bluuebunny/crossref_metadata_2025 huggingface dataset:
Repolarization characteristics indicate electrical instability in ventricular arrhythmia originating from papillary muscle
Authors: Muenkler P , Klatt N , Scherschel K , Kuklik P , Jungen C , Cavus E , Eickholt C , Christoph J , Christ T , Willems S , Riedel R , Kirchhof P , Meyer C
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DZHK (German Center for Cardiovascular Research)

Introduction

Cardiac arrhythmia originating from the papillary muscle can trigger ventricular fibrillation and cause sudden cardiac death even in the absence of structural heart disease. Yet, no clinical parameters are known to reflect the propensity of arrhythmia to degenerate into ventricular fibrillation.

Purpose

We aimed at identification of parameters associated with degeneration of ventricular arrhythmia into ventricular fibrillation.

Methods

Ventricular arrhythmia was induced by aconitine injection into the papillary muscle of healthy sheep (n = 12) in an open-chest model. Endocardial high-density-mapping and epicardial mapping were performed. We determined repolarization time and activation-recovery-interval according to the Wyatt method.

Results

During focal arrhythmia faster conduction occurred in longitudinal and basal direction than transversal and apical direction. The electrical restitution curve, modelling relation of diastolic interval and activation-recovery-interval, is steeper in aconitine-induced ventricular arrhythmia than in ventricular pacing or sinus rhythm. Steeper restitution curves reflect electrical instability and propensity to degenerate into ventricular fibrillation. The repolarization-related parameters activation-recovery interval and repolarization time exhibit higher heterogeneity per beat in ventricular arrhythmia preceding degeneration into ventricular fibrillation. Repolarization time in relation to cycle length (RT/CL), which can easily be measured during electrophysiological procedures, differentiates self-limiting from degenerating arrhythmia with high specificity and sensitivity.

Conclusion

In structurally normal ovine hearts, the ratio of repolarization and cycle length (RT/CL) in ventricular arrhythmia and greater dispersion of repolarization are indicators of subsequent degeneration into ventricular fibrillation. While dispersion of repolarization is not easily acquired in clinical routine, a simple index (RT/CL) may be sufficient to differentiate between self-limiting and electrically instable arrhythmia with propensity to degenerate to ventricular fibrillation. Abstract Figure. Repolarization in VA model
Facilitators and barriers to implementing lifestyle intervention programme to prevent cognitive decline
Authors: Kulmala Jenni , Rosenberg Anna , Ngandu Tiia , Hemiö Katri , Tenkula Tarja , Hyytiä Arja , Vienola Minna , Huhtamäki-Kuoppala Minna , Saarinen Anneli , Korkki Saana , Laatikainen Tiina , Solomon Alina , Kivipelto Miia
Published: May 2021

Background

The Finnish Intervention Study to Prevent Cognitive Impairment and Disability is a randomized controlled trial that has tested the efficacy of a multidomain intervention targeting modifiable risk factors to prevent cognitive impairment/dementia. A combination of healthy diet, physical, social and cognitive activity, and management of cardiovascular risks was shown to be an effective model to promote brain health among older people. The aim of this qualitative study was to explore healthcare professionals’ perceptions of facilitators and barriers to implementing this lifestyle programme into health care.

Methods

Four semi-structured focus group interviews were conducted among healthcare professionals working in primary care and in non-governmental organizations (N=27). Participants were asked to discuss their perceptions of facilitators and barriers for implementing the multidomain intervention into clinical practice. Interviews were analyzed using content analysis.

Results

Barriers and facilitators described by the healthcare professionals were related to infrastructure and resources, client’s personal characteristics and the lifestyle intervention itself. These main categories included several sub-categories related to knowledge, motivation, resources, individualization and collaboration. The interviewees pointed out that more education on dementia prevention is needed, the work should be coordinated efficiently, resources to provide preventive health care should be adequate and multiprofessional collaboration is needed.

Conclusions

Transferring a lifestyle intervention from a trial-setting to real life requires knowledge about the factors that influence effective implementation. Identifying drivers and constraints of successful implementation helps to design and tailor future prevention programmes, increases motivation and adherence and supports system change.
Insights into Old English Lexicography: Lemmatisation ofgĀnand Its Prefix-Formations using a Corpus-Based Database
Authors: García Fernández Laura
Published: May 2021

This article contributes to Old English lexicography by providing a list of lemmas and inflectional forms for the Old English derived verbs (prefixed verbs) of gān ‘to go’. Entries for these lemmas, if listed by Old English dictionaries, are often incomplete, but, more importantly, they are not based on a lemmatised corpus. This is particularly problematic in the case of languages like Old English that are rife with morphological variation. The methodology followed in this study comprises searches on a lexical database and manual revision of the hits. The searches are launched on the lemmatiser Norna, and the hits are checked with available lexicographical sources, secondary sources and annotated corpora. Finally, ambiguous cases are examined in their context. The final list of lemmas and inflectional forms amounts to 104 inflectional forms which are attributed to 14 different lemmas, including one lemma and up to 61 inflectional forms never before listed by dictionaries. Special attention is paid to the contrast between what is attested in the Old English corpora and what is available from the sources. In addition to providing insights into the inventory of lemmas and inflectional forms for the derivatives (prefixed verbs) of the verb gān as attested in The Dictionary of Old English Corpus, which was not available until now from lexicographical sources, this article contributes recommendations for the linguistic analysis of Old English using corpus-based lexical databases.
Beyond timelines: the challenges of combining theoretical premises and speakers’ insights about the assessment, validation and inclusion of Spanish neologisms in dictionaries
Authors: Sánchez Ibáñez Miguel , Maroto Nava
Published: May 2021

