bluuebunny/crossref_metadata_2025 huggingface dataset:
The Caucasus in Russian foreign policy strategy
Authors: Sushentsov Andrey , Neklyudov Nikita
Published: May 2020

The Caucasus has always been a formative region for Russian foreign policy-making. While the North Caucasus has retained its position as Russia’s most fragile and politically instable region, the South Caucasus provided the most pressing security challenges shaping Russian foreign policy since the early nineteenth century. In this article, we argue that the Caucasus comprises a distinct environment that exposes the underlying features of the Russian grand strategy, namely its propensity to hard power and balancing, and yet, at the same time, the fragility of Russia’s position within such a turbulent region. The historical strategic equation with Turkey and Iran has in recent decades been supplemented with a competitive Russia-NATO security dynamic in the Black sea. The threat of possible NATO enlargement in the South Caucasus forces Moscow to draw particular attention to the southern direction of its defences. The situation has become even more complicated with the onset of the Ukraine crisis and Russian engagement in Syria. Historical experience teaches Russia to cease any other foreign policy endeavours until the Caucasus is at peace or at least does not threaten a spill-over of instability. For now, this is a very distant prospect.
Ashamed and Alone—Risk Factors for Alcohol Craving Among Depressed Emerging Adults
Authors: Bilevicius Elena , Clark Courtney C , Johnson Edward A , Keough Matthew T
Published: May 2020

Aims

Comorbid alcohol use and depression have the highest prevalence among emerging adults and are associated with a number of consequences. Self-medication theory posits individuals with depression use alcohol to cope with their negative emotions. Preliminary work has investigated the social context of depression-related drinking and found that solitary drinking is a risky, atypical behaviour in emerging adulthood that is associated with alcohol misuse. However, it is unknown about what is unfolding in the moment that is driving depression-related drinking in solitary contexts. Accordingly, we used an experimental study to examine if shame mediated the association between depression and in-lab alcohol craving.

Methods

Emerging adults (N = 80) completed a shame induction followed by an alcohol cue exposure in either a solitary or social condition. We used moderated mediation to test hypotheses.

Results

Consistent with hypotheses, conditional indirect effects supported the mediation of depression and alcohol craving through shame among those in the solitary condition, but not in the social condition. There was no support for guilt as a mediator.

Conclusion

Our study demonstrates that shame is a specific emotional experience that contributes to solitary drinking among depressed emerging adults. It is important to use these results to inform interventions that directly target solitary contexts and shame.
Acorn woodpeckers vocally discriminate current and former group members from nongroup members
Authors: Pardo Michael A , Hayes Casey E , Walters Eric L , Koenig Walter D
Published: May 2020

In species with long-term social relationships, the ability to recognize individuals after extended separation and the ability to discriminate between former social affiliates that have died and those that have left the group but may return are likely to be beneficial. Few studies, however, have investigated whether animals can make these discriminations. We presented acorn woodpeckers (Melanerpes formicivorus), a group-living, cooperatively breeding bird, with playbacks of current group members, former group members still living nearby, former group members that had died or left the study area, and familiar nongroup members. Subjects responded more quickly to the calls of nongroup members than to the calls of current group members or former group members still living in the study area but did not discriminate between nongroup members and former group members that had died or disappeared. This suggests that acorn woodpeckers can vocally recognize both current group members and former group members that have dispersed to nearby groups and that they either forget former group members that no longer live in the vicinity or classify them differently from former group members that still live nearby. This study suggests an important role for vocal recognition in maintaining valuable relationships with social affiliates postdispersal.
The Role of Education in Developing Students’ Professional Resilience for Social Work Practice: A Systematic Scoping Review
Authors: Hitchcock Clarissa , Hughes Mark , McPherson Lynne , Whitaker Louise
Published: May 2020

Social work practitioners are called on to be resilient in an increasingly complex and challenging human service environment. This study presents the results of a systematic scoping review aimed at understanding the role of social work education in developing students’ professional resilience in preparation for their future social work practice. The application of a comprehensive search strategy resulted in the inclusion of thirty-two articles, published between 2008 and 2018. A descriptive thematic analysis highlighted the political and contextual influences on this recent and emerging body of literature, together with three key themes. These themes centred around education building resilience through screening social work applicants, targeted knowledge provision and inclusive educational processes. The findings draw attention to the emphasis on social workers being individually responsible and accountable for their professional resilience, with this potentially reinforced and facilitated through education processes. The findings identify the need for future research to investigate environmental influences on social workers’ resilience, including how educators support students to understand and shape them.
Arthroscopic superior capsular reconstruction versus latissimus dorsi transfer for irreparable rotator cuff lesions: a systematic review
Authors: Osti Leonardo , Milani Lorenzo , Gerace Emanuele , Padovani Sara , Massari Leo , Maffulli Nicola
Published: May 2020

Introduction

The present systematic review compared arthroscopic superior capsular reconstruction (ASCR) and latissimus dorsi transfer (ALDT) for the management of massive irreparable rotator cuff lesions.

Sources of data

We performed a systematic review searching the literature on Medline, Cochrane and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Areas of agreement

We included a total of 20 articles, 10 on ASCR and 10 on ALDT (12 retrospective and 8 prospective studies), all published between 2013 and 2019.

