bluuebunny/crossref_metadata_2025 huggingface dataset:
An extended stellar halo discovered in the Fornax dwarf spheroidal using Gaia EDR3
Authors: Yang Yanbin , Hammer François , Jiao Yongjun , Pawlowski Marcel S
Published: March 2022

We have studied the extent of the Red Giant Branch stellar population in the Fornax dwarf spheroidal galaxy using the spatially extended and homogeneous data set from Gaia EDR3. Our pre-selection of stars belonging to Fornax is based on their proper motions, parallaxes, and colour–magnitude diagram. The latter criteria provide a Fornax star sample, which we further restrict by colour and magnitude to eliminate contaminations due to either Milky Way stars or QSOs. The precision of the data has been sufficient to reach extremely small contaminations (0.02–0.3 per cent), allowing us to reach to a background level 12 magnitudes deeper than the central surface brightness of Fornax. We discover a break in the density profile, which reveals the presence of an additional component that extents 2.1 degree in radius, i.e. 5.4 kpc, and almost seven times the half-light radius of Fornax. The extended new component represents 10 per cent of the stellar mass of Fornax, and behaves like an extended halo. The absence of tidally elongated features at such an unprecedented depth (equivalent to 37.94 ± 0.16 mag arcsec−2 in V-band) rules out a possible role of tidal stripping. We instead suggest that Fornax is likely at first infall, and has lost its gas very recently, which consequently leads to a lack of gravity implying that residual stars have spherically expanded to form the newly discovered stellar halo of Fornax.
An APEX search for carbon emission from NGC 1977 proplyds
Authors: Haworth Thomas J , Kim Jinyoung S , Qiao Lin , Winter Andrew J , Williams Jonathan P , Clarke Cathie J , Owen James E , Facchini Stefano , Ansdell Megan , Kama Mikhel , Ballabio Giulia
Published: March 2022

We used the Atacama Pathfinder Experiment (APEX) telescope to search for C I 1-0 (492.16 GHz) emission towards eight proplyds in NGC 1977, which is an FUV radiation environment two orders of magnitude weaker than that irradiating the Orion Nebular Cluster (ONC) proplyds. C I is expected to enable us to probe the wind launching region of externally photo-evaporating discs. Of the eight targets observed, no 3σ detections of the C I line were made despite reaching sensitivities deeper than the anticipated requirement for detection from prior APEX CI observations of nearby discs and models of external photo-evaporation of quite massive discs. By comparing both the proplyd mass loss rates and C I flux constraints with a large grid of external photo-evaporation simulations, we determine that the non-detections are in fact fully consistent with the models if the proplyd discs are very low mass. Deeper observations in C I and probes of the disc mass with other tracers (e.g. in the continuum and CO) can test this. If such a test finds higher masses, this would imply carbon depletion in the outer disc, as has been proposed for other discs with surprisingly low C I fluxes, though more massive discs would also be incompatible with models that can explain the observed mass loss rates and C I non-detections. The expected remaining lifetimes of the proplyds are estimated to be similar to those of proplyds in the ONC at 0.1 Myr. Rapid destruction of discs is therefore also a feature of common, intermediate UV environments.
CHANG-ES – XXVII. A radio/X-ray catalogue of compact sources in and around edge-on galaxies
Authors: Irwin Judith , Dyer Jacqueline , Drake Leonardo , Wang Q Daniel , Stil Jeroen , Stein Yelena , English Jayanne , Wiegert Theresa
Published: March 2022

We present catalogues of discrete, compact radio sources in and around the discs of 35 edge-on galaxies in the Continuum Halos in Nearby Galaxies – an EVLA Survey. The sources were extracted using the pybdsf program at both 1.6 GHz (L band) and 6.0 GHz (C band) from matching resolution (≈3 arcsec) data. We also present catalogues of X-ray sources from Chandra data sets for 27 of the galaxies. The sources at the two radio frequency bands were positionally cross-correlated with each other, and the result cross-correlated with the X-ray sources. All catalogues are included for download with this paper. We detect a total of 2507 sources at L band and 1413 sources at C band. 75 sources have been successfully cross-correlated in both radio bands plus X-ray. Three new nuclear sources are candidates for low luminosity active galactic nuclei in NGC 3877, NGC 4192, and NGC 5792; the one in NGC 3877 also appears to be variable. We also find new nuclear sources in two companion galaxies: NGC 4435 (companion to NGC 4438) and NGC 4298 (companion to NGC 4302). We have also discovered what appears to be a foreground double star; each star has X-ray emission and there is radio emission at both L band and C band in between them. This could be a colliding wind binary system. Suggestions for follow-up studies are offered.
Oscillating dynamical friction on galactic bars by trapped dark matter
Authors: Chiba Rimpei , Schönrich Ralph
Published: March 2022

