bluuebunny/crossref_metadata_2025 huggingface dataset:
The fluffy Gene of Neurospora crassa Is Necessary and Sufficient to Induce Conidiophore Development
Authors: Bailey-Shrode Lori , Ebbole Daniel J
Published: April 2021

The fl (fluffy) gene of Neurospora crassa encodes a binuclear zinc cluster protein that regulates the production of asexual spores called macroconidia. Two other genes, acon-2 and acon-3, play major roles in controlling development. fl is induced specifically in differentiating tissue during conidiation and acon-2 plays a role in this induction. We examined the function of fl by manipulating its level of expression in wild-type and developmental mutant strains. Increasing expression of fl from a heterologous promoter in a wild-type genetic background is sufficient to induce conidiophore development. Elevated expression of fl leads to induction of development of the acon-2 mutant in nitrogen-starved cultures, but does not bypass the conidiation defect of the acon-3 mutant. These findings indicate that fl acts downstream of acon-2 and upstream of acon-3 in regulating gene expression during development. The eas, con-6, and con-10 genes are induced at different times during development. Morphological changes induced by artificially elevated fl expression in the absence of environmental cues were correlated with increased expression of eas, but not con-6 or con-10. Thus, although inappropriate expression of fl in vegetative hyphae is sufficient to induce conidial morphogenesis, complete reconstitution of development leading to the formation of mature conidia may require environmental signals to regulate fl activity and/or appropriate induction of fl expression in the developing conidiophore.
Mating Within the Meiotic Tetrad and the Maintenance of Genomic Heterozygosity
Authors: Hood Michael E , Antonovics Janis
Published: April 2021

Mating among the products of a single meiosis (automixis or meiotic parthenogenesis) is found in diverse groups of plant, animal, and fungal taxa. Restoration of the diploid stage is often strictly controlled and brings together products separated at the first meiotic division. Despite apparent similarities to diploid selfing, the theoretical prediction is that heterozygosity should be maintained on all chromosomes when it is linked to the centromeres and thus also segregates at the first meiotic division. Using the fungus Microbotryum, we directly test this prediction by linear tetrad analysis. The patterns of meiotic segregation for chromosome size variation (electrophoretic karyotypes) and PCR products (AFLP procedures) were determined for Microbotryum lineages native to North America and Europe. Our data reveal a surprisingly dynamic genome that is rich in heterozygosity and where size-dimorphic autosomes are common. The genetic variation agrees with the prediction of centromere-linked heterozygosity. This was observed to the greatest extent in the lineage of Microbotryum native to North America where there was consistent first-division segregation and independent assortment of multiple linkage groups. The data also show properties that distinguish the fungal sex chromosomes from the autosomes in both lineages of Microbotryum. We describe a scenario where the mating system of automixis with first-division restitution is the result of feedback mechanisms to control exposure of genetic load.
Molecular and Functional Analysis of scalloped Recessive Lethal Alleles in Drosophila melanogaster
Authors: Srivastava Ajay , Simmonds Andrew J , Garg Ankush , Fossheim Leif , Campbell Shelagh D , Bell John B
Published: April 2021

The Drosophila melanogaster scalloped (sd) gene is a homolog of the human TEF-1 gene and is a member of the TEA/ATTS domain-containing family of transcription factors. In Drosophila, sd is involved in wing development as well as neural development. Herein, data are presented from a molecular analysis of five recessive lethal sd alleles. Only one of these alleles complements a viable allele associated with an sd mutant wing phenotype, suggesting that functions important for wing development are compromised by the noncomplementing alleles. Two of the wing noncomplementing alleles have mutations that help to define a VG-binding domain for the SD protein in vivo, and another noncomplementing allele has a lesion within the TEA DNA-binding domain. The VG-binding domain overlaps with a domain important for viability of the fly, since two of the sd lethal lesions are located there. The fifth lethal affects a yet undefined motif lying just outside the VG-binding domain in the C-terminal direction that affects both wing phenotype and viability. This is the first example linking mutations affecting specific amino acids in the SD protein with phenotypic consequences for the organism.
Integration and Modularity of Quantitative Trait Locus Effects on Geometric Shape in the Mouse Mandible
Authors: Klingenberg Christian Peter , Leamy Larry J , Cheverud James M
Published: April 2021

The mouse mandible has long served as a model system for complex morphological structures. Here we use new methodology based on geometric morphometrics to test the hypothesis that the mandible consists of two main modules, the alveolar region and the ascending ramus, and that this modularity is reflected in the effects of quantitative trait loci (QTL). The shape of each mandible was analyzed by the positions of 16 morphological landmarks and these data were analyzed using Procrustes analysis. Interval mapping in the F2 generation from intercrosses of the LG/J and SM/J strains revealed 33 QTL affecting mandible shape. The QTL effects corresponded to a variety of shape changes, but ordination or a parametric bootstrap test of clustering did not reveal any distinct groups of QTL that would affect primarily one module or the other. The correlations of landmark positions between the two modules tended to be lower than the correlations between arbitrary subsets of landmarks, indicating that the modules were relatively independent of each other and confirming the hypothesized location of the boundary between them. While these results are in agreement with the hypothesis of modularity, they also underscore that modularity is a question of the relative degrees to which QTL contribute to different traits, rather than a question of discrete sets of QTL contributing to discrete sets of traits.
Midterm results of stand-alone thoracoscopic epicardial ablation with box lesion for atrial fibrillation
Authors: Yu Chunyu , Li Haojie , Zhang Heng , Zheng Zhe
Published: April 2021

OBJECTIVES

The short-term results of video-assisted thoracoscopic surgical ablation (VTSA) with box lesion have been highly variable, and the actual efficacy requires clarification through longer follow-ups. We aimed to report which patients might benefit more from VTSA with box lesion by longer follow-up.