Areas of controversy

ASCR and ALDT are technical demanding procedures. When compared to each other, they do not produce significantly different improvements in clinical outcome.

Growing points

Both ASCR and ALDT are valid options for surgical management of MIRCLs. Although ALDT has shown a greater complication rate and a less improvement in acromion-humeral distance, its clinical outcomes overlap those obtained with ASCR.

Areas timely for developing research

Further comparative prospective and retrospective studies with longer follow-up could confirm which surgical procedure can lead to better outcomes with a lower complication rate.
Christian Bioethics: Immanent Goals or a Transcendent Orientation?
Authors: Cherry Mark J
Published: May 2020

This issue of Christian Bioethics explores foundational debates regarding the orientation and application of Christian bioethics. Should Christian bioethics be approached as essentially a human activity, grounded in scholarly study of theological arguments and religious virtues, oriented toward practical social ends, or should Christian bioethics be recognized as the result of properly oriented prayer, fasting, and asceticism leading to an encounter with God? The gulf between these two general perspectives—the creation of immanent human goods versus submission to a fully transcendent God—is significant and, as ongoing debate in Christian Bioethics: Non-Ecumenical Studies in Medical Morality over the past nearly three decades has made clear, the implications are both intellectually engaging and spiritually profound.
Asymptomatic Transmission During the Coronavirus Disease 2019 Pandemic and Implications for Public Health Strategies
Authors: Huff Hanalise V , Singh Avantika
Published: May 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly in a few months despite global public health strategies to curb transmission by testing symptomatic patients and social distancing. This review summarizes evidence that highlights transmission by asymptomatic and presymptomatic individuals. Viral load of asymptomatic and symptomatic cases is comparable. Viral shedding is highest before symptom onset, suggesting high transmissibility before symptoms. Within universally tested subgroups, high percentages of SARS-CoV-2 infected asymptomatic individuals were found. Asymptomatic transmission was reported in several clusters, including a Wuhan study showing an alarming rate of intrahospital transmission. Several countries reported higher prevalence among healthcare workers than general population raising concern that healthcare workers could act as silent vectors. Therefore, current strategies that rely solely on “symptom onset” for infection identification need urgent reassessment. Extensive universal testing irrespective of symptoms may be considered, with priority placed on groups with high frequency exposure to positive patients.
Metatranscriptomic Characterization of Coronavirus Disease 2019 Identified a Host Transcriptional Classifier Associated With Immune Signaling
Authors: Zhang Haocheng , Ai Jing-Wen , Yang Wenjiao , Zhou Xian , He Fusheng , Xie Shumei , Zeng Weiqi , Li Yang , Yu Yiqi , Gou Xuejing , Li Yongjun , Wang Xiaorui , Su Hang , Zhu Zhaoqin , Xu Teng , Zhang Wenhong
Published: May 2020

Background

The recent identification of a novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2, has caused a global outbreak of respiratory illnesses. The rapidly developing pandemic has posed great challenges to diagnosis of this novel infection. However, little is known about the metatranscriptomic characteristics of patients with coronavirus disease 2019 (COVID-19).

Methods

We analyzed metatranscriptomics in 187 patients (62 cases with COVID-19 and 125 with non–COVID-19 pneumonia). Transcriptional aspects of 3 core elements, pathogens, the microbiome, and host responses, were evaluated. Based on the host transcriptional signature, we built a host gene classifier and examined its potential for diagnosing COVID-19 and indicating disease severity.

Results

The airway microbiome in COVID-19 patients had reduced alpha diversity, with 18 taxa of differential abundance. Potentially pathogenic microbes were also detected in 47% of the COVID-19 cases, 58% of which were respiratory viruses. Host gene analysis revealed a transcriptional signature of 36 differentially expressed genes significantly associated with immune pathways, such as cytokine signaling. The host gene classifier built on such a signature exhibited the potential for diagnosing COVID-19 (area under the curve of 0.75–0.89) and indicating disease severity.

Conclusions

Compared with those with non–COVID-19 pneumonias, COVID-19 patients appeared to have a more disrupted airway microbiome with frequent potential concurrent infections and a special trigger host immune response in certain pathways, such as interferon-gamma signaling. The immune-associated host transcriptional signatures of COVID-19 hold promise as a tool for improving COVID-19 diagnosis and indicating disease severity.
LSTUR regression theory and the instability of the sample correlation coefficient between financial return indices
Authors: Ginker Tim , Lieberman Offer
Published: May 2020

It is well known that the sample correlation coefficient between many financial return indices exhibits substantial variation on any reasonable sampling window. This stylised fact contradicts a unit root model for the underlying processes in levels, as the statistic converges in probability to a constant under this modeling scheme. In this paper, we establish asymptotic theory for regression in local stochastic unit root (LSTUR) variables. An empirical application reveals that the new theory explains very well the instability, in both sign and scale, of the sample correlation coefficient between gold, oil, and stock return price indices. In addition, we establish spurious regression theory for LSTUR variables, which generalises the results known hitherto, as well as a theory for balanced regression in this setting.
Whole-exome sequencing of a large Chinese azoospermia and severe oligospermia cohort identifies novel infertility causative variants and genes
Authors: Chen Shitao , Wang Guishuan , Zheng Xiaoguo , Ge Shunna , Dai Yubing , Ping Ping , Chen Xiangfeng , Liu Guihua , Zhang Jing , Yang Yang , Zhang Xinzong , Zhong An , Zhu Yongtong , Chu Qingjun , Huang Yonghan , Zhang Yong , Shen Changli , Yuan Yiming , Yuan Qilong , Pei Xiuying , Cheng C Yan , Sun Fei
Published: May 2020