The dynamic evolution of galactic bars in standard ΛCDM models is dominated by angular momentum loss to the dark matter haloes via dynamical friction. Traditional approximations to dynamical friction are formulated using the linearized collisionless Boltzmann equation and have been shown to be valid in the fast limit, i.e. for rapidly slowing bars. However, the linear assumption breaks down within a few dynamical periods for typical slowly evolving bars, which trap a significant amount of disc stars and dark matter in resonances. Recent observations of the Galactic bar imply this slow regime at the main bar resonances. We formulate the time-dependent dynamical friction in the slow limit and explore its mechanism in the general slow regime with test-particle simulations. Here, angular momentum exchange is dominated by resonantly trapped orbits which slowly librate around the resonances. In typical equilibrium haloes, the initial phase-space density within the trapped zone is higher at lower angular momentum. Since the libration frequency falls towards the separatrix, this density contrast winds up into a phase-space spiral, resulting in a dynamical friction that oscillates with ∼Gyr periods and damps over secular time-scales. We quantify the long-term behaviour of this torque with secular perturbation theory, and predict two observable consequences: (i) The phase-space spirals may be detectable in the stellar disc where the number of windings encodes the age of the bar. (ii) The torque causes weak oscillations in the bar’s pattern speed, overlaying the overall slowdown – while not discussed, this feature is visible in previous simulations.
The impact of natal kicks on galactic r-process enrichment by neutron star mergers
Authors: van de Voort Freeke , Pakmor Rüdiger , Bieri Rebekka , Grand Robert J J
Published: March 2022

We study galactic enrichment with rapid neutron capture (r-process) elements in cosmological, magnetohydrodynamical simulations of a Milky Way-mass galaxy. We include a variety of enrichment models, based on either neutron star mergers or a rare class of core-collapse supernova as sole r-process sources. For the first time in cosmological simulations, we implement neutron star natal kicks on-the-fly to study their impact. With kicks, neutron star mergers are more likely to occur outside the galaxy disc, but how far the binaries travel before merging also depends on the kick velocity distribution and shape of the delay time distribution for neutron star mergers. In our fiducial model, the median r-process abundance ratio is somewhat lower and the trend with metallicity is slightly steeper when kicks are included. In a model ‘optimized’ to better match observations, with a higher rate of early neutron star mergers, the median r-process abundances are fairly unaffected by kicks. In both models, the scatter in r-process abundances is much larger with natal kicks, especially at low metallicity, giving rise to more r-process enhanced stars. We experimented with a range of kick velocities and find that with lower velocities, the scatter is reduced, but is still larger than without natal kicks. We discuss the possibility that the observed scatter in r-process abundances is predominantly caused by natal kicks removing the r-process sources far from their birth sites, making enrichment more inhomogeneous, rather than the usual interpretation that the scatter is set by the rarity of its production source.
Successful management of a case of intestinal Behçet’s disease with a splenic abscess by intensified immunosuppressive therapy without splenectomy
Authors: Sato Noriko , Yamaide Fumiya , Shibata Ryohei , Nakano Taiji , Yamaide Akiko , Saito Takeshi , Shimojo Naoki
Published: March 2022

Behçet’s disease (BD) is often associated with neutrophilic dermatosis. However, BD is rarely associated with aseptic abscesses in the spleen or liver. A 2-year-old girl presented to our hospital with a 2-week history of fever, abdominal pain, and a skin ulcer on her leg. Each time her skin was punctured with a needle for a blood test or spinal fluid test, she developed intractable aseptic abscesses on her skin. She was diagnosed with intestinal BD based on gastrointestinal endoscopy findings and was treated with prednisolone, mesalazine, and elemental diet therapy. Although these were effective for her colon ulcers, low-grade fever and mild abdominal pain persisted. Abdominal computed tomography revealed a low-density area in the spleen. Although it is recommended to check the contents with puncture drainage, it was difficult due to the risk of bleeding and pathergy. The abscess expanded despite antimicrobial therapy. We discontinued antimicrobial therapy and switched to intensified immunosuppressive therapy for BD [intravenous infliximab (IFX)]. After administration of IFX, the splenic abscess gradually disappeared, and all her symptoms improved. In cases of BD with splenic abscesses resistant to antimicrobial therapy, intensifying immunosuppressive therapy can be expected to shrink the abscesses and avoid splenectomy.
One-Day Versus Three-Day Dexamethasone with NK1RA for Patients Receiving Carboplatin and Moderate Emetogenic Chemotherapy: A Network Meta-analysis
Authors: Watanabe Daichi , Iihara Hirotoshi , Fujii Hironori , Makiyama Akitaka , Nishida Shohei , Suzuki Akio
Published: March 2022

Background

The dexamethasone (DEX)-sparing strategy, which limits administration of DEX to day one, is reportedly non-inferior to conventional antiemetic regimens comprising multiple-day DEX. However, the usefulness of the DEX-sparing strategy in triplet antiemetic prophylaxis (neurokinin-1 receptor antagonist [NK1RA] + serotonin receptor antagonist [5HT3RA] + DEX) for carboplatin and moderate emetogenic chemotherapy (MEC) has not been clarified.

Patients and Methods

We systematically reviewed randomized controlled trials that examined the efficacy of antiemetics for preventing chemotherapy-induced nausea and vomiting associated with carboplatin and MEC. We conducted a network meta-analysis to compare the antiemesis efficacy of three-day DEX with NK1RA (3-DEX + NK1RA) and one-day DEX with NK1RA (1-DEX + NK1RA). The primary outcome was complete response during the delayed phase (CR-DP). The secondary outcome was no nausea during the delayed phase (NN-DP).

Results

Seventeen trials involving 4534 patients were included. The proportion who experienced CR-DP was 82.5% (95% credible interval [CI], 73.9-88.6) and 73.5% (95% CI, 62.8-80.9) among those who received 3-DEX + NK1RA and 1-DEX + NK1RA, respectively. There was no significant difference between the two regimens. However, 3-DEX + NK1RA tended to be superior to 1-DEX + NK1RA, with an absolute risk difference of 9.0% (95% CI, −2.3 to 21.1) in CR-DP and 24.7% (95% CI: −14.9 to 54.6) in NN-DP. 3-DEX + NK1RA also tended to be superior to 1-DEX + NK1RA in patients who received carboplatin-based chemotherapy, for whom the absolute risk difference was 12.3% (95% CI, −3.2 to 30.7).