METHODS

From September 2010 to November 2016, patients with atrial fibrillation (AF) who underwent VTSA with box lesion were screened. All enrolled patients visited the outpatient clinic and underwent 24-h Holter monitoring at 3, 6 and 12 months after surgery and annually thereafter.

RESULTS

A total of 91 consecutive patients [age, 58.0 (interquartile interval from 52.0 to 62.0) years; male, 71.4%] with paroxysmal (67%) or persistent/long-standing persistent (33%) AF were enrolled. After a median follow-up of 48 months (interquartile interval from 36 to 60 months), freedom from atrial tachyarrhythmias without antiarrhythmic drugs (AADs) was 76.5%, 66.0% and 66.0% for paroxysmal AF and 58.6%, 47.8% and 34.2% for persistent/long-standing persistent AF at 12, 36 and 60 months, respectively (P = 0.017). The preoperative left atrial diameter >40 mm (hazard ratio: 2.837, 95% confidence interval: 1.408–5.716; P = 0.004) and age >50 years (hazard ratio: 2.927, 95% confidence interval: 1.359–6.305; P = 0.006) were associated with recurrences of atrial tachyarrhythmias. In patients with paroxysmal AF and left atrial diameter ≤40 mm (n = 43), freedom from atrial tachyarrhythmias without AADs was 81.4%, 74.3% and 74.3% at 12, 36 and 60 months, respectively.

CONCLUSIONS

In patients with paroxysmal AF and left atrial diameter ≤40 mm, 5-year freedom from atrial tachyarrhythmias without AADs was 74.3%, which was better than that in patients with left atrial diameter >40 mm. A larger sample size and improved study design are needed to confirm our conclusions.
Basophils, a neglected minority in the immune system, have come into the limelight at last
Authors: Karasuyama Hajime , Shibata Sho , Yoshikawa Soichiro , Miyake Kensuke
Published: April 2021

Basophils, the rarest granulocytes, were identified by Paul Ehrlich more than 140 years ago, much earlier than the discovery of T and B cells. Unfortunately, basophils were often mixed up with tissue-resident mast cells because of some phenotypic similarities between them and considered erroneously as minor relatives or blood-circulating precursors of mast cells. Moreover, basophil research was hindered by the rarity of basophils and the paucity of useful analytical tools, and therefore basophils had often been neglected in immunological studies. A series of studies using newly developed tools, including basophil-depleting antibodies and genetically engineered mice deficient only in basophils, have clearly defined previously unrecognized roles of basophils, that are distinct from those played by tissue-resident mast cells. In this mini-review, we highlight recent advances in our understanding of basophil functions, particularly focusing on their roles in the regulation of innate and acquired immunity, allergic reactions, autoimmunity and protective immunity against parasitic infections, mainly based on animal studies. Further studies on human basophils would facilitate the development of new strategies for the treatment of basophil-associated disorders.
Improving Information from Manipulable Data
Authors: Frankel Alex , Kartik Navin
Published: April 2021

Data-based decision making must account for the manipulation of data by agents who are aware of how decisions are being made and want to affect their allocations. We study a framework in which, due to such manipulation, data become less informative when decisions depend more strongly on data. We formalize why and how a decision maker should commit to underutilizing data. Doing so attenuates information loss and thereby improves allocation accuracy.
Moving Stories: Methodological Challenges to Mapping Narratives and Networks of People in Diasporas
Authors: Fabos Anita H , Kahn Leora , Sarkis Marianne
Published: April 2021

Narrative work with people displaced by conflict, and the methods we use to elicit and interpret their stories, offers the possibility to examine a common set of assumptions about place, movement and voice. Forced migration narrative inquiry has always focussed upon people’s movement, but storylines have a strong tendency to resolve this movement through the narrator’s return to settled, bordered life. Our ‘moving stories’ proposal builds on a narrative turn that features the mobile experiences of people whose association with settled life has been redefined through forced displacement. We present examples of diaspora storytelling that suggest how we might shift our lens to recognise circumstances where people’s movement is a key feature of the narrative frame, rather than a temporary condition or problem to be solved. By doing so, we allow ourselves to better see the stories that emerge through and because of mobile strategies and connections.
Association Between Graft Function and Urine CXCL10 and Acylcarnitines Levels in Kidney Transplant Recipients
Authors: Başak Oktay Saniye , Akbaş Sadıka Halide , Yilmaz Vural Taner , Özen Küçükçetin İkbal , Toru Havva Serap , Yücel Süleyman Gültekin
Published: April 2021

Objective

To evaluate post-transplantation graft functions noninvasively by using urine C-X-C motif chemokine 10 (CXCL10) and metabolome analysis.