Rare coding variants have been proven to be one of the significant factors contributing to spermatogenic failure in patients with non-obstructive azoospermia (NOA) and severe oligospermia (SO). To delineate the molecular characteristics of idiopathic NOA and SO, we performed whole-exome sequencing of 314 unrelated patients of Chinese Han origin and verified our findings by comparing to 400 fertile controls. We detected six pathogenic/likely pathogenic variants and four variants of unknown significance, in genes known to cause NOA/SO, and 9 of which had not been earlier reported. Additionally, we identified 20 novel NOA candidate genes affecting 25 patients. Among them, five (BRDT, CHD5, MCM9, MLH3 and ZFX) were considered as strong candidates based on the evidence obtained from murine functional studies and human single-cell (sc)RNA-sequencing data. These genetic findings provide insight into the aetiology of human NOA/SO and pave the way for further functional analysis and molecular diagnosis of male infertility.
Resilience of clinical text de-identified with “hiding in plain sight” to hostile reidentification attacks by human readers
Authors: Carrell David S , Malin Bradley A , Cronkite David J , Aberdeen John S , Clark Cheryl , Li Muqun (Rachel) , Bastakoty Dikshya , Nyemba Steve , Hirschman Lynette
Published: May 2020

Objective

Effective, scalable de-identification of personally identifying information (PII) for information-rich clinical text is critical to support secondary use, but no method is 100% effective. The hiding-in-plain-sight (HIPS) approach attempts to solve this “residual PII problem.” HIPS replaces PII tagged by a de-identification system with realistic but fictitious (resynthesized) content, making it harder to detect remaining unredacted PII.

Materials and Methods

Using 2000 representative clinical documents from 2 healthcare settings (4000 total), we used a novel method to generate 2 de-identified 100-document corpora (200 documents total) in which PII tagged by a typical automated machine-learned tagger was replaced by HIPS-resynthesized content. Four readers conducted aggressive reidentification attacks to isolate leaked PII: 2 readers from within the originating institution and 2 external readers.

Results

Overall, mean recall of leaked PII was 26.8% and mean precision was 37.2%. Mean recall was 9% (mean precision = 37%) for patient ages, 32% (mean precision = 26%) for dates, 25% (mean precision = 37%) for doctor names, 45% (mean precision = 55%) for organization names, and 23% (mean precision = 57%) for patient names. Recall was 32% (precision = 40%) for internal and 22% (precision =33%) for external readers.

Discussion and Conclusions

Approximately 70% of leaked PII “hiding” in a corpus de-identified with HIPS resynthesis is resilient to detection by human readers in a realistic, aggressive reidentification attack scenario—more than double the rate reported in previous studies but less than the rate reported for an attack assisted by machine learning methods.
Siliplant1 protein precipitates silica in sorghum silica cells
Authors: Kumar Santosh , Adiram-Filiba Nurit , Blum Shula , Sanchez-Lopez Javier Arturo , Tzfadia Oren , Omid Ayelet , Volpin Hanne , Heifetz Yael , Goobes Gil , Elbaum Rivka
Published: May 2020

Silicon is absorbed by plant roots as silicic acid. The acid moves with the transpiration stream to the shoot, and mineralizes as silica. In grasses, leaf epidermal cells called silica cells deposit silica in most of their volume using an unknown biological factor. Using bioinformatics tools, we identified a previously uncharacterized protein in Sorghum bicolor, which we named Siliplant1 (Slp1). Slp1 is a basic protein with seven repeat units rich in proline, lysine, and glutamic acid. We found Slp1 RNA in sorghum immature leaf and immature inflorescence. In leaves, transcription was highest just before the active silicification zone (ASZ). There, Slp1 was localized specifically to developing silica cells, packed inside vesicles and scattered throughout the cytoplasm or near the cell boundary. These vesicles fused with the membrane, releasing their content in the apoplastic space. A short peptide that is repeated five times in Slp1 precipitated silica in vitro at a biologically relevant silicic acid concentration. Transient overexpression of Slp1 in sorghum resulted in ectopic silica deposition in all leaf epidermal cell types. Our results show that Slp1 precipitates silica in sorghum silica cells.
TFII-I-mediated polymerase pausing antagonizes GLI2 induction by TGFβ
Authors: McCleary-Wheeler Angela L , Paradise Brooke D , Almada Luciana L , Carlson Annika J , Marks David L , Vrabel Anne , Vera Renzo E , Sigafoos Ashley N , Olson Rachel L , Fernandez-Zapico Martin E
Published: May 2020