Conclusions

Care is needed when administering the DEX-sparing strategy in combination with NK1RA to patients receiving carboplatin and non-carboplatin MEC.
A climate justice perspective on international labour migration and climate change adaptation among Tuvaluan workers
Authors: Farbotko Carol , Kitara Taukiei , Dun Olivia , Evans Christopher
Published: March 2022

Research on climate change and human mobility has posited migration as a potentially adaptive response. In the Pacific Islands region, international labour migration specifically is an important component of emerging climate change mobility policy, at both regional and national scales. However, the existence of opportunities for people in climate-exposed locations to move for work does not, on its own, advance climate justice. To gain insights into the nexus of climate justice, labour migration and adaptation, this paper explores the social and emotional experiences of international labour migration programme participants from climate-vulnerable Tuvalu as well as the emergent climate mobility regime in which this migration is taking place, drawing on qualitative research undertaken on the policy context and with workers from Tuvalu on short-term contracts under Australia’s Pacific Labour Scheme. Their experiences, their perceptions of climate change and their role as livelihood earners for families are explored to consider issues of climate justice in understanding labour migration as adaptation. While the workers benefited economically, they experienced significant social and emotional issues including poor mental health and family breakdown during their time working abroad, in addition to long-term climate change concerns. Further, the labour mobility programme in which they participated does not recognize migration-as-adaptation or climate justice, even though these are an emergent priority in the climate mobility regime. This highlights the need to consider how international labour migration programmes can be strengthened to advance climate justice for climate vulnerable populations on the move.
Detection of gamma-rays around SNR HB9 and its implications for the diffusive shock-acceleration history
Authors: Oka Tomohiko , Ishizaki Wataru
Published: March 2022

We analyze the GeV gamma-ray emission data from the vicinity of the supernova remnant (SNR) HB9 (G160.9+2.6) from the Fermi-LAT 12 yr observations to quantify the evolution of diffusive shock acceleration (DSA) in the SNR. In the vicinity of HB9, there are molecular clouds whose locations do not coincide with the SNR shell in the line of sight. We detect significant gamma-ray emissions above 1 GeV spatially coinciding with the two prominent cloud regions, as well as emission from the SNR shell, the latter of which is consistent with the results of previous studies. The energy spectrum above 1 GeV in each region is fitted with a simple power-law function of dN/dE ∝ E−Γ. The fitting result indicates harder spectra, with power-law indices of Γ = 1.84 ± 0.18 and 1.84 ± 0.14, than that at the SNR shell, with Γ = 2.55 ± 0.10. The observed spectra from the cloud regions are found to be consistent with the theoretically expected gamma-ray emissions originating in the protons that escaped from SNR HB9, where particles can be accelerated up to higher energies than those in the shell at present. The resultant diffusion coefficient in the vicinity of the SNR is comparable to that of the Galactic mean.
Manipulation of Lignin Monomer Composition Combined with the Introduction of Monolignol Conjugate Biosynthesis Leads to Synergistic Changes in Lignin Structure
Authors: Smith Rebecca A , Lu Fachuang , Muro-Villanueva Fabiola , Cusumano Joanne C , Chapple Clint , Ralph John
Published: March 2022

The complexity of lignin structure impedes efficient cell wall digestibility. Native lignin is composed of a mixture of three dominant monomers, coupled together through a variety of linkages. Work over the past few decades has demonstrated that lignin composition can be altered through a variety of mutational and transgenic approaches such that the polymer is derived almost entirely from a single monomer. In this study, we investigated changes to lignin structure and digestibility in Arabidopsis thaliana in near-single-monolignol transgenics and mutants and determined whether novel monolignol conjugates, produced by a FERULOYL-CoA MONOLIGNOL TRANSFERASE (FMT) or a p-COUMAROYL-CoA MONOLIGNOL TRANSFERASE (PMT), could be integrated into these novel polymers to further improve saccharification efficiency. Monolignol conjugates, including a new conjugate of interest, p-coumaryl p-coumarate, were successfully integrated into high-H, high-G and high-S lignins in A. thaliana. Regardless of lignin composition, FMT- and PMT-expressing plants produced monolignol ferulates and monolignol p-coumarates, respectively, and incorporated them into their lignin. Through the production and incorporation of monolignol conjugates into near-single-monolignol lignins, we demonstrated that substrate availability, rather than monolignol transferase substrate preference, is the most important determining factor in the production of monolignol conjugates, and lignin composition helps dictate cell wall digestibility.
Inducible epigenome editing probes for the role of histone H3K4 methylation in Arabidopsis heat stress memory
Authors: Oberkofler Vicky , Bäurle Isabel
Published: March 2022