Methods

The 65 living-donor kidney-transplant recipients in our cohort underwent renal biopsy to investigate possible graft dysfunction. The patients were divided into 2 groups, according to pathology reports: chronic allograft dysfunction (CAD; n = 18) and antibody-mediated/humoral allograft rejection (AMR; n = 16). The control group was composed of renal transplant recipients with stable health (n = 33). We performed serum creatinine, blood urea nitrogen (BUN), cystatin C, urine protein, CXCL10, and metabolome analyses on specimens from the patients.

Results

BUN, creatinine, cystatin C, urine protein, leucine + isoleucine, citrulline, and free/acetyl/propionyl carnitine levels were significantly higher in patients with CAD and AMR, compared with the control individuals. CXCL10 levels were significantly elevated in patients with AMR, compared with patients with CAD and controls. CXCL10 (AUC = 0.771) and cystatin C (AUC = 0.746) were significantly higher in the AMR group, compared with the CAD group (P<.02).

Conclusions

CXCL10 and metabolome analyzes are useful for evaluation of graft functions. Also, CXCL10 might be useful as a supplementary noninvasive screening test for diagnosis of allograft rejection.
Lupus nephritis and ANCA-associated vasculitis: towards precision medicine?
Authors: Rosenkranz Alexander R , Tesar Vladimir
Published: April 2021

Historically the treatment of lupus nephritis (LN) and anti-neutrophil cytoplasmic antibody (ANCA) vasculitis was ‘one size fits all’; however, with the emergence of precision medicine initiatives, the field is moving towards more personalized treatment approaches. The recent development of a more accurate and reproducible histopathological classification system for LN could lead to better disease categorization and therefore more targeted therapies. A better understanding of the pathophysiology of LN has provided evidence that not only T but also B cells play an important role, opening new opportunities for individualized treatment approaches. Recent trials have shown calcineurin inhibitors and the anti-CD20 antibodies rituximab and ofatumumab to be effective in the treatment of LN, adding new treatment options. State-of-the-art targeted therapy in ANCA-associated vasculitis (AAV) takes interindividual heterogeneity in disease severity, type of ANCA antibody [myeloperoxidase versus proteinase 3 (PR3)] and the risk for side effects of therapy into consideration. In addition, within an individual, induction therapy differs from maintenance therapy, the same holding true in incident and relapsing disease. Rituximab is now widely used in AAV and it has become clear that prolonged B cell depletion, as in LN, must be achieved to obtain a long-lasting clinical response, especially in anti-PR3-associated disease. Still, despite these advances, molecular and genetic markers are rarely incorporated into diagnostic and treatment algorithms and true precision medicine remains an aspiration that hopefully can be achieved.
Pathways of China's PM2.5 air quality 2015–2060 in the context of carbon neutrality
Authors: Cheng Jing , Tong Dan , Zhang Qiang , Liu Yang , Lei Yu , Yan Gang , Yan Liu , Yu Sha , Cui Ryna Yiyun , Clarke Leon , Geng Guannan , Zheng Bo , Zhang Xiaoye , Davis Steven J , He Kebin
Published: April 2021

Clean air policies in China have substantially reduced particulate matter (PM2.5) air pollution in recent years, primarily by curbing end-of-pipe emissions. However, reaching the level of the World Health Organization (WHO) guidelines may instead depend upon the air quality co-benefits of ambitious climate action. Here, we assess pathways of Chinese PM2.5 air quality from 2015 to 2060 under a combination of scenarios that link global and Chinese climate mitigation pathways (i.e. global 2°C- and 1.5°C-pathways, National Determined Contributions (NDC) pledges and carbon neutrality goals) to local clean air policies. We find that China can achieve both its near-term climate goals (peak emissions) and PM2.5 air quality annual standard (35 μg/m3) by 2030 by fulfilling its NDC pledges and continuing air pollution control policies. However, the benefits of end-of-pipe control reductions are mostly exhausted by 2030, and reducing PM2.5 exposure of the majority of the Chinese population to below 10 μg/m3 by 2060 will likely require more ambitious climate mitigation efforts such as China's carbon neutrality goals and global 1.5°C-pathways. Our results thus highlight that China's carbon neutrality goals will play a critical role in reducing air pollution exposure to the level of the WHO guidelines and protecting public health.
Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams
Authors: Pinner Nathan A , Tapley Natalie G , Barber Katie E , Stover Kayla R , Wagner Jamie L
Published: April 2021

Background

Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a β-lactam have worse clinical outcomes compared to nonobese patients and to identify if therapeutic drug monitoring may be beneficial.

Methods

This multicenter, retrospective cohort included hospitalized adults admitted from July 2015 to July 2017 treated with a β-lactam as definitive monotherapy against a gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): nonobese (BMI ≤29.9 kg/m2) and obese (BMI ≥30.0 kg/m2). The primary outcome was clinical treatment failure, and secondary outcomes were hospital length of stay, inpatient all-cause mortality, and 30-day all-cause readmission.