Lexicographic exclusion filtering as a strategy to determine the suitability of neologisms to be included in dictionaries has proved to be insufficient. Therefore, a methodology to rank neologisms in a more objective and quantitative way, based on their most distinctive features as new words is put forward here. In addition, the results of applying this methodology to a sample of more than 3,000 units compiled from Spanish newspapers over a specific time span (2009-2016) are contrasted along with the insights provided by a group of native speakers collected by means of a crowdsourcing strategy. By combining theoretical approaches and speakers’ insights, the validity of the suggested methodology is partially corroborated. Moreover, insights given by the speakers involved concerning their prescriptive conception of neology and its place within dictionaries are outlined.
Smaller decline of renal function after nephroureterectomy predicts poorer prognosis of upper tract urothelial carcinoma: a multicentre retrospective study
Authors: Yamada Yukio , Nakagawa Tohru , Miyakawa Jimpei , Kawai Taketo , Tabata Mariko , Kaneko Tomoyuki , Taguchi Satoru , Naito Akihiro , Hikatsu Masahiro , Sato Yusuke , Murata Taro , Matsumoto Akihiko , Miyazaki Hideyo , Suzuki Motofumi , Enomoto Yutaka , Nishimatsu Hiroaki , Kondo Yasushi , Takeuchi Takumi , Tanaka Yoshinori , Kume Haruki
Published: May 2021

Purpose

Renal function is frequently impaired in the patients with upper tract urothelial carcinoma. We aimed to evaluate the impact of renal function and its change after surgery on survival rates in patients with upper tract urothelial carcinoma after nephroureterectomy.

Methods

The study cohort comprised 755 patients with upper tract urothelial carcinoma who underwent nephroureterectomy between 1995 and 2016 at nine hospitals in Japan. Estimated glomerular filtration rate was calculated using the three-variable Japanese equation for glomerular filtration rate estimation from serum creatinine level and age. Outcomes were recurrence-free, cancer-specific and overall survivals. Univariate and multivariate Cox proportional hazards regression analyses were used.

Results

Median patients’ age was 72 years old. Pre- and post-surgical median estimated glomerular filtration rate were 55.5 and 42.9 ml/min/1.73 m2, respectively. Median estimated glomerular filtration rate decline after surgery, which represents function of the affected side kidney, was 13.1 ml/min/1.73 m2. The 5-year recurrence-free, cancer-specific and overall survivals were 68.3, 79.4 and 74.0%, respectively. Multivariate analysis indicated that lower preoperative estimated glomerular filtration rate and estimated glomerular filtration rate decline were associated with poorer recurrence-free, cancer-specific and overall survivals, but post-operative estimated glomerular filtration rate was not. Estimated glomerular filtration rate decline was more significant poor-prognosticator than preoperative estimated glomerular filtration rate. Proportions of the patients with estimated glomerular filtration rate <60 ml/min/1.73 m2 before surgery were 50.6 and 73.2% in organ-confined disease and locally advanced disease, respectively (P < 0.0001). After surgery, they were 91.6 and 89.8%, respectively (P = 0.3896).

Conclusions

Lower preoperative renal function, especially of the affected side kidney, was significantly associated with poor prognosis after nephroureterectomy for upper tract urothelial carcinoma. Many patients with locally advanced disease have reduced renal function at diagnosis and even more after surgery.
Volatility Bursts: A Discrete-Time Option Model with Multiple Volatility Components
Authors: Lilla Francesca
Published: May 2021

I propose an affine discrete-time model, called Vector Autoregressive Gamma with volatility Bursts (VARG-B) in which volatility experiences, in addition to frequent and small changes, periods of sudden and extreme movements generated by a latent factor which evolves according to the Autoregressive Gamma Zero process. A key advantage of the discrete-time specification is the possibility of estimating the model using Kalman Filter techniques. Moreover, the VARG-B model leads to a fully analytic conditional Laplace transform which boils down to a closed-form option pricing formula. When estimated on S&P500 index options and returns, the new model provides more accurate option pricing and modeling of the IV surface compared with some alternative models.
Long-Term Itching in a Tourist Following Bite by a Nymph of Dermacentor auratus (Acari: Ixodidae) in Cambodia
Authors: Chitimia-Dobler Lidia , Schaper Sabine , Bröker Michael , Nava Santiago
Published: May 2021

The impact of tick bites during holidays in tropical countries is seldom reported. Here, we describe long-term skin alterations and itching experienced by a German tourist following the bite of a nymph of Dermacentor auratus Supino, 1897 in Cambodia. Tick infestation may be neglected by travelers. Therefore, careful travel history is necessary when travelers report a tick bite after spending holiday in tropical and subtropical countries.
Impact of pharmacist intervention on antidepressant medication adherence and disease severity in patients with major depressive disorder in fragile north-east Nigeria
Authors: Yusuf Hadiza , Magaji Mohammed G , Maiha Bilkisu B , Yakubu Sani I , Haruna Wazis C , Mohammed Shafiu
Published: May 2021

Objectives

Medication adherence is emerging as a major public health challenge particularly in patients with depression. The aim of this study was to explore the usefulness of a pharmacist intervention to improve antidepressant medication adherence and disease severity in patients with major depressive disorder.