Histone modifications play a crucial role in the integration of environmental signals to mediate gene expression outcomes. However, genetic and pharmacological interference often causes pleiotropic effects, creating the urgent need for methods that allow locus-specific manipulation of histone modifications, preferably in an inducible manner. Here, we report an inducible system for epigenome editing in Arabidopsis (Arabidopsis thaliana) using a heat-inducible dCas9 to target a JUMONJI (JMJ) histone H3 lysine 4 (H3K4) demethylase domain to a locus of interest. As a model locus, we target the ASCORBATE PEROXIDASE2 (APX2) gene that shows transcriptional memory after heat stress (HS), correlating with H3K4 hyper-methylation. We show that dCas9–JMJ is targeted in a HS-dependent manner to APX2 and that the HS-induced overaccumulation of H3K4 trimethylation (H3K4me3) decreases when dCas9–JMJ binds to the locus. This results in reduced HS-mediated transcriptional memory at the APX2 locus. Targeting an enzymatically inactive JMJ protein in an analogous manner affected transcriptional memory less than the active JMJ protein; however, we still observed a decrease in H3K4 methylation levels. Thus, the inducible targeting of dCas9–JMJ to APX2 was effective in reducing H3K4 methylation levels. As the effect was not fully dependent on enzyme activity of the eraser domain, the dCas9–JMJ fusion protein may act in part independently of its demethylase activity. This underlines the need for caution in the design and interpretation of epigenome editing studies. We expect our versatile inducible epigenome editing system to be especially useful for studying temporal dynamics of chromatin modifications.
Cancer and immune-mediated necrotizing myopathy: a longitudinal referral case-controlled outcomes evaluation
Authors: Shelly Shahar , Beecher Grayson , Milone Margherita , Liewluck Teerin , Ernste Floranne , Triplett James , Naddaf Elie , Zekeridou Anastasia , McKeon Andrew , Pittock Sean J , Dubey Divyanshu , Mills John R , Mandrekar Jay , Klein Christopher J
Published: March 2022

Objectives

To investigate immune-mediated necrotizing myopathy (IMNM) association with cancer and its clinical implications.

Methods

IMNM cases were identified 1 January 2000 to 31 December 2020 matching sex and age controls (4:1).

Results

A total of 152 patients with IMNM were identified and among serologically tested, 60% (83/140) were HMGCR-IgG+, 14% (20/140) were SRP-IgG+ and 26% (37/140) were seronegative. Cancer rates were not significantly different between serological subgroups; 18.1% (15/83) HMGCR-IgG+, 25% (5/20) SRP-IgG+ and 30% (11/37) seronegative (P = 0.34). Cancer screening was performed within 12 months from IMNM diagnosis in 88% (134/152) (whole-body CT plus FDG-PET CT in 53, CT alone in 72 and FDG-PET alone in 9). FDG-PET/CT was positive in 73% (25/34) of cancers. Increasing age was the only risk associated with cancer (P = 0.02). The odds of developing cancer at ±3 or ±5 years from IMNM diagnosis was not higher than controls (OR = 0.49; CI: 0.325–0.76). Lifetime IMNM diagnosis of cancer was less compared with controls (OR = 0.5 CI: 0.33–0.78, P = 0.002). Most patients responded to treatment (137/147, P < 0.001). Death and treatment response did not significantly differ between cancer [23% (8/34); 88% (29/33)] and non-cancer patients [19% (23/118); 92% (108/118)]. In total, 13% (20/152) of patients died during follow-up compared with 14% (41/290) of medicine and 16% (46/290) of neurology controls (P = 0.8). Seropositives had greater life expectancy than seronegatives (P = 0.01).

Conclusions

Greater cancer risk is not observed in IMNM vs controls. Cancer screening in IMNM should be individualized based on age-personal and family history, including consideration of FDG-PET/CT. Immune-treatment response did not differ with cancer.
Live Birth With or Without Preimplantation Genetic Testing for Aneuploidy
Authors: Yan Junhao , Qin Yingying , Zhao Han , Sun Yun , Gong Fei , Li Rong , Sun Xiaoxi , Ling Xiufeng , Li Hong , Hao Cuifang , Tan Jichun , Yang Jing , Zhu Yimin , Liu Fenghua , Chen Dawei , Wei Daimin , Lu Juanjuan , Ni Tianxiang , Zhou Wei , Wu Keliang , Gao Yuan , Shi Yuhua , Lu Yao , Zhang Ting , Wu Wei , Ma Xiang , Ma Hailan , Fu Jing , Zhang Junqiang , Meng Qingxia , Zhang Heping , Legro Richard S. , Chen Zi-Jiang
Published: March 2022

(Abstracted from N Engl J Med 2021;385:2047–2058)

To optimize live birth rate per transfer in in vitro fertilization (IVF), morphologic score based on visualization and genetic status based on preimplantation genetic testing for aneuploidy (PGT-A) are used to select the highest quality embryos. Although some studies suggest an increased live birth rate among women of advanced maternal age, it is less clear whether PGT-A in women with good prognosis for live birth experience a similar benefit.
Associations Between Historically Redlined Districts and Racial Disparities in Current Obstetric Outcomes
Authors: Hollenbach Stefanie J. , Thornburg Loralei L. , Glantz J. Christopher , Hill Elaine
Published: March 2022

(Abstracted from JAMA Netw Open 2021;4:e2126707)

Significant racial and ethnic disparities in infant and maternal mortality rates exist in the United States, with Black women carrying a disproportionate burden due to a range of obstetric outcomes. The drivers behind these disparities have revealed a multifactorial cause, including the physical environment, socioeconomic factors, individual health behaviors, stress, genetic factors, and structural racism.
Measuring Clinically Meaningful Change in Outcomes for Youth With Chronic Pain Following Graded Exposure Treatment
Authors: Harrison Lauren E. , Heathcote Lauren C. , Khazendar Zeena , Richardson Patricia A. , Simons Laura E.
Published: March 2022

Introduction:

Functional improvement is a critical outcome for individuals living with chronic pain. Graded exposure treatment (GET) has been associated with statistically significant improvements in functional outcomes for youth with chronic pain by targeting pain-related fear and avoidance.