Results

There were 257 (43.6%) obese patients and 332 (56.4%) nonobese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by third-generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) nonobese patients (P < .001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than nonobese patients (P = .002), but no differences were found for all-cause mortality (P = .117) or infection-related readmission (0 = 0.112).

Conclusions

Obese patients treated with β-lactams have higher rates of treatment failure and longer hospitalization periods than nonobese patients. Future studies are needed to assess the impact of therapeutic drug monitoring and specific dosing recommendations for targeted infection types.
Increased expression of ANAC017 primes for accelerated senescence
Authors: Broda Martyna , Khan Kasim , O’Leary Brendan , Pružinská Adriana , Lee Chun Pong , Millar A Harvey , Van Aken Olivier
Published: April 2021

Recent studies in Arabidopsis (Arabidopsis thaliana) have reported conflicting roles for NAC DOMAIN CONTAINING PROTEIN 17 (ANAC017), a transcription factor regulating mitochondria-to-nuclear signaling, and its closest paralog NAC DOMAIN CONTAINING PROTEIN 16 (ANAC016), in leaf senescence. By synchronizing senescence in individually darkened leaves of knockout and overexpressing mutants from these contrasting studies, we demonstrate that elevated ANAC017 expression consistently causes accelerated senescence and cell death. A time-resolved transcriptome analysis revealed that senescence-associated pathways such as autophagy are not constitutively activated in ANAC017 overexpression lines, but require a senescence-stimulus to trigger accelerated induction. ANAC017 transcript and ANAC017-target genes are constitutively upregulated in ANAC017 overexpression lines, but surprisingly show a transient “super-induction” 1 d after senescence induction. This induction of ANAC017 and its target genes is observed during the later stages of age-related and dark-induced senescence, indicating the ANAC017 pathway is also activated in natural senescence. In contrast, knockout mutants of ANAC017 showed lowered senescence-induced induction of ANAC017 target genes during the late stages of dark-induced senescence. Finally, promoter binding analyses show that the ANAC016 promoter sequence is directly bound by ANAC017, so ANAC016 likely acts downstream of ANAC017 and is directly transcriptionally controlled by ANAC017 in a feed-forward loop during late senescence.
An epidemiological investigation of COVID-19 outbreaks in a group of care homes in Wales, UK: a retrospective cohort study
Authors: Williams O , Williams C , Turner D , Bull M , Watkins J , Hurt L
Published: April 2021

Background

This study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions.

Methods

Participants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R.

Results

About 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61–31.34).

Conclusions

There were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.
Associations of actigraphic sleep and circadian rest/activity rhythms with cognition in the early phase of Alzheimer’s disease
Authors: Alfini Alfonso , Albert Marilyn , Faria Andreia V , Soldan Anja , Pettigrew Corinne , Wanigatunga Sarah , Zipunnikov Vadim , Spira Adam P
Published: April 2021

Study Objectives

To compare sleep and circadian rest/activity rhythms (RARs), quantified by standard and novel actigraphic metrics, between controls and participants with mild cognitive impairment (MCI), and to examine the cross-sectional relationships between these measures and cognition.

Methods

Actigraphy data were collected in 179 older individuals (mean age = 72.6 years) with normal cognition (n = 153) and MCI (n = 26). Sleep parameters (e.g. sleep efficiency), and standard nonparametric RARs (e.g. interdaily stability) were generated. Functional principal component analysis (fPCA) was used to generate three novel RAR metrics (fPC1, fPC2, and fPC3). Cognitive composite scores reflecting episodic memory and executive function were derived using factor analysis. Regression models compared sleep and RAR parameters between diagnostic groups and their association with cognitive performance.

Results

Compared to controls, the MCI group exhibited lower levels of the standard RAR parameter: relative amplitude and fPC3—a novel RAR whereby lower scores reflected a lower rhythm peak, as well as greater nighttime activity and less activity in the morning. Across groups, several standard RAR parameters (e.g. interdaily stability) and fPC3 were associated with better episodic memory and executive function performance. Additionally, several standard RAR measures (e.g. relative amplitude) and the novel RAR measure fPC1 (reflecting the total volume of activity and rhythm strength) were associated with better executive function performance.

Conclusions

Individuals with MCI have altered circadian RARs compared to controls, including the novel RAR metric fPC3, reflecting greater nighttime activity and less activity in the morning compared to mean values. Additionally, these measures are significantly associated with cognitive performance.
Full-Thickness Facial Pressure Injury and Buried Dentition from Prone Positioning in a Patient with COVID-19
Authors: Conlon Christopher , Slovacek Cedar , Jalalabadi Faryan , Winocour Sebastian , Olorunnipa Olushola
Published: April 2021

Prone positioning is recognized for its efficacy in the treatment of acute respiratory distress syndrome related to COVID-19. Here the authors present a case of a facial pressure injury and buried dentition that occurred as a result of prolonged prone positioning in a patient who was COVID-19 positive. The patient was treated with primary closure of the injury and pressure offloading.
Comparative Outcomes of Laparoscopic Gastrectomy and Open Gastrectomy for Scirrhous Gastric Cancer: A Multicenter Retrospective Cohort Study
Authors: Fujita Yusuke , Nishigori Tatsuto , Kadokawa Yoshio , Itami Atsushi , Kondo Masato , Hosogi Hisahiro , Kanaya Seiichiro , Kawada Hironori , Hata Hiroaki , Yamamoto Michihiro , Kinjo Yousuke , Tanaka Eiji , Manaka Dai , Satoh Seiji , Okabe Hiroshi , Tsunoda Shigeru , Sakaguchi Masazumi , Hisamori Shigeo , Hida Koya , Tanaka Shiro , Obama Kazutaka
Published: April 2021

Objective:

A multicenter retrospective cohort study was performed to compare the outcomes of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for scirrhous gastric cancer (GC) as a unique subtype also known as type 4 gastric cancer or linitis plastica.