Methods

This prospective interventional study was conducted between April 2019 and March 2020 among 101 patients at the Federal Neuro-Psychiatric Hospital, Maiduguri, Nigeria. Consenting patients were randomised into usual care or intervention groups using a computer-generated list. Data were collected at baseline, 3 months and 6 months. Medication adherence and depression severity were assessed using the Medication Adherence Rating Scale and Beck Depression Inventory respectively.

Key findings

At baseline, both the usual care and intervention groups had low mean scores for medication adherence [5.22 (SD = 1.51) versus 5.46 (SD = 1.46)] and high mean scores for depression severity [24.16 (SD = 13.50) versus 27.07 (SD = 16.12)]. At 6 months, there was a significant difference (P < 0.001) between the mean medication adherence scores of 5.22 (SD = 1.90) and 9.15 (SD = 1.62), in the usual care and intervention groups respectively. A significant difference (P = 0.033) was also observed at 6 months between the mean depression severity scores of the usual care and intervention groups [21.40 (SD = 11.52) and 17.34 (SD = 6.96)]. Medication adherence (P < 0.001, Partial eta squared = 0.279) and depression severity (P < 0.001, Partial eta squared = 0.170) positively changed with time in the presence of the intervention.

Conclusions

The intervention significantly improved antidepressant medication adherence and disease severity in patients with major depressive disorder.
Lemierre’s Syndrome Due to the Zoonotic Anaerobe Bacteroides pyogenes: Case Report and Literature Review
Authors: Goggin Kathryn P , Beckmann Nicholas , Bettin Kristen , Carrillo-Marquez Maria , Wood Joshua , Arnold Sandra R
Published: May 2021

Although Fusobacterium necrophorum is well described as an emerging pathogen of acute mastoiditis in young children, infection with other anaerobes can lead to similar severe sequelae including intracranial and extracranial suppurative thrombophlebitis and sepsis. We describe a patient whose unremarkable exposure history assumed increased significance upon obtaining the results of 16S next generation sequencing from a surgical specimen. The novel pathogen Bacteroides pyogenes is reviewed herein.
Quasi-periodic dipping in the ultraluminous X-ray source, NGC 247 ULX-1
Authors: Alston W N , Pinto C , Barret D , D’Aì A , Del Santo M , Earnshaw H , Fabian A C , Fuerst F , Kara E , Kosec P , Middleton M J , Parker M L , Pintore F , Robba A , Roberts T P , Sathyaprakash R , Walton D , Ambrosi E
Published: May 2021

Most ultraluminous X-ray sources (ULXs) are believed to be stellar mass black holes or neutron stars accreting beyond the Eddington limit. Determining the nature of the compact object and the accretion mode from broad-band spectroscopy is currently a challenge, but the observed timing properties provide insight into the compact object and details of the geometry and accretion processes. Here, we report a timing analysis for an 800 ks XMM–Newton campaign on the supersoft ultraluminous X-ray source, NGC 247 ULX-1. Deep and frequent dips occur in the X-ray light curve, with the amplitude increasing with increasing energy band. Power spectra and coherence analysis reveals the dipping preferentially occurs on ∼5 and ∼10 ks time-scales. The dips can be caused by either the occultation of the central X-ray source by an optically thick structure, such as warping of the accretion disc, or from obscuration by a wind launched from the accretion disc, or both. This behaviour supports the idea that supersoft ULXs are viewed close to edge-on to the accretion disc.
The SAMI Galaxy Survey: a statistical approach to an optimal classification of stellar kinematics in galaxy surveys
Authors: van de Sande Jesse , Vaughan Sam P , Cortese Luca , Scott Nicholas , Bland-Hawthorn Joss , Croom Scott M , Lagos Claudia D P , Brough Sarah , Bryant Julia J , Devriendt Julien , Dubois Yohan , D’Eugenio Francesco , Foster Caroline , Fraser-McKelvie Amelia , Harborne Katherine E , Lawrence Jon S , Oh Sree , Owers Matt S , Poci Adriano , Remus Rhea-Silvia , Richards Samuel N , Schulze Felix , Sweet Sarah M , Varidel Mathew R , Welker Charlotte
Published: May 2021