Objective:

The aim of the present study was to explore clinically meaningful change in outcomes in adolescents with chronic pain following participation in a GET, and to then classify patients as treatment responders versus nonresponders.

Materials and Methods:

Participants included 27 youth (M
age=13.5) with chronic pain enrolled in a recently published single-arm randomized baseline trial of GET Living. Reliable change at the individual level was assessed using the Reliable Change Index (RCI). Adolescents were classified as treatment responders if they achieved a reliable change in outcomes across time points and also demonstrated a change in clinical severity range in the expected direction (ie, from severe to moderate).

Results:

Reliable and clinically significant improvements in pain-related fear and avoidance, functional disability, and school functioning were demonstrated at discharge, with improvements maintained at 3-month and 6-month follow-up. Among core outcomes, 48% (n=13) of patients were classified as treatment responders in one or more outcomes at discharge, with this increasing to 76% (n=19) at 3-month follow-up.

Discussion:

Examining reliable and clinically meaningful change (vs. statistical significance alone) provides a way to examine treatment response to an intervention and to enhance the interpretability of findings, helping to bridge the gap between clinical trials and clinical practice by providing guidelines for interpretation.
Interobserver and Intraobserver Agreement are Unsatisfactory When Determining Abstract Study Design and Level of Evidence
Authors: Patel Neeraj M. , Schmitz Matthew R. , Bastrom Tracey P. , Ghag Ravi , Janicki Joseph A. , Kushare Indranil V. , Lewis Ronald , Mistovich Ronald Justin , Nelson Susan E. , Sawyer Jeffrey R. , Vanderhave Kelly L. , Wallace Maegen J. , McKay Scott D.
Published: March 2022

Background:

Understanding differences between types of study design (SD) and level of evidence (LOE) are important when selecting research for presentation or publication and determining its potential clinical impact. The purpose of this study was to evaluate interobserver and intraobserver reliability when assigning LOE and SD as well as quantify the impact of a commonly used reference aid on these assessments.

Methods:

Thirty-six accepted abstracts from the Pediatric Orthopaedic Society of North America (POSNA) 2021 annual meeting were selected for this study. Thirteen reviewers from the POSNA Evidence-Based Practice Committee were asked to determine LOE and SD for each abstract, first without any assistance or resources. Four weeks later, abstracts were reviewed again with the guidance of the Journal of Bone and Joint Surgery (JBJS) LOE chart, which is adapted from the Oxford Centre for Evidence-Based Medicine. Interobserver and intraobserver reliability were calculated using Fleiss’ kappa statistic (k). χ2 analysis was used to compare the rate of SD-LOE mismatch between the first and second round of reviews.

Results:

Interobserver reliability for LOE improved slightly from fair (k=0.28) to moderate (k=0.43) with use of the JBJS chart. There was better agreement with increasing LOE, with the most frequent disagreement between levels 3 and 4. Interobserver reliability for SD was fair for both rounds 1 (k=0.29) and 2 (k=0.37). Similar to LOE, there was better agreement with stronger SD. Intraobserver reliability was widely variable for both LOE and SD (k=0.10 to 0.92 for both). When matching a selected SD to its associated LOE, the overall rate of correct concordance was 82% in round 1 and 92% in round 2 (P<0.001).

Conclusion:

Interobserver reliability for LOE and SD was fair to moderate at best, even among experienced reviewers. Use of the JBJS/Oxford chart mildly improved agreement on LOE and resulted in less SD-LOE mismatch, but did not affect agreement on SD.

Level of Evidence:

Level II.
Surgical Intervention is Associated With Improvements in the ASIA Impairment Scale in Gunshot-induced Spinal Injuries of the Thoracic and Lumbar Spine
Authors: Goh Brian C. , Striano Brendan M. , Crawford Alexander M. , Tobert Daniel G. , Fogel Harold A. , Cha Thomas D. , Schwab Joseph H. , Bono Christopher M. , Hershman Stuart H.
Published: March 2022

Study Design:

Retrospective cohort study of patients from the National Spinal Cord Injury Statistical Center (NSCISC).

Objective:

The aim was to compare the outcomes of patients with gunshot-induced spinal injuries (GSIs) treated operatively and nonoperatively.

Summary of Background Data:

The treatment of neurological deficits associated with gunshot wounds to the spine has been controversial. Treatment has varied widely, ranging from nonoperative to aggressive surgery.

Methods:

Patient demographics, clinical information, and outcomes were extracted. Surgical intervention was defined as a “laminectomy, neural canal restoration, open reduction, spinal fusion, or internal fixation of the spine.” The primary outcome was the American Spinal Injury Association (ASIA) Impairment Scale. Statistical comparisons of baseline demographics and neurological outcomes between operative and nonoperative cohorts were performed.