Background:

Although data on the efficacy and safety of LG as an alternative to OG are emerging, the applicability of LG to scirrhous GC remains unclear.

Methods:

Patients with clinical type 4 GC undergoing gastrectomy at 13 hospitals from 2005 to 2015 were retrospectively reviewed. As the primary endpoint, we compared overall survival (OS) between the LG and OG groups. To adjust for confounding factors, we used multivariate Cox regression analysis for the main analyses and propensity-score matching for sensitivity analysis. Short-term outcomes and recurrence-free survival were also compared.

Results:

A total of 288 patients (LG, 62; OG, 226) were included in the main analysis. Postoperative complications occurred in 25.8% and 30.1%, respectively (P = 0.44). No significant difference in recurrence-free survival was observed (P = 0.72). The 5-year OS rates were 32.4% and 31.6% in the LG and OG groups, respectively (P = 0.60). The hazard ratio (LG/OG) for OS was 0.98 (95% confidence interval [CI], 0.65–1.43) in the multivariate regression analysis. In the sensitivity analyses after propensity-score matching, the hazard ratio for OS was 0.92 (95% CI, 0.58–1.45).

Conclusions:

Considering the hazard ratios and 95% CIs for OS, LG for scirrhous GC was not associated with worse survival than that for OG.
Perioperative Modifications to the Open TLIF Provide Comparable Short-term Outcomes to the MIS-TLIF
Authors: Berkman Richard A. , Wright Amanda H. , Khan Inamullah , Sivaganesan Ahilan
Published: April 2021

Study Design:

This study is a retrospective review of patients’ charts and data from longitudinally collected clinical outcomes and opioid use.

Objective:

In the current study, we aim to compare short-term outcomes data for 139 Open transforaminal interbody fusion (TLIF) patients to recently published data for tubular and endoscopic MIS-TLIF.

Background Context:

In response to the downsides associated with Open TLIF, such as large incision, blood loss, delayed ambulation, prolonged hospitalization, and opioid-reliance, spine surgeons developed tubular retractor based “minimally-invasive” TLIF. However, the traditional Open TLIF retains its significance in terms of providing successful fusion and improved patient-reported outcomes (PROs).

Methods:

We adapted several techniques with an aim to improve short-term outcomes for our Open TLIF patients that combined extensive perioperative counselling, an emphasis on early mobilization, avoidance of overuse of opioid analgesics, early discharge with home care arrangements, use of a posthospitalization drainage tube with intraoperative surgical modifications using small incisions (4–5 cm), a narrow 20 mm retractor, minimal muscle injury, and use of a cell saver to minimize net blood loss. The demographics and perioperative results were compared with data from recent MIS-TLIF studies using Student t test for continuous and χ2/exact test for categorical variables.

Results:

Among the total 139 patients, 115 underwent a single-level procedure, 90% of whom were discharged on the first postoperative day (length of stay=1.13±0.47 d) with an average net estimated blood loss of 176.17±87.88 mL. There were 24 two-level procedures with an average length of stay of 1.57±0.84 days, average net estimated blood loss was 216.96±85.70 mL. The patients had statistically significant improvements in PROs at 3 and 12 months.

Conclusions:

The results of this study identify that patients who underwent modified Open TLIF demonstrated favorable short-term outcomes, as compared with the tubular MIS-TLIF, by virtue of avoidance of blood transfusions, shorter hospital stays, and significantly less opioid usage while experiencing satisfactory PROs.
Iliac Screw Fixation Revisited
Authors: von Glinski Alexander , Elia Christopher J. , Wiginton James G. , Ansari Darius , Pierre Clifford , Ishak Basem , Yilmaz Emre , Blecher Ronen , Dettori Joseph R. , Hayman Erik , Schildhauer Thomas A. , Oskouian Rod J. , Chapman Jens R.
Published: April 2021

Study Design:

A retrospective study.

Objective:

To describe the modified iliac screw (mILS) technique and compare it to other spinopelvic fixation techniques in terms of wound healing complications, hardware prominence, and failure.

Summary of Background Data:

The traditional entry point of an iliac screw often causes postoperative gluteal pain from the prominent screw head. The use of an offset connector also adds a point of weakness to the construct. By choosing a different screw entry point offset connectors can be avoided, and the screw head itself is less prominent, thereby reducing postoperative discomfort.