The modulation of GLI2, an oncogenic transcription factor commonly upregulated in cancer, is in many cases not due to genetic defects, suggesting dysregulation through alternative mechanisms. The identity of these molecular events remains for the most part unknown. Here, we identified TFII-I as a novel repressor of GLI2 expression. Mapping experiments suggest that the INR region of the GLI2 promoter is necessary for GLI2 repression. ChIP studies showed that TFII-I binds to this INR. TFII-I knockdown decreased the binding of NELF-A, a component of the promoter–proximal pausing complex at this site, and enriched phosphorylated RNAPII serine 2 in the GLI2 gene body. Immunoprecipitation studies demonstrate TFII-I interaction with SPT5, another pausing complex component. TFII-I overexpression antagonized GLI2 induction by TGFβ, a known activator of GLI2 in cancer cells. TGFβ reduced endogenous TFII-I binding to the INR and increased RNAPII SerP2 in the gene body. We demonstrate that this regulatory mechanism is not exclusive of GLI2. TGFβ-induced genes CCR7, TGFβ1 and EGR3 showed similar decreased TFII-I and NELF-A INR binding and increased RNAPII SerP2 in the gene body post-TGFβ treatment. Together these results identify TFII-I as a novel repressor of a subset of TGFβ-responsive genes through the regulation of RNAPII pausing.
Postoperative hemorrhage secondary to acquired hemophilia A
Authors: Asher Zachary P. , Buckner Tyler W. , McIntyre Robert C.
Published: May 2020

Acquired hemophilia A in postoperative patients can cause major bleeding and an accurate diagnosis is required for effective treatment. Standard treatment is costly, difficult to obtain, and takes 4 to 6 weeks to be effective. This article describes a patient successfully treated with recombinant factor VIIa, porcine factor VIII, plasmapheresis, rituximab, and high-dose corticosteroids.
Amyotrophic lateral sclerosis
Authors: Vacca Vincent M.
Published: May 2020

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disease that is always fatal, although treatment can help slow disease progression. This article discusses the etiology and pathophysiology, signs and symptoms, diagnosis, and clinical management of ALS, with special nursing considerations to help patients at the end of life.
Empowering nurses to activate the rapid response team
Authors: Granitto Margaret , Linenfelser Paula , Hursey Ryan , Parsons Megan , Norton Colleen
Published: May 2020

All clinical nurses need to be prepared to recognize deterioration in a patient's clinical status and activate the rapid response team when appropriate. This article explores the clinical nurse's role in recognizing and responding to deterioration in a patient's condition with a focus on hospital-based nurses practicing on a medical-surgical unit.
Relationship Between Alcohol-related Family Adversity, Alcohol Use Across Adolescence, and Mental States Recognition in Young Adulthood
Authors: Kopera Maciej , Trucco Elisa M. , Jakubczyk Andrzej , Suszek Hubert , Kobyliński Paweł , Wojnar Marcin , Zucker Robert A.
Published: May 2020

Objectives:

Although a theoretical link between childhood adversity and mental states recognition has been established, empirical findings are mixed. Some prior work indicates that childhood adversity might enhance, preserve, or reduce mentalization skills in selected at-risk populations. In the current study, we examine whether the presence of risky alcohol use during adolescence moderates the association between childhood alcohol-related family adversity and mental states recognition in young adulthood.

Methods:

Secondary data analysis was conducted on 266 young adults who participated in the Michigan Longitudinal Study—a multiwave prospective study on at-risk youth. Children were assessed after initial recruitment (wave 1, target child age range 3–5 years), with assessments repeated every 3 years using parallel measures. The current study focuses on data spanning wave 2 (age range 7–9 years) through wave 6 (target child age range 18–21 years). A family adversity index was derived reflecting exposure to a maladaptive family environment during childhood as assessed at wave 1. An alcohol use risk factor was established reflecting early problem alcohol use during adolescence (target child age range 12–17 years). Mental states recognition was measured with a computerized version of the Reading the Mind in the Eyes Task (RMET) at wave 6. Information about demographics, psychopathological symptoms, and IQ was obtained. The alcohol use risk factor was tested as a potential moderator of the association between childhood family adversity on RMET performance during young adulthood.

Results:

Alcohol use risk moderated the relationship between childhood alcohol-related family adversity, and negative and neutral mental states recognition. Specifically, childhood family adversity was positively associated with neutral mental states recognition among participants high in alcohol risk (P = 0.03) and positively associated with negative mental states recognition among participants at average (P = 0.02) and high (P = 0.002) levels of alcohol risk.

Conclusions:

Findings indicate that history of childhood adversity may actually improve young adult negative and neutral mental states recognition among those demonstrating high levels of risky alcohol use, as substance use may serve as an external self-regulatory tool. Clinical interventions that target enhancing metacognitive competence and emotion regulation could ultimately help to break the cycle of alcohol-related family adversity.
Appropriate Use Criteria for Treatment of Pediatric Supracondylar Humerus Fractures With Vascular Injury: Do Our Hospital Practice Patterns Agree With Current Recommendations?
Authors: Brandt Aaron M. , Wally Meghan K. , Casey Virginia F. , Clark Christian C. , Paloski Michael D. , Scannell Brian P. , Brighton Brian K.
Published: May 2020

Background:

Managing the pulseless pediatric supracondylar humerus fracture (PSHF) remains a significant clinical decision-making challenge for the treating surgeon. The purpose of the study is to determine frequency of the treatments according to the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC) for the PSHF with vascular injury and evaluate the appropriateness of these interventions.