Results:

In total, 961 patients with GSI and at least 1-year follow-up were identified from 1975 to 2015. The majority of patients were Black/African American (55.6%), male (89.7%), and 15–29 years old (73.8%). Of those treated surgically (19.7% of all patients), 34.2% had improvement in their ASIA Impairment Scale score at 1 year, compared with 20.6% treated nonoperatively. Overall, surgery was associated with a 2.0 [95% confidence interval (CI): 1.4–2.8] times greater likelihood of ASIA Impairment Scale improvement at 1 year. Specifically, benefit was seen in thoracic (odds ratio: 2.5; 95% CI: 1.4–4.6) and lumbar injuries (odds ratio: 1.7; 95% CI: 1.1–3.1), but not cervical injuries.

Conclusions:

While surgical indications are always determined on an individualized basis, in our review of GSIs, surgical intervention was associated with a greater likelihood of neurological recovery. Specifically, patients with thoracic and lumbar GSIs had a 2.5 and 1.7-times greater likelihood of improvement in their ASIA Impairment Scale score 1 year after injury, respectively, if they underwent surgical intervention.
Mapping Injury Prevention With Microsoft Excel
Authors: Sharrah Mark L. , Bechtel Kaitlin E.
Published: March 2022

BACKGROUND:

Level I trauma centers must conduct injury prevention activities within their communities, despite limited resources available to them. To direct resources where they are most needed, injury prevention personnel at our trauma center use a novel method employing standard computer software. Although this method can be applied toward any injury population and prevention program, the example of targeting elderly falls prevention with A Matter of Balance classes is provided.

OBJECTIVE:

To share an innovative, yet efficient, technique to direct injury prevention efforts using Microsoft Excel map charts.

METHODS:

Using fictitious trauma registry data, an elderly falls rate is computed for each zip code. The top falls areas are then compared visually with areas where A Matter of Balance classes were conducted using Microsoft Excel map charts.

RESULTS:

Disparate areas of outreach, as well as areas where resources are inefficiently utilized, present in a manner that is easily recognized and communicated.

CONCLUSION:

Microsoft Excel map charts provide an effective and efficient means of displaying areas of greatest need, assessing disparities between those needs and outreach efforts that were conducted, and communicating with leadership.
Multiregion Trauma Center Follow-Up Protocol for Transferred Trauma Patients
Authors: Moran Mary E. , Moore Deanah , Krizo Jessica , Keefe Judy , Houck Olivia C , Rossler Danielle N. , George Richard L.
Published: March 2022

BACKGROUND:

Trauma centers routinely utilize the Injury Severity Score for performance improvement. Yet, transferring facilities do not always have access to patients' final Injury Severity Score.

OBJECTIVE:

The purpose of this project was to develop and implement a multiregion Injury Severity Score follow-up feedback protocol for transferring facilities to receive standardized information on patient treatment and the ability to calculate an accurate follow-up Injury Severity Score of transferred patients.

METHODS:

This project included 25 Adult and Pediatric Level I, II, and III trauma centers within three regional trauma systems in a Midwestern state. This project included trauma centers that used one of the two different trauma registry software systems as a solution to develop and implement a protocol for follow-up feedback for transferred trauma patients. A template was created to capture data posttransfer to calculate a final Injury Severity Score.

RESULTS:

The feedback protocol was well received by participating regions. Implementation revealed the impact of variable trauma registry software on the ability to create multi-institution feedback programs.

CONCLUSION:

Trauma systems can implement similar strategies to ensure transferring trauma centers routinely receive standardized, timely patient feedback.
Cannabidiol for the Management of Endometriosis and Chronic Pelvic Pain
Authors: Mistry Megha , Simpson Paul , Morris Edward , Fritz Ann-Katrin , Karavadra Babu , Lennox Carole , Prosser-Snelling Ed
Published: March 2022

(Abstracted from J Minim Invasive Gynecol 2022;29:169–176)

Current treatments for women with endometriosis are largely ineffective for management of pain and other symptoms. In addition, they often affect fertility and can have undesirable adverse effects that impede the long-term management of the condition.
Angiomyofibroblastoma and Potential Mimicking Soft Tissue Tumors That May Occasionally Present in the Retroperitoneum: An Approach to the Differential Diagnosis With Report of an Unusual Index Case Abutting the Kidney
Authors: Collins Katrina , Warmke Laura M. , Chen Shaoxiong , Ulbright Thomas M.
Published: March 2022

The retroperitoneal soft tissues, extending from the pelvic floor to the level of the diaphragm, are the source of a variety of mesenchymal neoplasms with overlapping features and distinct clinical behaviors, making their distinction of crucial importance. Herein, we report a rare retroperitoneal angiomyofibroblastoma (AMFB) that presented as a right abdominal mass in a 25-year-old woman and that clinically simulated a primary renal carcinoma. The patient underwent complete surgical resection showing a well-circumscribed tumor adjacent to but separate from the right kidney. It was comprised of irregular, often anastomosing islands and cords of plump to spindled cells in a collagenous stroma with numerous thin-walled vessels. The tumor cells clustered around the vessels and admixed with moderate numbers of adipocytes. There was neither significant nuclear atypia nor mitotic activity. Immunohistochemically, the tumor cells showed strong reactivity for desmin, diffuse expression of estrogen and progesterone receptors, retained nuclear expression of retinoblastoma protein, and absent CD34 expression. The immunomorphological features were these of a “lipomatous variant” of AMFB of the retroperitoneum. The occurrence of AMFB in the retroperitoneum is unexpected since it mostly develops in the lower genital tract of young women, making its recognition in this rare location difficult. As a consequence, more common pelvic or retroperitoneal soft tissue neoplasms may represent the primary diagnostic considerations. We, therefore, review a variety of soft tissue tumors occurring in the pelvis/retroperitoneum that, to some degree, may mimic AMFB, and present key findings to assist in accurate diagnosis.
Anterior Neck Resurfacing Using Multiple Free Flaps in Patients With Burn Sequelae of the Anterior Neck and Chest
Authors: Angrigiani Claudio , Neligan Peter C. , Artero Guillermo , Thrikutam Nikhitha P.
Published: March 2022

Background

It has been established that patients with burn sequelae of the anterior neck and chest have a significant degree of flap descent and deficit in neck extension when resurfaced with a single free flap. A protocol was developed to avoid flap descent in these patients by resurfacing the neck with multiple free flaps. The purpose of this article is to present our protocol for treatment and long-term results of this technique.