Materials and Methods:

A retrospective analysis was performed of adult patients undergoing lumbopelvic fixation (LPF) between January 2014 and June 2019. Patients were grouped into 1 of 3 groups based on the technique of pelvic fixation: S2 alar-iliac (S2AI) screw, traditional iliac screw (tILS), and mILS. The primary outcome parameter was the minimal distance from screw head to skin. Secondary outcome parameters were instrumentation loosening/failure, adjacent level fractures, pseudoarthrosis, and medial or lateral iliac screw perforation.

Results:

A total of 190 patients undergoing LPF were included in the following 3 groups: mILS group (n=113), tILS group (n=40), and S2AI group (n=37). The mean minimal distance from screw head to skin in the mILS group was 31.3 mm compared with 23.7 mm in the tILS group (P<0.00199). No statistically significant differences were found when comparing the 3 groups with respect to complications. The mILS group did not show any cases of prominent instrumentation and had the lowest rate of instrumentation failure.

Conclusions:

The mILS technique is an acceptable alternative for LPF, offering the benefits of iliac screw fixation while avoiding offset connectors and screw prominence complications associated with tILS.

Level of Evidence:

Level III.
Fear Avoidance Beliefs and Outcome After Surgery for Degenerative Lumbar Spine
Authors: Knafo Steven , Apra Caroline , Eloy Gauthier , Guigui Pierre , Bouyer Benjamin
Published: April 2021

Study Design:

This was a prospective cohort study.

Objective:

The aim of this study is to question the influence of fear avoidance beliefs on functional outcome following surgery for degenerative lumbar spine.

Background:

Fear avoidance beliefs are well-studied modifiers of low back pain. Nonetheless, the influence of fear avoidance beliefs on the outcome of spinal surgery remains controversial.

Methods:

We conducted a prospective cohort study including patients undergoing surgery for degenerative lumbar discopathy, spondylolisthesis, and stenosis. Patients completed a preoperative questionnaire including the Fear Avoidance Beliefs Questionnaire (FABQ) as well as Visual Analog Scales for radicular and lumbar pain (VAS-R/L), Oswestry Disability Index (ODI), and Short-Form 36 health survey (SF36). Functional outcome was measured at least 6 months after surgery using ODI.

Results:

Sixty-three patients with a mean follow-up of 254 days (8.5 mo, minimum=179 d, maximum=534 d) were included in the study. Women showed stronger work-related fear avoidance beliefs but there was no other difference in baseline characteristics and functional outcome between patients with low or high (>75th percentile) baseline FABQ-P or FABQ-W scores. Individual variables associated with whether patients reached minimal clinically important difference for ODI were: working status [odds ratio (OR)=0.13; 95% confidence interval (95% CI), 0.03–0.62; P=0.01], American Society of Anesthesiologists classification score (OR=0.32; 95% CI, 0.11–0.92; P=0.03), preoperative duration of symptoms (OR=0.94; 95% CI, 0.89–0.99; P=0.03), and preoperative ODI (OR=1.03; 95% CI, 1.00–1.07; P=0.05). Neither physical nor work-related preoperative FABQ scores were predictors of functional results.

Conclusions:

In our study, the FABQ was not associated with functional outcome following surgery for degenerative lumbar spine. Other psychological patient-reported measures are needed to refine selection of patients undergoing spine surgery in order to ensure better outcomes.
Hydroxocobalamin in Refractory Septic Shock: A Retrospective Case Series
Authors: Sacco Alicia J. , Cunningham Cody A. , Kosiorek Heidi E. , Sen Ayan
Published: April 2021

Objectives:

Refractory septic shock is associated with high morbidity and mortality. Hydroxocobalamin is used to treat postoperative vasoplegia; however, data supporting its use in the setting of refractory septic shock is limited and restricted to case reports. This study evaluates the effect of hydroxocobalamin on mean arterial pressure and vasopressor requirements in a series of patients with refractory septic shock.

Design:

Single-center, retrospective analysis.

Setting:

Urban, tertiary-care ICU.

Patients:

Adult ICU patients with refractory septic shock treated with hydroxocobalamin between August 2018 and January 2020.

Interventions:

Hydroxocobalamin 5 g IV infusion.

MEASUREMENTS AND MAIN RESULTS:

Twenty-six patients were included for the analysis. Administration of hydroxocobalamin was associated with an increase in mean arterial pressure at 1, 6, and 24 hours postdose (+16.3, +14.3, and +16.3 mm Hg, respectively; p < 0.001). Increase in mean arterial pressure from baseline remained statistically significant when controlling for sex, age, and comorbid conditions. There was no change in the norepinephrine equivalents patients required 1 hour following hydroxocobalamin administration, but a statistically significant decrease in norepinephrine equivalent was observed at 6 and 24 hours postdose (p < 0.001).