Methods:

We identified all PSHF with concern for vascular injury at one high volume, level 1 trauma center managed by 6 fellowship-trained pediatric orthopaedic surgeons over 4.5 years. Demographic information and other injury and treatment variables were obtained. Each patient was classified as 1 of the 6 patient scenarios specified by the AAOS AUC. Each of the 18 interventions identified in the AUC were documented, including the level of “appropriateness” as specified by AAOS AUC.

Results:

A total of 638 PSHF were managed identified; of these, 52 were pink, pulseless, or dysvascular (8.2%). Only 7 of the 18 treatment options suggested by the AUC were used in this cohort. Across all 7 interventions used in this cohort, 20.2% (17/84) of interventions were “appropriate,” 52.4% (44/84) were “maybe appropriate,” 22.6% (19/84) were “rarely appropriate,” and 4.8% (4/84) were not listed in treatment options.

Conclusions:

Supracondylar fractures are the most common injury to the elbow seen in children and are variable in presentation and management. The pink, pulseless fracture continues to be a major topic for research and discussion due to the morbidity if not treated “appropriately.” The AUC were created to help guide practitioners when strong evidence is lacking. In this study at a single, pediatric hospital, there was variation and disagreement with “appropriateness” of treatments that were performed but this discrepancy did not result in any poor outcomes. Although the AUC do offer valuable guidance, our findings highlight a need for continued research in this area to help validate the AUC and help strengthen the recommendations moving forward.

Level of Evidence:

Level III—retrospective.
Trends in Reoperation for Surgical Site Infection After Spinal Surgery With Instrumentation in a Multicenter Study
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ando Kei , Nakashima Hiroaki , Kato Fumihiko , Sato Koji , Kanemura Tokumi , Matsubara Yuji , Yoshihara Hisatake , Hirasawa Atsuhiko , Deguchi Masao , Shinjo Ryuichi , Sakai Yoshihito , Inoue Hidenori , Ishiguro Naoki
Published: May 2020

Study Design.

A multicenter retrospective analysis of a prospectively maintained database.

Objective.

To examine the characteristics of reoperation for surgical site infection (SSI) after spinal instrumentation surgery, including the efficacy of treatment for SSI and instrumentation retention.

Summary of Background Data.

Aging of the population and advances in surgical techniques have increased the demand for spinal surgery in elderly patients. Treatment of SSI after this surgery has the main goals of eliminating infection and retaining instrumentation.

Methods.

The subjects were 16,707 patients who underwent spine surgery with instrumentation in 11 hospitals affiliated with the Nagoya Spine Group from 2004 to 2015. Details of those requiring reoperations for SSI were obtained from surgical records at each hospital.

Results.

There were significant increases in the mean age at the time of surgery (54.6–63.7 years) and the number of instrumentation surgeries (726–1977) from 2004 to 2015. The incidence of reoperation for SSI varied from 0.9% to 1.8%, with a decreasing trend over time. Reoperation for SSI was performed in 206 cases (115 men, 91 women; mean age 63.2 years). The average number of reoperations (1.4 vs. 2.3, P < 0.05), time from SSI to first reoperation (4.3 vs. 9.5 days, P < 0.05), and the methicillin-resistant Staphylococcus identification rate (20% vs. 37%, P < 0.01) were all significantly lower in cases with instrumentation retention (n = 145) compared to those with instrumentation removal (n = 61).

Conclusion.

There were marked trends of aging of patients and an increase in operations over the study period; however, the incidences of reoperation and instrumentation removal due to SSI significantly decreased over the same period. Rapid debridement after SSI diagnosis may have contributed to instrumentation retention. These results can serve as a guide for developing strategies for SSI treatment and for improved planning of spine surgery in an aging society.

Level of Evidence: 3
Prevalence of Occult Infections in Posterior Instrumented Spinal Fusion
Authors: Callanan Tucker C. , Abjornson Celeste , DiCarlo Edward , Henry Michael , Sama Andrew A. , Girardi Federico P. , Schroeder Josh , Kiely Paul , Lebl Darren R. , Cammisa Frank P.
Published: May 2020

Study Design:

This is a prospective observational study.

Objective:

The aim of this study is to determine the rate of occult infection after instrumented spine surgery in presumed aseptic patients.

Summary of Background Data:

The reported incidence rate of delayed/occult infection determined by positive culture swabs after instrumented spine surgery in prospective studies is 0.2%–6.9%. However, this rate may be higher as delayed infections are challenging to diagnose. Fever can be absent and inflammatory markers are often normal. If indolent organisms exist in low concentrations surrounding the instrumentation, these organisms can possibly avoid detection and disrupt bone formation leading to instrumentation loosening, pain generation, and/or failure of a solid fusion.

Materials and Methods:

This study included 50 consecutive presumed aseptic patients undergoing a posterior revision requiring removal of instrumentation at least 6 months following their index procedure. Common markers of infection were examined preoperatively. Multiple culture swabs were taken directly from the removed instrumentation and cultured for 14 days.