Large galaxy samples from multiobject integral field spectroscopic (IFS) surveys now allow for a statistical analysis of the z ∼ 0 galaxy population using resolved kinematic measurements. However, the improvement in number statistics comes at a cost, with multiobject IFS survey more severely impacted by the effect of seeing and lower signal-to-noise ratio. We present an analysis of ∼1800 galaxies from the SAMI Galaxy Survey taking into account these effects. We investigate the spread and overlap in the kinematic distributions of the spin parameter proxy $\lambda _{R_{\rm {e}}}$ as a function of stellar mass and ellipticity εe. For SAMI data, the distributions of galaxies identified as regular and non-regular rotators with kinemetry show considerable overlap in the $\lambda _{R_{\rm {e}}}$–εe diagram. In contrast, visually classified galaxies (obvious and non-obvious rotators) are better separated in $\lambda _{R_{\rm {e}}}$ space, with less overlap of both distributions. Then, we use a Bayesian mixture model to analyse the observed $\lambda _{R_{\rm {e}}}$–log (M⋆/M⊙) distribution. By allowing the mixture probability to vary as a function of mass, we investigate whether the data are best fit with a single kinematic distribution or with two. Below log (M⋆/M⊙) ∼ 10.5, a single beta distribution is sufficient to fit the complete $\lambda _{R_{\rm {e}}}$ distribution, whereas a second beta distribution is required above log (M⋆/M⊙) ∼ 10.5 to account for a population of low-$\lambda _{R_{\rm {e}}}$ galaxies. While the Bayesian mixture model presents the cleanest separation of the two kinematic populations, we find the unique information provided by visual classification of galaxy kinematic maps should not be disregarded in future studies. Applied to mock-observations from different cosmological simulations, the mixture model also predicts bimodal $\lambda _{R_{\rm {e}}}$ distributions, albeit with different positions of the $\lambda _{R_{\rm {e}}}$ peaks. Our analysis validates the conclusions from previous, smaller IFS surveys, but also demonstrates the importance of using selection criteria for identifying different kinematic classes that are dictated by the quality and resolution of the observed or simulated data.
The SAMI Galaxy Survey: the role of disc fading and progenitor bias in kinematic transitions
Authors: Croom S M , Taranu D S , van de Sande J , Lagos C D P , Harborne K E , Bland-Hawthorn J , Brough S , Bryant J J , Cortese L , Foster C , Goodwin M , Groves B , Khalid A , Lawrence J , Medling A M , Richards S N , Owers M S , Scott N , Vaughan S P
Published: May 2021

We use comparisons between the Sydney-AAO Multi-object Integral Field Spectrograph (SAMI) Galaxy Survey and equilibrium galaxy models to infer the importance of disc fading in the transition of spirals into lenticular (S0) galaxies. The local S0 population has both higher photometric concentration and lower stellar spin than spiral galaxies of comparable mass and we test whether this separation can be accounted for by passive aging alone. We construct a suite of dynamically self-consistent galaxy models, with a bulge, disc, and halo using the galactics code. The dispersion-dominated bulge is given a uniformly old stellar population, while the disc is given a current star formation rate putting it on the main sequence, followed by sudden instantaneous quenching. We then generate mock observables (r-band images, stellar velocity, and dispersion maps) as a function of time since quenching for a range of bulge/total (B/T) mass ratios. The disc fading leads to a decline in measured spin as the bulge contribution becomes more dominant, and also leads to increased concentration. However, the quantitative changes observed after 5 Gyr of disc fading cannot account for all of the observed difference. We see similar results if we instead subdivide our SAMI Galaxy Survey sample by star formation (relative to the main sequence). We use EAGLE simulations to also take into account progenitor bias, using size evolution to infer quenching time. The EAGLE simulations suggest that the progenitors of current passive galaxies typically have slightly higher spin than present day star-forming disc galaxies of the same mass. As a result, progenitor bias moves the data further from the disc fading model scenario, implying that intrinsic dynamical evolution must be important in the transition from star-forming discs to passive discs.
The ZTF Source Classification Project – II. Periodicity and variability processing metrics
Authors: Coughlin Michael W , Burdge Kevin , Duev Dmitry A , Katz Michael L , van Roestel Jan , Drake Andrew , Graham Matthew J , Hillenbrand Lynne , Mahabal Ashish A , Masci Frank J , Mróz Przemek , Prince Thomas A , Yao Yuhan , Bellm Eric C , Burruss Rick , Dekany Richard , Jaodand Amruta , Kaplan David L , Kupfer Thomas , Laher Russ R , Riddle Reed , Rigault Mickael , Rodriguez Hector , Rusholme Ben , Zolkower Jeffry
Published: May 2021

The current generation of all-sky surveys is rapidly expanding our ability to study variable and transient sources. These surveys, with a variety of sensitivities, cadences, and fields of view, probe many ranges of time-scale and magnitude. Data from the Zwicky Transient Facility (ZTF) yields an opportunity to find variables on time-scales from minutes to months. In this paper, we present the codebase, ztfperiodic, and the computational metrics employed for the catalogue based on ZTF’s Second Data Release. We describe the publicly available, graphical-process-unit optimized period-finding algorithms employed, and highlight the benefit of existing and future graphical-process-unit clusters. We show how generating metrics as input to catalogues of this scale is possible for future ZTF data releases. Further work will be needed for future data from the Vera C. Rubin Observatory’s Legacy Survey of Space and Time.
Defensible endowments: comparing different approaches in English and ancient Roman law
Authors: Pratt Simon
Published: May 2021

Whilst the parallels between ancient Roman fideicommissa and English trusts are well-documented, the author argues that insufficient attention has been given to their fundamental differences. This is particularly evident in the different methodologies employed by each system to protect endowments from potential attack by impatient beneficiaries. Accordingly, this article explores how English jurisprudence relied upon conditional terms—possibly informed by ancient Greek and Neoplatonic scholarship—to achieve defensibility and security for English trusts in ways that differ significantly from the Roman scheme. By doing so, this article raises important new questions about how English law has placed boundaries upon valid conditionality.
More than 20 years of experience with Dega transiliac osteotomy in the treatment of dislocated hip joints in children with cerebral palsy
Authors: Pruszczyński Błażej , Synder Marek , Drobniewski Marek , Borowski Andrzej
Published: May 2021