Conclusions:

Hydroxocobalamin provides sustained hemodynamic benefit at 24 hours in patients with refractory septic shock.
Using Concept Unique Identifiers to Filter Electronic Health Records for Delirium Cases
Authors: Oosterhouse Kimberly J. , Young Cynthia D. , Desai Manushi , Birch Steven , Price Ron , Bobay Kathleen L.
Published: April 2021

Delirium, an acute mental status change associated with inattention, confusion, hypervigilance, or somnolence due to a medical cause, is considered a medical emergency. Unfortunately, screening and diagnosis of delirium in acute care are often inadequate. It is estimated that 60% of delirium cases are not identified, and in claims data, they are underreported. Using information technology, we investigated whether concept unique identifiers from the Unified Language Medical System Metathesaurus could be used as a method to filter electronic health records for possible delirium cases. This article provides the reader with an overview of delirium, the Unified Language Medical System Metathesaurus, and our method for retrospectively filtering electronic health records for delirium cases from our clinical research database. Using a retrospective observational approach, we randomly selected 150 electronic health records with narrative notes containing a delirium concept unique identifier. One hundred records were used for training and 50 were used for validation and interrater reliability. Our results validate electronic health record–selected concept unique identifiers and provide insights into their use. Refinement and application of this method on a larger scale can provide an initial filter for identifying patients with delirium from the electronic health record.
Attaining Quality Matters Certification for a Registered Nurse–Bachelor of Science in Nursing Program
Authors: Bryan Carol S. , Oberlander James F. , Reuille Kristi M. , Lewandowski Kelly Ann , Topp Robert , Grothaus Liz , Suh Sylvia M.
Published: April 2021

Increased demand for nurses and improved technology have increased the development and popularity of online education programs over the past two decades; however, the online format has revealed numerous pedagogical and implementation challenges. One primary challenge is the lack of structural design standards across all courses in the program. The lack of standardization is linked to decreased student outcomes, satisfaction, and retention. The Quality Matters course design rubric and program certification provide a methodical process to standardize the format of all courses in an online education program. The Quality Matters course rubric is designed to increase student and faculty engagement and reduce variability in course design. At the current university, the application of Quality Matters processes and standards was first trialed with a few individual courses. Following the trial, faculty and administration decided to begin the process of seeking Quality Matters certification for the entire registered nurse–bachelor of science in nursing program. This article describes the process of attaining Quality Matters program certification for an online registered nurse–bachelor of science in nursing program. The nursing process and the Human Performance Technology evaluation model were used as appraisal frameworks guiding this program's QM certification process.
Exploring Factors of Mobile Device Adoption in Nursing Education
Authors: Forehand Jeffery W. , Benson Angela D. , Chance Kasey D. , Armstrong Brittney
Published: April 2021

The world has seen an explosion in mobile device technology over the past decade, in addition to the impact that COVID-19 has placed on nursing education programs. More specifically, mobile devices have afforded users with endless possibilities. This upsurge in mobile technology has altered the way people use and interact with their device. One such example is how these devices are being utilized for the purposes of learning due to social distancing guidelines. Thus, it becomes important to explore and understand those factors that will influence the use of mobile devices for learning. The purpose of this study was to explore variables that might influence the adoption of mobile devices among nursing faculty. The Unified Theory of Acceptance and Use of Technology served as the theoretical basis for this study and guiding framework. An exploratory quantitative survey research design was utilized to explore specific variables and their impact on mobile device adoption among participants. It was found that 85%, six of the seven research variables were statistically significant predictors of mobile device adoption. Mobile devices have the potential to leverage a wealth of resources for both users and faculty. Therefore, recommendations for developing increased use of mobile device technology for teaching and learning will be suggested.
Surgical Margin Mapping of Melanoma In Situ Using In Vivo Reflectance Confocal Microscopy Mosaics
Authors: Durkin John R. , Tchanque-Fossuo Catherine N. , Rose Alexander N. , Elwood Hillary R. , Stepenaskie Shelly , Barbosa Naiara S.
Published: April 2021

BACKGROUND

Melanoma in situ (MIS) can have poorly defined borders and subclinical extension that makes margin control challenging. Reflectance confocal microscopy (RCM) is a promising noninvasive technique that can be used to assess subclinical spread.

OBJECTIVE

To optimize surgical margins of histology-proven MIS using RCM mosaics.

MATERIALS AND METHODS

Prospective review of 22 patients with histology-proven MIS who underwent RCM margin mapping prior to staged excision, between August 1, 2018, and August 13, 2020, at the Department of Dermatology, University of New Mexico, School of Medicine.

RESULTS

Twenty patients (91%) had tumor clearance on the first stage using a 3-mm surgical margin after confocal margin mapping.

CONCLUSION

Reflectance confocal microscopy margin mapping using the mosaic device tends to clear MIS in one stage, and the use of the handheld device may improve the accuracy for difficult anatomic areas. Current Procedural Terminology codes for RCM do not reflect the time required and complexity of the procedure. Reflectance confocal microscopy margin mapping prior to excision has the potential to decrease the number of stages needed for melanoma removal, reduce treatment time, and cost.
Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Primary School Age Children After Partial Reopening of Schools in England
Authors: Powell Annabel A. , Amin-Chowdhury Zahin , Mensah Anna , Ramsay Mary E. , Saliba Vanessa , Ladhani Shamez N.
Published: April 2021