Results:

Of the 50 patients, 19 (38%) were culture-positive (CP) for bacteria upon removal of their instrumentation, with 14 patients (28%) having ≥2 positive specimens of the same organism. The average length of time between the index procedure and the revision surgery was 4.55 years (range: 0.53–21 y). Polymicrobial infections were found in 26% (5/19) of CP patients. The most prevalent microorganism found was Propionibacterium acnes, in 63% (12/19) of CP patients. There was no significant difference between CP and culture-negative patients regarding preoperative markers for infection, age, or length between index and revision procedures.

Conclusions:

The results of this study indicate a positive culture rate of 38% in presumed aseptic patients who had previously undergone instrumented spine surgery. These results are consistent with other retrospective studies and are >6 times greater than any previous prospective study utilizing culture swabs.

Level of Evidence:

Level-III.
Transpsoas Lumbar Interbody Fusion Without Psoas Stimulated Electromyography
Authors: Patel Shyam A. , Goyal Dhruv K.C. , Reid Daniel , Patel Ram , Babu Jacob , Fereydonyan Naderafshar , Anderson David Greg
Published: May 2020

Study Design:

This is a retrospective case review.

Objective:

The objective of this study was to present an anatomic approach to transpsoas interbody fusion without psoas stimulated electromyography (sEMG) and to evaluate the rate of neurological and approach-related complications.

Background:

The transpsoas approaches have become commonly utilized for lumbar interbody fusion and may have certain advantages compared with other methods of interbody stabilization. Traditionally, transpsoas approaches have been performed utilizing sEMG as it has been purported to reduce the risk of injury to the lumbar plexus; however, an anatomic approach to transpsoas surgery is also possible as cadaveric studies have demonstrated the anatomy of the psoas muscle and lumbar plexus.

Methods:

Patients who underwent transpsoas interbody fusion using an anatomic approach without psoas sEMG between 2005 and 2018 were enrolled in this study. The preoperative and postoperative medical records for this cohort were carefully reviewed to identify any new or persistent radicular symptoms, neurological deficits or approach-related complications.

Results:

A total of 133 patients (48 males, 85 females) underwent transpsoas interbody fusion at 222 levels in this cohort—which had a mean age of 63 (61, 65) years and body mass index of 28.8 (27.8, 29.9). New neurological complications were seen in 5 patients (3.8%) and 5 patients (3.8%) were found to have new postoperative radicular pain, up to 3 months postoperatively. The total number of perioperative, approach-related complications was 7 (5.3%) for the entire cohort.

Conclusion:

An anatomic transpsoas approach to the interbody space without psoas sEMG demonstrated a rate of neurological and approach-related complications that was comparable or superior to the rate of complications reported using the traditional transpsoas approach with sEMG.
Economic Impact of Proximal Junctional Kyphosis
Authors: Theologis Alekos A. , Gussous Yazeed M. , Berven Sigurd H.
Published: May 2020

Proximal junctional kyphosis (PJK) is a common occurrence after posterior thoracolumbar instrumented spinal fusions for adult spinal deformity (ASD). Despite its relative frequency, PJK’s economic impact has only recently gained appreciation and attention. On the basis of the available literature, direct costs associated with revision surgery for PJK range from ∼$20,000 to $120,000. The average direct costs for revision operations for PJK in the lower thoracic spine are similar to the costs for revision operations for PJK in the upper thoracic spine. Variability in costs may be attributable to variations in surgical strategies and individual hospital’s postoperative care protocols and pricing. In the discussion to follow, the economic impact of PJK after operative intervention for ASD will be showcased by presenting it in the larger context of our health care system’s focus on value-based care, the health burden of ASD, and quality and costs associated with ASD operations.
Cabozantinib as an emerging treatment for sarcoma
Authors: Schöffski Patrick , Blay Jean-Yves , Ray-Coquard Isabelle
Published: May 2020

Purpose of review

Sarcomas are a diverse group of rare solid tumors with limited treatment options for patients with advanced, inoperable disease. Cabozantinib is a tyrosine kinase inhibitor currently approved for advanced renal cell, hepatocellular, and medullary thyroid carcinoma. Cabozantinib has potent activity against a variety of kinases, including MET, vascular endothelial growth factor receptor, and AXL, that are associated with sarcoma growth and development. Here we review the preclinical findings and clinical development of cabozantinib in the treatment of soft tissue sarcoma, gastrointestinal stromal tumors (GIST), osteosarcoma, and Ewing sarcoma.

Recent findings

In vitro, cabozantinib has shown relevant activity in inhibiting the growth and viability of soft tissue sarcoma, GIST, osteosarcoma, and Ewing sarcoma tumor cell lines. Cabozantinib also promoted the regression of GIST in various murine xenografts, including imatinib-resistant models. More than 10 prospective trials with cabozantinib that included patients with sarcomas have been completed or are currently ongoing. Clinical activity with cabozantinib has been recently reported in phase 2 clinical trials for patients with GIST and for patients with osteosarcoma or Ewing sarcoma.

Cabozantinib has shown promising activity for the treatment of various sarcomas, supporting further evaluation in this setting.
Bleb Plication for a Leaking Bleb After Trabeculectomy
Authors: Sugimoto Koichiro , Asano-Shimizu Kimiko , Murata Hiroshi , Yamashita Takehiro , Asaoka Ryo
Published: May 2020

Purpose:

The purpose of this work was to report a new method for the repair of ischemic bleb leaks. Bleb leakage is a serious complication of glaucoma filtering surgery with mitomycin C. Many surgical methods have been proposed to seal the leakage from a bleb; however, this novel plication method is effective, relatively easy to perform, and safe.