Methods

Twenty-five 25 patients with burn sequelae of the anterior neck and anterior thorax were retrospectively identified. Ten patients were treated with a single free flap (group 1), and 15 patients were treated with multiple free flaps (group 2). Patients were followed up for an average of 7 years after their definitive reconstructive procedure at which time measurements including flap descent from sternal notch, deficit of neck extension, and subjective reports of discomfort were obtained.

Results

Patients in group 1 demonstrated 8 cm (interquartile range [IQR], 1.75 cm) of flap descent, whereas patients in group 2 demonstrated 0.5 cm (IQR, 0 cm) of flap descent. Patients in group 1 demonstrated 12.5 degrees (IQR, 10 degrees) of deficit in neck extension, whereas patients in group 2 demonstrated 0 degrees (IQR, 0 degrees) of deficit in neck extension. Analysis demonstrated significantly greater descent and deficit in neck extension in group 1 compared with group 2.

Conclusions

Patients with burn sequelae of the neck and anterior chest experience less flap descent and deficits in neck extension when resurfaced with multiple free flaps.
Innervated Reconstruction of Fingertip Degloving Injury Using a Dorsal Digital Perforator Flap Combined With a Cross-Finger Flap
Authors: Wang Tongfu , Wang Li , Wang Hui , Zhang Wenlong , Yu Zhiliang , Zhang Jingyu
Published: March 2022

Background

The reconstruction of a fingertip degloving injury presents a functional and aesthetic challenge. We used a dorsal digital perforator flap combined with a cross-finger flap to reconstruct this type of injury. The purposes of this retrospective study were to evaluate the efficacy of the combined flaps and to present our clinical experience.

Methods

From November 2016 to October 2019, 16 patients (13 men and 3 women) with fingertip degloving injuries were treated with a dorsal digital perforator flap combined with a cross-finger flap for innervated reconstruction. We used an innervated dorsal digital perforator flap for the reconstruction of the dorsal defect of the degloved fingertip and an innervated cross-finger flap for the volar defect. The average size of the defect was 4.2 × 1.9 cm. The average sizes of the flaps were 2.3 × 2.1 cm (the dorsal digital perforator flap) and 2.5 × 2.1 cm (the cross-finger flap).

Results

All flaps and skin grafts survived completely without ischemia or venous congestion. All wounds and their donor sites healed primarily without exudation and infection. Patients were followed up for a mean time of 11.3 ± 1.9 months (range, 9–15 months). At the final follow-up, no significant difference was seen in the averaged total active motion between the injured fingers and the contralateral fingers. No significant difference was found in the averaged total active motion between the donor fingers and the contralateral fingers. All flaps obtained excellent or good sensory performance. All flaps had mild cold intolerance. Thirteen patients had no pain, 2 reported mild pain, and 1 experienced moderate pain. Ten patients were very satisfied with the appearance of the reconstructed finger.

Conclusions

The dorsal digital perforator flap combined with a cross-finger flap is an effective and reliable method for the reconstruction of fingertip degloving injuries.
Impact of Socioeconomic Status on Breast Reconstruction Outcomes
Authors: Martin Morgan S. , Kebede Sara , Saad Omar A. , Baker Nusaiba F. , Losken Albert
Published: March 2022

Background

Minority patients and those from low socioeconomic backgrounds are faced with barriers to care regarding breast reconstruction. With this study, we seek to elucidate variances in demographics to determine predictors of complications in implant-based breast reconstruction.

Methods

Patients who underwent breast reconstruction with either direct to implant or immediate expander reconstruction by 1 surgeon were identified using the preoperative Breast-Q.

Current income statistics available from the US Census Bureau by self-reported zip code were used to determine the median household income (MHI) to stratify differing socioeconomic backgrounds. Demographics were compared with body mass index, comorbidities, overall rate of postoperative complications, rate of implant infection, and type of reconstruction.

Results

Two hundred ninety-five patients met inclusion criteria. Overall rate of complications and rate of breast implant infection was higher for MHI of less than $50,000 compared with greater than $50,000 (P = 0.043 overall complications 40.20% vs 28.8%) (P = 0.04 implant infection 14.4% vs 7.1%). African American patients had higher body mass index (P = <0.001), rates of HTN (P = <0.001), and diabetes (P = 0.001), and were more likely to have a lower income (P = <0.001). There was, however, no difference in overall complications (P = 0.26), implant infection rate (P = 0.994), or capsular contracture (0.367) based on race. There was no difference in rate of comorbidities between low and high socioeconomic areas.

Conclusion

This cohort demonstrates a higher rate of overall complications and infection in patients with a lower MHI and no difference based on race despite having higher risk factors for complications.