Cerebral palsy in children, which is the result of a nonprogressing damage to the central nervous system, causes motor and posture disorders that change with age. The level of child activity correlates with the hip dislocation risk. It most often affects nonwalking patients and those with tetraparesis or oblique pelvis. The aim of the study was to assess the effectiveness and clinical value of Dega pelvic osteotomy with accompanying directional femoral bone osteotomy after minimum of 20 years from surgery of patients with cerebral palsy. The conducted research was retrospective and concerned the children operated at our Hospital. The assessment was carried out in 346 children with spastic hip during the years 1993–2000. The inclusion criteria were applied: unilateral dislocation of the hip, the observation period of at least 20 years, pelvic osteotomy by Dega method and combined with varus derotation femur osteotomy. The analysis involved fifteen patients. The follow-up period was minimum 20 years (20–27 years). The average migration percentage decreased from 88% down to 25%, and an improved range of mobility was observed in the operated joint after surgery. However, the range of mobility was again significantly reduced during the last control examination after a minimum of 20 years. In all hips, the degenerative joint disease was present. Pelvic transiliac osteotomy, according to Dega, with VDRO, ensures very effective correction of the deficit in femoral head coverage by the acetabulum in the upper, lateral and posterior parts. However, it does not prevent the development of the early degenerative disease of the joint.
Prolonged non-weightbearing treatment decreases femoral head deformity compared to symptomatic treatment in the initial stage of Legg–Calvé–Perthes disease
Authors: Peck Jeffrey B. , Greenhill Dustin A. , Morris William Z. , Do Dang-Huy , McGuire Molly F. , Kim Harry K.W.
Published: May 2021

The purpose of this study is to investigate the potential benefit of using prolonged non-weightbearing (PNWB) as a treatment option for early-stage Legg–Calvé–Perthes disease (LCPD). An Institutional Review Board (IRB) approved this retrospective study of patients with LCPD and ≥2-year follow-up. Patients 6–12 years of age were included if treatment began in Waldenstrom stage 1 or 2A. PNWB consisted of ≥6 months of non- or toe-touch weightbearing. PNWB was recommended if perfusion MRI demonstrated ≥40% hypoperfusion of the femoral head and parents decided against operative treatment. The control group consisted of symptomatically treated patients. Deformity index and epiphyseal quotient were measured at 2-year follow-up. Stulberg classification and sphericity deviation score (SDS) were determined at skeletal maturity or at a minimum of 5-year follow-up. When treatment was initiated in Waldenstrom stage 1, the PNWB group had significantly less femoral head deformity, including deformity index (0.21 vs. 0.52; P < 0.001), epiphyseal quotient (69% vs. 43%; P < 0.001), SDS (18 vs. 52; P = 0.004), and Stulberg (50% good vs. 0% good; P = 0.044). The PNWB group mean hypoperfusion was 68%, indicating severe hypoperfusion. Duration of recommended non-weight bearing in the PNWB group was 11.5 months (range 7–17 months). Despite severe femoral head hypoperfusion, PNWB begun during the initial stage of LCPD decreased femoral head deformity. PNWB should be considered a treatment option for patients/parents who do not wish to pursue operative intervention in early-stage LCPD with substantial hypoperfusion. Level of Evidence III – retrospective comparative study.
Machine Learning Approach in Predicting Clinically Significant Improvements After Surgery in Patients with Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Maki Satoshi , Furuya Takeo , Yoshii Toshitaka , Egawa Satoru , Sakai Kenichiro , Kusano Kazuo , Nakagawa Yukihiro , Hirai Takashi , Wada Kanichiro , Katsumi Keiichi , Fujii Kengo , Kimura Atsushi , Nagoshi Narihito , Kanchiku Tsukasa , Nagamoto Yukitaka , Oshima Yasushi , Ando Kei , Takahata Masahiko , Mori Kanji , Nakajima Hideaki , Murata Kazuma , Matsunaga Shunji , Kaito Takashi , Yamada Kei , Kobayashi Sho , Kato Satoshi , Ohba Tetsuro , Inami Satoshi , Fujibayashi Shunsuke , Katoh Hiroyuki , Kanno Haruo , Imagama Shiro , Koda Masao , Kawaguchi Yoshiharu , Takeshita Katsushi , Matsumoto Morio , Ohtori Seiji , Yamazaki Masashi , Okawa Atsushi
Published: May 2021

Study Design.

A retrospective analysis of prospectively collected data.

Objective.

This study aimed to create a prognostic model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using machine learning (ML).

Summary of Background Data.

Determining surgical outcomes helps surgeons provide prognostic information to patients and manage their expectations. ML is a mathematical model that finds patterns from a large sample of data and makes predictions outperforming traditional statistical methods.

Methods.

Of 478 patients, 397 and 370 patients had complete follow-up information at 1 and 2 years, respectively, and were included in the analysis. A minimal clinically important difference (MCID) was defined as an acquired Japanese Orthopedic Association (JOA) score of ≥2.5 points, after which a ML model that predicts whether MCID can be achieved 1 and 2 years after surgery was created. Patient background, clinical symptoms, and imaging findings were used as variables for analysis. The ML model was created using LightGBM, XGBoost, random forest, and logistic regression, after which the accuracy and area under the receiver-operating characteristic curve (AUC) were calculated.

Results.