Methods:

We describe the case reports of 2 patients with leakage from a bleb who were treated with the new method. The conjunctiva was lifted away from the sclera as extensively as possible around the ischemic conjunctiva toward the fornix using a bleb knife. Thereafter, 10-0 nylon sutures were applied between the nonischemic conjunctiva located just outside the ischemic conjunctiva and the corneal limbus. The ischemic conjunctiva was not removed, but covered with the nonischemic conjunctiva that was advanced toward the corneal limbus by these sutures.

Results:

After treatment, no recurrence of bleb leakage was observed. Moreover, no ischemic changes were observed in the advanced nonischemic conjunctiva or plicated conjunctiva.

Conclusion:

This new method of bleb plication was effective for sealing bleb leakage.
High Burden of Serious Bacterial Infections in African Children Treated for Cancer
Authors: Naidu Gita , Izu Alane , Poyiadjis Stelios , MacKinnon Diane , Rowe Biance , Madhi Shabir Ahmed
Published: May 2020

Background:

Infections in children treated for cancer contribute to morbidity and mortality. There is a paucity of studies on the incidence, etiology, risk factors and outcome of bacterial infections in African children treated for cancer. The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in children with cancer.

Methods:

The study enrolled children 1–19 years old with cancer and infections. Children were investigated for infection as part of standard of care.

Results:

One hundred sixty-nine children were enrolled, 82 with hematologic malignancies and 87 with solid tumors and 10.7% were HIV infected. The incidence (per 100 child-years) of septic episodes (101) microbiologically confirmed (70.9) septic episodes, Gram-positive (48.5) and Gram-negative (37.6) sepsis was higher in children with hematologic malignancies than in those with solid tumors. The most common Gram-positive bacteria were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium, while the most common Gram-negative bacteria were Escherichia coli, Acinetobacter baumannii and Pseudomonas species. The C-reactive protein and procalcitonin was higher in microbiologically confirmed sepsis. The case fatality risk was 40.4%; 80% attributed to sepsis. The odds of dying from sepsis were higher in children with profound [adjusted odds ratio (aOR) = 3.96; P = 0.004] or prolonged neutropenia (aOR = 3.71; P = 0.011) and profound lymphopenia (aOR = 4.09; P = 0.003) and independently associated with pneumonia (53.85% vs. 29.23%; aOR = 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR = 4.3; P = 0.005).

Conclusion:

The study emphasizes the high burden of sepsis in African children treated for cancer and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.
Research Informing Practice in Early Childhood Intervention
Authors: Kemp Coral
Published: May 2020

The adoption of interventions for infants and young children with disabilities/delays or at risk of disability/delay is likely to be influenced by sources other than research evidence. Where the available research evidence does influence the choice of intervention, there may be difficulties translating research that has been implemented in a controlled environment to an intervention that can be successfully applied in natural settings. Such settings include the family home as well as early childhood education and care centers. Incentives for the use of evidence-based interventions in early intervention settings include improved outcomes for infants and young children, service credibility, and program accountability. Barriers to using evidence-based practice (EBP) in natural settings include difficulties with identifying EBP and in reliably implementing evidence-based interventions. Lack of quality professional training and absence of support from competent coaches/mentors can also compromise the adoption and effective implementation of EBP. Collaborative partnerships between researchers and practitioners, where the goals of both parties have equal value, may assist with bridging the research-to-practice gap. Incentives, barriers, and opportunities are explored in this article.
Endobronchial Valve Placement for Persistent Air Leaks Secondary to Pulmonary Infections
Authors: Flora Arjan S. , Aragaki-Nakahodo Alejandro , Benzaquen Sadia
Published: May 2020

Background:

Pneumothoraces associated with infectious diseases have a higher rate of treatment failure and longer length of hospital stay than those associated with obstructive lung diseases and malignancy. Little is mentioned in the medical literature concerning the use of endobronchial 1-way valves in treating alveolar-pleural fistulae (APF) caused by pulmonary infections.

Methods:

A 7-year, single-center, retrospective analysis of patients consented for exempted off-label use of the Olympus Spiration Implantable Endobronchial Valve system to control prolonged air leaks at the University of Cincinnati Medical Center.

Results:

Nineteen consecutive patients had 22 separate APF events from pulmonary infections during which a total of 101 valves were placed over 23 procedures (average 4.4±2.8 valves per procedure). The average time from the first chest tube placement to valve placement was 23.4±20.8 days (range, 2 to 84 d). Chest tubes were successfully removed in 19 (86.4%) of 22 APF events without further intervention. In events not including chest tubes remaining solely for empyema treatment after cessation of air leak (n=14), the average time from valve placement to the removal of all chest tubes was 12.8±20.2 days (1 to 81 d). Thirty and ninety day all-cause mortality was 15.8%. On average, valves were removed 64.1±27.1 days (range, 38 to 135 d) after placement.