In England, the easing of national lockdown in response to the coronavirus disease 2019 pandemic included the reopening of some primary school years on June 1, 2020. National surveillance did not identify any increase in the year groups attending school. Most children had a severe acute respiratory syndrome coronavirus 2 positive household contact. Hospitalizations for coronavirus disease 2019 were rare, but 2.7% (7/259) had persistent symptoms 1 month later.
Novel Treatment of Infant With COVID-19 With the Sialidase Fusion Protein, DAS181
Authors: Danziger-Isakov Lara , Khalil Nadim , Divanovic Allison , Frenck Robert , Grimley Michael , Iliopoulos Ilias , Marsh Rebecca , Paulsen Grant , Phillips Christine L. , Schulert Grant , Spearman Paul , Blum Samantha , Hui-Chin Ho Jennifer
Published: April 2021

We describe the successful treatment of a 10-month-old female with respiratory distress secondary to Coronavirus disease 2019 (COVID-19) with the nebulized investigational drug, DAS181. Therapy was well tolerated, and the patient had minimal side effects. The patient’s respiratory distress and positive viral polymerase chain reaction rapidly resolved after initiation of therapy.
Pragmatic trials of pain therapies: a systematic review of methods
Authors: Hohenschurz-Schmidt David , Kleykamp Bethea A. , Draper-Rodi Jerry , Vollert Jan , Chan Jessica , Ferguson McKenzie , McNicol Ewan , Phalip Jules , Evans Scott R. , Turk Dennis C. , Dworkin Robert H. , Rice Andrew S.C.
Published: April 2021

Pragmatic randomised clinical trials aim to directly inform clinical or health policy decision making. Here, we systematically review methods and design of pragmatic trials of pain therapies to examine methods, identify common challenges, and areas for improvement. Seven databases were searched for pragmatic randomised controlled clinical trials that assessed pain treatment in a clinical population of adults reporting pain. All screening steps and data extractions were performed twice. Data were synthesised descriptively, and correlation analyses between prespecified trial features and PRECIS-2 (PRagmatic–Explanatory Continuum Indicator Summary 2) ratings and attrition were performed. Protocol registration: PROSPERO-ID CRD42020178954. Of 57 included trials, only 21% assessed pharmacological interventions, the remainder physical, surgical, psychological, or self-management pain therapies. Three-quarters of the trials were comparative effectiveness designs, often conducted in multiple centres (median: 5; Q1/3: 1, 9.25) and with a median sample size of 234 patients at randomization (Q1/3: 135.5; 363.5). Although most trials recruited patients with chronic pain, reporting of pain duration was poor and not well described. Reporting was comprehensive for most general items, while often deficient for specific pragmatic aspects. Average ratings for pragmatism were highest for treatment adherence flexibility and clinical relevance of outcome measures. They were lowest for patient recruitment methods and extent of follow-up measurements and appointments. Current practice in pragmatic trials of pain treatments can be improved in areas such as patient recruitment and reporting of methods, analysis, and interpretation of data. These improvements will facilitate translatability to other real-world settings—the purpose of pragmatic trials.
Association between attentional bias to experimentally induced pain and to pain-related words in healthy individuals: the moderating role of interpretation bias
Authors: Broadbent Philippa , Schoth Daniel E. , Liossi Christina
Published: April 2021

Attentional bias to pain-related information may contribute to chronic pain maintenance. It is theoretically predicted that attentional bias to pain-related language derives from attentional bias to painful sensations; however, the complex interconnection between these types of attentional bias has not yet been tested. This study aimed to investigate the association between attentional bias to pain words and attentional bias to the location of pain, as well as the moderating role of pain-related interpretation bias in this association. Fifty-four healthy individuals performed a visual probe task with pain-related and neutral words, during which eye movements were tracked. In a subset of trials, participants were presented with a cold pain stimulus on one hand. Pain-related interpretation and memory biases were also assessed. Attentional bias to pain words and attentional bias to the pain location were not significantly correlated, although the association was significantly moderated by interpretation bias. A combination of pain-related interpretation bias and attentional bias to painful sensations was associated with avoidance of pain words. In addition, first fixation durations on pain words were longer when the pain word and cold pain stimulus were presented on the same side of the body, as compared to on opposite sides. This indicates that congruency between the locations of pain and pain-related information may strengthen attentional bias. Overall, these findings indicate that cognitive biases to pain-related information interact with cognitive biases to somatosensory information. The implications of these findings for attentional bias modification interventions are discussed.
Demographics, Preventive Services Compliance, Health, and Healthcare Experiences of Lesbian, Gay, and Bisexual Employed Adults
Authors: Burton Wayne N. , Schultz Alyssa B. , Quinn Colin
Published: April 2021

Objective:

This study examined demographics, health risks and conditions, preventive services, and health care experiences of lesbian, gay, bisexual, transgender, or questioning (LGBTQ) adults who are employed in the United States.

Methods:

Male and female gay, lesbian, or bisexual employees (N = 1191) from seven companies participated in an online survey.

Results:

Differences were observed in the characteristics of gays, lesbians, and bisexuals on a number of demographic, health, and preventive services measures. Differences were also seen compared to previous studies about LGBTQ adults in the general population.

Conclusions:

Employers have a vested interest in making sure their employees have access to quality health care that addresses their unique needs. There is much room for improvement in this area, since a large percentage of respondents reported negative health care experiences, avoiding or postponing care, and difficulty finding an LGBTQ-experienced healthcare provider.