The mean JOA score was 10.3 preoperatively, 13.4 at 1 year after surgery, and 13.5 at 2 years after surgery. XGBoost showed the highest AUC (0.72) and high accuracy (67.8) for predicting MCID at 1 year, whereas random forest had the highest AUC (0.75) and accuracy (69.6) for predicting MCID at 2 years. Among the included features, total preoperative JOA score, duration of symptoms, body weight, sensory function of the lower extremity sub-score of the JOA, and age were identified as having the most significance in most of ML models.

Conclusion.

Constructing a prognostic ML model for surgical outcomes in patients with OPLL is feasible, suggesting the potential application of ML for predictive models of spinal surgery.

Level of Evidence: 4
The Preoperative Cross-sectional Area of the Deep Cervical Extensor Muscles Does Not Predict Loss of Lordosis After Cervical Laminoplasty
Authors: Liu Jinping , Xie Rong , Ruan Huibing , Rivera Joshua , Li Bo , Mahmood Burooj , Lee Justin , Guizar Rafael , Mahmoudieh Yasmine , Mummaneni Praveen V. , Chou Dean
Published: May 2021

Study Design:

This was a retrospective, single center.

Objectives:

The objective of this study was to investigate the association between the cross-sectional area (CSA) of the deep extensor muscles (DEM) and postlaminoplasty alignment.

Summary of Background Data:

The preoperative CSA of the semispinalis cervicis (SC) has been reported to correlate with loss of lordosis (LL) after laminoplasty, with a CSA <154.5 mm2 associated with a 10 degrees LL.

Methods:

Laminoplasty patients at the University of California San Francisco between 2009 and 2018 by 2 spine surgeons were retrospectively studied. Patients with previous cervical surgery or nondegenerative diagnoses were excluded. Measurements included the C2–C7 Cobb, T1 slope, and cervical sagittal vertical axis. Preoperative DEM CSA was measured on magnetic resonance imaging. Variables associated with lordosis were analyzed with univariate analysis and multivariate logistic regression, and association between postoperative cervical alignment and the musculature was evaluated.

Results:

Seventy-six patients with a mean age of 64 years were included. The average follow-up was 22.53 months. The overall average CSA of the DEM was 2274.55 mm2 and that of the SC was 275.64 mm2. Means of both CSAs were higher in men (P<0.001). Linear regression showed no correlation between LL with CSA of the DEM or the SC (r=0.005, P=0.119; r=0.001, P=0.095). Univariate and multivariate regression showed no differences in the CSA of the DEM and SC between groups with and without LL (P=0.092, 0.117 and 0.163, 0.292). There was no correlation in LL with sex or body mass index (P>0.05).

Conclusions:

Preoperative CSA of the deep cervical extensor muscles may not predict LL after cervical laminoplasty. The correlation between the preoperative SC CSA and postoperative cervical alignment may not be as strong as previously reported.
Teriparatide Treatment Increases Hounsfield Units in the Thoracic Spine, Lumbar Spine, Sacrum, and Ilium Out of Proportion to the Cervical Spine
Authors: Mikula Anthony L. , St. Jeor Jeffery D. , Naylor Ryan M. , Bernatz James T. , Patel Nitesh P. , Fogelson Jeremy L. , Larson Annalise Noelle , Nassr Ahmad , Sebastian Arjun S. , Freedman Brett , Currier Bradford L. , Bydon Mohamad , Kennel Kurt A. , Yaszemski Michael J. , Anderson Paul A. , Elder Benjamin D.
Published: May 2021

Study Design:

This was a retrospective chart review.

Objective:

The objective of this study was to compare the effect of teriparatide on Hounsfield Units (HU) in the cervical spine, thoracic spine, lumbar spine, sacrum, and pelvis. Second, to correlate HU changes at each spinal level with bone mineral density (BMD) on dual-energy x-ray absorptiometry (DXA).

Summary of Background Data:

HU represent a method to estimate BMD and can be used either separately or in conjunction with BMD from DXA.

Materials and Methods:

A retrospective chart review included patients who had been treated with at least 6 months of teriparatide. HU were measured in the vertebral bodies of the cervical, thoracic, and lumbosacral spine and iliac crests. Lumbar and femoral neck BMD as measured on DXA was collected when available.

Results:

One hundred twenty-five patients were identified for analysis with an average age of 67 years who underwent a mean (±SD) of 22±8 months of teriparatide therapy. HU improvement in the cervical spine was 11% (P=0.19), 25% in the thoracic spine (P=0.002), 23% in the lumbar spine (P=0.027), 17% in the sacrum (P=0.11), and 29% in the iliac crests (P=0.09). Lumbar HU correlated better than cervical HU with BMD as measured on DXA.