Conclusion:

Based on our institutional experience, endobronchial valves may be a treatment option for select patients with persistent air leaks caused by pulmonary infections. Further standardized and comparative studies are required to fully understand the risks and benefits of this treatment.
Temporal trends in management and outcome of patients with acute coronary syndrome according to admission low-density lipoprotein cholesterol levels
Authors: Shuvy Mony , Peretz Alona , Gotsman Israel , Vorobeichik Dina , Shlomo Nir , Minha Saar , Pereg David
Published: May 2020

Background

The importance of differences in baseline low-density lipoprotein cholesterol (LDL-C) levels and pretreatment with statins on the temporal improvement in outcome of acute coronary syndrome (ACS) patients has not been studied yet.

Methods

Patients were divided into two groups according to baseline LDL-C levels: LDL-C <130 mg/dl and LDL-C ≥130 mg/dl. Baseline characteristics, clinical data and outcomes were compared for each LDL-C group between patients enrolled in early (2000–2006), mid (2008–2010) and recent (2013–2016) surveys.

Results

The study population was comprised of 8343 patients. Patients with LDL-C <130 mg/dl were older and were more commonly pretreated with aspirin and statins compared to patients with LDL-C ≥130 mg/dl. Patients included in recent surveys were more frequently selected for an invasive strategy with coronary angiography and subsequent revascularization, and were more commonly treated with guideline-based medical therapy. For patients with a LDL-C ≥130 mg/dl, the temporal improvements in therapy were associated with lower 1-year mortality rates (7.2, 4.4 and 3.5% for patients in early, mid and late surveys, respectively, P = 0.006). That temporal improvement in outcomes existed only in statin-naïve patients. For patients with LDL-C <130 mg/dl, temporal improvement in treatment was not accompanied by a reduction in 30 day or 1-year mortality rates.

Conclusion

Treatment of ACS patients has improved over the past decades regardless of LDL-C levels. This improvement was accompanied by lower mortality rates in ACS patients with LDL-C ≥130 mg/dl, but not in patients with LDL-C <130 mg/dl.
An outlook on biomarkers in cardiogenic shock
Authors: Iborra-Egea Oriol , Montero Santi , Bayes-Genis Antoni
Published: May 2020

Purpose of review

Cardiogenic shock is a severe complication with mortality rates of ∼50% that requires a rapid and complex management to aid and identify the highest and lowest risk patients. To that end, novel cardiogenic shock biomarkers are needed to improve risk stratification and to personalize therapy.

Recent findings

Established biomarkers such as BNP, NT-proBNP, ST2, and troponins provide insufficient predictive value in cardiogenic shock. More recent biomarkers, including DPP3, adrenomedullin, angiopoietin 2, and the CS4P score are gaining momentum. DPP3 showed early prediction of refractory status and survival in cardiogenic shock. The CS4P score is based on the levels of liver fatty acid-binding protein (L-FABP), beta-2-microglobulin (B2M), fructose-bisphosphate aldolase B (ALDOB), and SerpinG1 (IC1). These proteins are not cardiac-specific but reflect multiorgan dysfunction, systemic inflammation, and immune activation. The CS4P improved reclassification of 32% of patients compared with the CardShock risk score.

A new wave of research focused on novel proteomic and molecular techniques, is providing new candidates that promise to aid clinical decision-making and patient stratification in cardiogenic shock. The CS4P score is emerging as the most robust, yet it requires prospective validation in cardiogenic shock patients managed with circulatory and ventricular assist devices.
Liver stiffness measurement is a potent predictor of histological fibrosis regression after hepatitis C virus clearance
Authors: Qiu Li-Xia , Liu Ya-Li , Lin Wei , Liu Yi-Rong , Yu Hai-Bin , Wang Xin-Xin , Sun Ya-Meng , Jin Rong-Hua , Hu Zhong-Jie , Zhang Jing
Published: May 2020

Background

Most of the studies on fibrosis regression prediction were based on noninvasive fibrosis markers and differ greatly. The ‘Beijing fibrosis classification’ can use histological results to classify fibrosis into progressive or ‘nonprogressive’ according to fibrotic septal morphology. We use this standard which served as the gold standard in order to find fibrosis regression predictors.

Aim

To study the predictors of fibrosis regression after hepatitis C virus clearance according to histological fibrosis staging by the ‘Beijing fibrosis classification’.

Materials and methods

This was a prospective cohort study. A total of 68 patients with advanced liver fibrosis or compensated cirrhosis who achieved sustained virological response were enrolled. Patients with the Ishak scores lower than 3 seemed to have fibrosis regression. The others were divided into the fibrosis progressive group and the nonprogressive group according to the ‘Beijing fibrosis classification’. Predictors of fibrosis regression were studied by logistic regression using baseline factors and the dynamic change in noninvasive fibrosis factors.

Results

Eighteen patients were assigned to the progressive group, and the others were assigned to the nonprogressive group. The baseline liver stiffness measurements (LSMs) of the progressive and nonprogressive groups were 14.35 (11.3, 27.3) kPa and 11.3 (8.3, 14.2) kPa, respectively, P = 0.02. The baseline LSM was the only predictor of fibrosis progression. With a cutoff of 11.85 kPa, the AUC was 0.71 (0.5, 0.9), and the negative predictive value was 0.92.

Conclusions

The baseline LSM was found to be the only predictor of fibrosis regression, 11.85 kPa is a possible ‘hepatic fibrosis return point’.