward the temporal direction. Of the total 1097 eyes, 119 eyes (10.85%) had a tilt greater than 7 degrees, and 89 eyes (8.11%) had a decentration more than 0.4 mm. Multivariate regression analysis showed that larger decentration, thicker LT, shorter axial length (AL), and FCR were associated with greater lens tilt (P < .001, P = .007, P = .006, and P = .003, respectively). In addition, greater tilt, older and thinner LT were correlated with larger decentration (all P < .001).

Conclusions:

Preoperative crystalline lens had a certain degree of tilt and decentration in age-related cataract. The greater tilt of the crystalline lens was, the larger decentration of it was. In addition, AL, FCR, LT, and age also correlated with tilt and decentration.
Age-related changes in crystalline lens tilt and decentration: swept-source OCT study
Authors: Li Zhangliang , Zhu Zehui , Li Xiuyuan , Meng Ziqi , Qu Wenyong , Zhao Yune
Published: March 2021

Purpose:

To investigate the age-related tilt and decentration of crystalline lenses using a swept-source optical coherence tomography biometer (SS-OCT) (CASIA2, Tomey Corp.).

Setting:

Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.

Design:

Cross-sectional study.

Methods:

The direction and magnitude of the crystalline lens were evaluated in 230 participants with ages ranging from 7 to 90 years using SS-OCT. The participants were divided into 4 age groups, and the differences among the groups were analyzed. Multiple linear regression was used to investigate the main factors influencing crystalline lens tilt and decentration.

Results:

The natural crystalline lens tilted toward the inferotemporal direction with a mean magnitude of 4.3 ± 1.5 degrees (range 0.7 to 8.95 degrees). The mean decentration toward the superotemporal direction was 0.17 ± 0.12 mm (range 0.03 to 1.15 mm). There was mirror symmetry between the right and left eyes. There were statistically significant differences in the crystalline lens tilt and decentration among the age groups. Multiple linear regression showed that changes in crystalline lens tilt depended on angle α (P < .01) and anterior chamber depth (ACD; P = .008), whereas crystalline lens decentration depended on angle κ (P = .003), age (P < .01), and angle α (P = .002).

Conclusions:

Although there was a statistically significant difference in crystalline lens tilt and decentration among age groups, the variation in the crystalline lens position was partially affected by age. The crystalline lens tilt was greater in eyes with wider angle α and shallower ACD, whereas crystalline lens decentration was greater in younger eyes with wider angles κ and α.