Conclusions:

Teriparatide increased average HU in the thoracolumbar spine to a proportionally greater extent than the cervical spine. The cervical spine had a higher baseline starting HU than the thoracolumbar spine. Lumbar HU correlated better than cervical and thoracic HU with BMD as measured on DXA.
EZH2 as an Epigenetic Regulator of Cardiovascular Development and Diseases
Authors: Yuan Jia-Li , Yin Cheng-Ye , Li Ying-Ze , Song Shuai , Fang Guo-Jian , Wang Qun-Shan
Published: May 2021

Enhancer of zeste homolog 2(EZH2) is an enzymatic subunit of polycomb repressive complex 2 (PRC2) and is responsible for catalyzing mono-, di-, and trimethylation of histone H3 at lysine-27(H3K27me1/2/3). Many noncoding RNAs or signaling pathways are involved in EZH2 functional alterations. This new epigenetic regulation of target genes is able to silence downstream gene expression and modify physiological and pathological processes in heart development, cardiomyocyte regeneration, and cardiovascular diseases, such as hypertrophy, ischemic heart diseases, atherosclerosis, and cardiac fibrosis. Targeting the function of EZH2 could be a potential therapeutic approach for cardiovascular diseases.
A New Surgical Approach to Body Contouring
Authors: Flores González Emmanuel Armando , Pérez Chávez Francisco , Ramírez Guerrero Oliver René , Gracida Mancilla Noé Isaías , Vázquez Apodaca Raquel Aracely
Published: May 2021

Background:

The success of body contouring surgery will largely depend on the correct choice and performance of the technique, and utilization of the necessary scientific measures. Thus, this study sought to highlight the combination and evolution of the abdominoplasty-assisted liposuction technique, while individualizing each case for the patient’s benefit.

Method:

We present a series of 188 cases from the past 3 years (2017–2019), using our modification to the surgical technique: performing 360-degree liposuction first, and then abdominoplasty in the same surgical time. We show our aesthetic results, surgical time, and complications, so as to compare them with the literature.

Results:

Of the 188 cases, 184 were women (97.9%) and 4 were men (2.1%). In 11 cases (5.8%), we recorded 4 hours as a minimum surgical time and 8 hours in 16 cases (8.5%) as a maximum time. Regarding complications, hematomas were recorded in 1 case (0.5%) as the least frequent complication and seromas in 18 cases (9.6%) as the most frequent complication. The aesthetic results, although not objectively measurable, are flattering for both the patient and the surgeon, as shown by documented evidence (photographs) before and after surgery.

Conclusions:

Our study supports favorable results. Modification of this technique has resulted in outstanding body contouring surgery. We hope this procedure can be reproduced because of its few complications and the pleasant results it yields.
Rhinoplasty for Hypertrophied Transverse Nasalis Muscle: A Case Report
Authors: Shah Mardan Qutaiba N. M. , Mrad Mohamed Amir , Khojah Abdullah A. , Hashem Fuad K.
Published: May 2021

Negatively impacting the aesthetics of the face, nasal deformities can be attributed to many congenital or acquired causes, of which muscular hypertrophy is uncustomary. In this article, we narrate a case of a 26-year-old woman with a prominently wide mid-vault, in addition to other abnormalities of the nose. It was thought to originate from soft tissue because it was thick and firm to palpation. Open rhinoplasty was done where hypertrophy of the paired transverse nasalis muscle was observed and resected. The patient enjoyed a safe postoperative period with excellent cosmetic results and minimal effect on the nasal function in terms of breathing and pronunciation. We recommend this approach to any patient with a similar disfigurement due to its simplicity and ability to correct other co-existing nasal disfigurements.
Ayurveda for Modern Obstetrics
Authors: Pisani-Conway Christina
Published: May 2021

Ayurveda is a system of holistic medicine that integrates health with lifestyle to restore balance and remove disease by resolving the imbalance that causes it. Ayurvedic techniques that support digestion, immunity, vitality, and rejuvenation can help assist women with a healthy conception, pregnancy, delivery, and postpartum. Ayurvedic approaches can help common but bothersome pregnancy symptoms as well as potentially prevent more serious pregnancy complications. Specific techniques, including developing a daily routine and the practice of pranayama to support vitality through breathing exercises are described to help guide modern obstetrical practice.
Hormonal Contraception: Systemic Estrogen and Progestin Preparations
Authors: Verma Nisha , Cwiak Carrie , Kaunitz Andrew M.
Published: May 2021

Combined hormonal contraception (CHC) are short-acting, reversible methods containing both estrogen and progestin. Available CHC methods include combined oral contraceptives, transdermal patches, and vaginal rings. The combined oral contraceptive remains the most commonly used contraceptive method in the United States. The general principles of CHC will be reviewed, including mechanism of action and effectiveness. Unless otherwise stated, these principles apply to all CHCs. When discussing clinical studies and specific considerations related only to pills, patches, or rings, the method(s) will be specified. Words that specify sex are used when discussing studies in which sex was specified.
Estimation of the Early Cs-137 Intake of Evacuees from Areas Affected by the 2011 Fukushima Daiichi Nuclear Power Plant Accident Based on Personal Behavioral Data and the Latest Atmospheric Transport and Dispersion Model Simulation
Authors: Kim Eunjoo , Igarashi Yu , Hashimoto Shozo , Tani Kotaro , Ishikawa Tetsuo , Kowatari Munehiko , Kurihara Osamu
Published: May 2021