Socioeconomic status is a multifaceted barrier to care that must be addressed in the perioperative period to decrease breast implant associated complications.
Reconstructive Trends After Tissue-Expander Loss in Breast Reconstruction
Authors: Ghosh Kanad , Marquez Jocellie , Niu Ellen , Rogoff Hunter , Monroig Kaitlin , Marmor William , Kianian Sara , Bui Duc T. , Huston Tara L.
Published: March 2022

Purpose

Tissue-expander breast reconstruction (TEBR) is a common method of reconstruction after mastectomy but may result in complications that may necessitate removal. Although complications in TEBR have been well studied, there is a paucity of data regarding outcomes after tissue-expander loss. In this study, we examine the eventual reconstructive pathways and associated factors of patients who required tissue-expander removal after infection.

Methods

This retrospective study examines patients undergoing breast reconstruction at a single institution. Patients included underwent mastectomy, immediate TEBR, and subsequent tissue-expander loss. Patients who underwent autologous reconstruction after mastectomy or had successful TEBR were excluded. Patients were followed for an average of 7 years, with a minimum of 2 years and a maximum of 13 years.

Results

A total of 674 TEBR patients were initially screened, of which 60 patients (8.9%) required tissue-expander removal because of infection or skin necrosis. Thirty-one of these patients (group 1) did not complete reconstruction after initial tissue-expander loss, whereas the remaining 29 patients (group 2) underwent either TEBR or autologous reconstruction after tissue-expander loss. Group 1 had a significantly higher mean body mass index than group 2 (32.61 ± 8.88 vs 28.69 ± 5.84; P = 0.049) and also lived further away from our institution than group 2 (P = 0.052), which trended toward significance. There were otherwise no significant differences in demographics between the 2 groups.

Among the 29 patients in group 2, 18 patients underwent a second TEBR (group 2a), and 11 patients underwent autologous reconstruction (group 2b). Patients in group 2b had a significantly greater mean number of complication related admissions (1.11 ± 0.323 vs 1.55 ± 0.688; P = 0.029) and also had higher occurrence of postmastectomy radiation therapy (16.7% vs 45.5%; P = 0.092), although this was not significant. There were otherwise no differences between the 2 groups.

Conclusion

Our data demonstrate the trends in breast reconstruction decision making after initial tissue-expander loss. This study elucidates the factors associated with patients who undergo different reconstructive options. Further work is needed to delineate the specific reasons between the decision to pursue different reconstructive pathways among a larger cohort of patients.
Long Term Incidence and Outcomes of Sinonasal and Otologic Disease in Patients With Pyriform Aperture Stenosis and Choanal Atresia
Authors: Godse Neal R. , Lu Nathan , Shaffer Amber D. , Stapleton Amanda L.
Published: March 2022

Pyriform aperture stenosis (PAS) and choanal atresia (CA) are 2 anatomic causes of newborn nasal obstruction. The goal of management of PAS and CA is to establish a patent nasal airway, often requiring surgery. No previous study has sought to assess the long term sinonasal and otologic disease incidence and outcomes in the PAS and CA population after surgical intervention. The goal of this study was to investigate whether surgical intervention in PAS and CA is correlated with the long-term development of sinonasal disease or otologic disease (either recurrent acute otitis media or chronic otitis media with effusion). Patients with a diagnosis of PAS or CA who underwent surgical intervention were retrospectively identified. Pertinent demographic risk factors, medical and syndromic diagnoses, number of surgical interventions, types of surgical interventions, and presence of sinonasal and otologic diseases were assessed. Fifty-three patients were included in the study: 8 patients with PAS and 45 with CA. The average follow-up time was 2.9 years. No PAS patients developed otologic or sino-nasal disease. Four of 45 patients with CA developed recurrent acute sinusitis (3 non-syndromic and 1 syndromic) and 19 of 45 patients developed otologic disease (9 non-syndromic and 10 syndromic). Coloboma, Heart, Choanal Atresia, Growth Retardation, Genitourinary, Ear Syndrome and unilateral CA correlated significantly with the subsequent development of otologic disease; however, the number of surgeries did not. This study suggests that surgery for PAS and CA do not increase the risk of long-term development of sinonasal or otologic disease.
Accuracy and Security Analysis of a Cranio-Maxillofacial Plastic Surgery Robot Equipped With Piezosurgery in Genioplasty
Authors: Sun Tiecheng , Lei Bowen , Zhong Yehong , Chen Zhewei , Yang Bin
Published: March 2022

This study aims to verify that the craniofacial plastic surgery robot with piezosurgery is more accurate and safer than traditional operations in genioplasty. This study chose data from the Digital Plastic Surgery of Plastic Surgery Hospital in the Chinese Academy of Medical Sciences and Peking Union Medical College. The CT data of the patient’s skull were reconstructed in the software, and the authors designed the measurement index. The surgical plan was designed as an ideal scheme (control group). Patients underwent traditional surgery according to the preoperative surgery plan (clinical group). Guided by surgical navigation, the osteotomy was operated on patients' same size plaster model using the surgery robot equipped with a piezosurgery (robot group). At last, the accuracy was calculated by CT data. There was no significant difference between the robotic group and control groups in the postoperative measurement index (P < 0.05). There was no significant difference between the robotic group and the control group (P > 0.05) in the line of osteotomy, but there was a significant difference between the clinical group and the control group in the line of the osteotomy.