More than 9 y have passed since the 2011 nuclear disaster in Fukushima Prefecture, Japan. During this period, much effort has been spent on the dose reconstruction for Fukushima residents; however, the estimation of the internal dose due to the potential intake of the short-lived radionuclides (mainly iodine-131) has been challenging because of the lack of direct human measurements at the early phase of the accident. Our previous study revealed that the residual cesium body contents observed in delayed whole-body counter (WBC) measurements of residents from Namie-town, one of the most affected municipalities, varied greatly with the timepoint of their evacuations on 12 March 2011 when the first explosive event occurred at the accident site; i.e., the late evacuees had much higher residual cesium body contents compared to the prompt evacuees. The present study thus aimed to clarify this finding by reproducing the exposure situation based on the evacuees' personal behavioral data in combination with the latest atmospheric transport and dispersion model (ATDM) simulation for 356 selected subjects in adult and 15-y (13–17 y) age groups. The results demonstrated that the ATDM simulation-based method could reasonably reproduce the subjects’ exposure situation, supporting the previous finding. However, the residual cesium-137 body contents calculated by this method were only 10%–20% of those in the subjects’ WBC measurements. This large discrepancy was considered to be caused by both the present method’s underestimation and the overestimation of the subjects’ early intake in the WBC measurements due to a conservative intake scenario not assuming potential additional intake. Additional studies are needed to further clarify the reasons for the discrepancy and to evaluate the magnitude of the inhalation dose in the accident.
Development of a Fission Neutron Spectrum from a D-T Neutron Generator by Spectrum Subtraction Technique
Authors: Scates Wade W. , Schrader Bradley J. , Casanova Konner M.
Published: May 2021

Californium-252 (252Cf) is considered essential by the National Institute of Standards and Technology for the calibration of neutron instrumentation and dosimetry. Californium-252 has a relatively short half-life of 2.645 y; consequently, it must be replaced frequently to produce an adequate neutron flux for calibration. The user community is currently looking for a replacement for 252Cf. The patented technology described herein has a high probability of being that replacement. A preferred method to replace 252Cf would use an affordable and easily maintained neutron source that generates neutrons in an energy spectrum as close to that of 252Cf as possible. Deuterium-tritium (D-T) neutron generators are both affordable and easily maintained, which makes them highly attractive for replacing 252Cf. The patented technology discussed in this paper simulates the 252Cf fission spectrum through a D-T neutron generator by using spectral subtraction. The primary spectrum is built using principally (n,xn) and (n,n′) reactions in a variety of materials. In conjunction with the primary spectrum, an engineered background spectrum is generated using a second set of materials. This engineered background spectrum corrects for differences between the primary and desired spectra. This subtraction technique generates a spectrum very similar to 252Cf while maintaining a reasonable flux. Further, by choosing different scattering materials, any fission spectrum can be matched, including the thermal and epithermal components. This flexibility expands the potential use of this technology beyond simulating 252Cf to any desired neutron spectrum below 14 MeV.
Development and Validation of a Natural Language Processing Algorithm to Extract Descriptors of Microbial Keratitis From the Electronic Health Record
Authors: Woodward Maria A. , Maganti Nenita , Niziol Leslie M. , Amin Sejal , Hou Andrew , Singh Karandeep
Published: May 2021

Purpose:

The purpose of this article was to develop and validate a natural language processing (NLP) algorithm to extract qualitative descriptors of microbial keratitis (MK) from electronic health records.

Methods:

In this retrospective cohort study, patients with MK diagnoses from 2 academic centers were identified using electronic health records. An NLP algorithm was created to extract MK centrality, depth, and thinning. A random sample of patient with MK encounters were used to train the algorithm (400 encounters of 100 patients) and compared with expert chart review. The algorithm was evaluated in internal (n = 100) and external validation data sets (n = 59) in comparison with masked chart review. Outcomes were sensitivity and specificity of the NLP algorithm to extract qualitative MK features as compared with masked chart review performed by an ophthalmologist.

Results:

Across data sets, gold-standard chart review found centrality was documented in 64.0% to 79.3% of charts, depth in 15.0% to 20.3%, and thinning in 25.4% to 31.3%. Compared with chart review, the NLP algorithm had a sensitivity of 80.3%, 50.0%, and 66.7% for identifying central MK, 85.4%, 66.7%, and 100% for deep MK, and 100.0%, 95.2%, and 100% for thin MK, in the training, internal, and external validation samples, respectively. Specificity was 41.1%, 38.6%, and 46.2% for centrality, 100%, 83.3%, and 71.4% for depth, and 93.3%, 100%, and was not applicable (n = 0) to the external data for thinning, in the samples, respectively.

Conclusions:

MK features are not documented consistently showing a lack of standardization in recording MK examination elements. NLP shows promise but will be limited if the available clinical data are missing from the chart.
Keratoplasty Rejection After the BNT162b2 messenger RNA Vaccine
Authors: Wasser Lauren M. , Roditi Eduardo , Zadok David , Berkowitz Liron , Weill Yishay
Published: May 2021

Purpose:

The aim of this report was to report 2 patients who presented with acute corneal graft rejection 2 weeks after receiving the BNT162b2 messenger RNA (mRNA) vaccine for severe acute respiratory syndrome coronavirus 2.

Methods:

Case report.

Results:

Two men, aged 73 and 56 years, with a history of penetrating keratoplasty due to keratoconus were noted to have acute corneal graft rejection 2 weeks after receiving a first dose of the BNT162b2 mRNA vaccine. Both patients were treated with hourly dexamethasone 0.1% and oral prednisone 60 mg per day with prompt resolution of keratoplasty rejection.

Conclusions:

The BNT162b2 mRNA vaccine may be have been associated with a low-risk corneal graft rejection that responded well to topical and systemic steroids. Treating physicians should be aware of this potential complication and patients should be advised to report any visual changes after vaccination.