bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinical and echocardiographic case report of carcinoid-related valvular heart disease
Authors: Ebrahimi Ali J. , Marogil Peter , Von Mering Gregory , Ahmed Mustafa
Published: November 2020

Background

Carcinoid syndrome is a rare disease caused by malignant neuroendocrine neoplasms. When vasoactive substances enter the systemic circulation, the triad of cutaneous flushing, bronchospasm, and diarrhoea often characterize carcinoid syndrome. Rarely, carcinoid syndrome can progress to involve the cardiac system, a condition known as carcinoid heart disease, often affecting right-sided valvular structures.

Case summary

Here, we present a case of malignant carcinoid syndrome with associated carcinoid heart disease in a 63-year-old female. The diagnosis of her dual regurgitant and stenotic valvular disease is detailed, with accompanying two- and three-dimensional echocardiographic images demonstrating the patient’s complex tricuspid dysfunction.

Discussion

Carcinoid heart disease encompasses a rare but important subset of valvular dysfunction caused by circulating vasoactive substances. Diagnosis utilizing serum studies, computed tomography scans, and echocardiography can help expedite the diagnosis and treatment of such rare conditions, and assist in the avoidance of complications. Despite its relatively well-recognized clinical presentation, carcinoid syndrome and its associated heart disease still remains a challenging condition to manage and treat, often requiring the input of several subspecialties to treat the condition appropriately.
Long-term and short-term outcomes of robot- versus video-assisted anatomic lung resection in lung cancer: a systematic review and meta-analysis
Authors: Wu Han , Jin Runsen , Yang Su , Park Bernard J , Li Hecheng
Published: November 2020

OBJECTIVES

Minimally invasive thoracic surgery has evolved with the introduction of robotic platforms. This study aimed to compare the long-term and short-term outcomes of the robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for anatomic lung resection.

METHODS

We searched published studies that investigated RATS and VATS in anatomic lung resection. Long-term outcomes (disease-free survival and overall survival) and short-term outcomes (30-day mortality, postoperative complications, conversion rate to open surgery and lymph node upstaging) were extracted. The features were compared and tested as hazard ratios (HRs) and odds ratios (ORs) at a 95% confidence interval (CI).

RESULTS

Twenty-five studies with 50 404 patients (7135 for RATS and 43 269 for VATS) were included. The RATS group had a longer disease-free survival than the VATS group (HR: 0.76; 95% CI: 0.59–0.97; P = 0.03), and the overall survival showed a similar trend but was not statistically significant (HR: 0.77; 95% CI: 0.57–1.05; P = 0.10). The RATS group showed a significantly lower 30-day mortality (OR: 0.55; 95% CI: 0.38–0.81; P = 0.002). No significant difference was found in postoperative complications (OR: 1.01; 95% CI: 0.87–1.16; P = 0.94), the conversion rate to open surgery (OR: 0.92; 95% CI: 0.56–1.52; P = 0.75) and lymph node upstaging (OR: 0.89; 95% CI: 0.52–1.54; P = 0.68).

CONCLUSIONS

RATS has comparable short-term outcomes and potential long-term survival benefits for anatomic lung resection compared with VATS.
The microbial rare biosphere: current concepts, methods and ecological principles
Authors: Pascoal Francisco , Costa Rodrigo , Magalhães Catarina
Published: November 2020

Our ability to describe the highly diverse pool of low abundance populations present in natural microbial communities is increasing at an unprecedented pace. Yet we currently lack an integrative view of the key taxa, functions and metabolic activity which make-up this communal pool, usually referred to as the ‘rare biosphere’, across the domains of life. In this context, this review examines the microbial rare biosphere in its broader sense, providing an historical perspective on representative studies which enabled to bridge the concept from macroecology to microbial ecology. It then addresses our current knowledge of the prokaryotic rare biosphere, and covers emerging insights into the ecology, taxonomy and evolution of low abundance microeukaryotic, viral and host-associated communities. We also review recent methodological advances and provide a synthetic overview on how the rare biosphere fits into different conceptual models used to explain microbial community assembly mechanisms, composition and function.
Progress in the elimination of lymphatic filariasis in the Western Pacific Region: successes and challenges
Authors: Yajima Aya , Ichimori Kazuyo
Published: November 2020

The Western Pacific Region is the largest and most diverse region in the world, made up of 37 countries and territories in the Pacific, Oceania and parts of Asia, with a population of more than 1.9 billion people stretching over an area from China and Mongolia in the north to New Zealand in the south. In 1999, 22 countries and territories in the Pacific joined together and launched the Pacific Programme to Eliminate Lymphatic Filariasis. Shortly after, the Global Programme to Eliminate Lymphatic Filariasis was launched in 2000. In 2004, 12 countries in the Asia subregion of the Western Pacific Region and Southeast Asian Region joined and developed the Mekong-Plus Strategic Plan for Elimination of Lymphatic Filariasis. Since then, significant efforts have been made by all endemic countries, with annual mass drug administration (MDA) as a principal strategy, through strong partnership with the WHO and other donors and partners. As a result, by the end of 2019, 10 of 22 endemic countries in the region, including 8 of 16 countries in the Pacific and 2 countries in the Asia subregion, achieved WHO validation for elimination of lymphatic filariasis (LF) as a public health problem. All the other countries are either progressing with post-MDA surveillance or accelerating efforts by adoption of the new triple drug therapy strategy and enhancement of MDA campaigns to tackle persistent transmission. Some 85% of the originally endemic implementation units have stopped MDA and the number of people requiring MDA for LF in the Western Pacific Region was reduced by 72% from 2000 to 2018. This paper reviews the progress, key success factors and remaining challenges and indicates the way forward to achieve LF elimination in the Western Pacific Region.
Simultaneous Detection of Anions and Carbohydrates in Cyanobacteria by Two-Dimensional Ion Chromatography
Authors: Jiang Lijun , Bao Yan , Guo Liang , Cui He , Wang Qi , Liu Kai , Hao Xiaoxian , Qiu Ruchen , Guo Zhiyan , Fa Yun
Published: November 2020

Background

The simultaneous analysis of several anions and carbohydrates by one-dimensional chromatography with a single detector is often complicated by the presence of overlapping peaks. To overcome this problem, analytes are usually analyzed separately making analysis long and tedious.

Objective

A method combining two-dimensional ion chromatography (2D-IC) and valve switching was developed for the simultaneous determination of anions (F−, Cl−, NO2−, SO42−, NO3−, and PO43−) and carbohydrates (glycerin, glucosyl glycerol, trehalose, mannose, glucose, galactose, fructose, ribose, and sucrose) in cyanobacteria.

Method

Interfering color compounds were removed by first passing the sample through graphitized carbon solid phase extraction (SPE) cartridges. Samples were applied to an AS11-HC column, which was used to separate the anions followed by quantification using a conductance detector. Carbohydrates eluted from the AS11-HC column were trapped and separated on a MA1 column and simultaneously quantified using electrochemical detection in the second dimension with valve switching.

Results

The following parameters were established: LOD, 0.001–0.030 (mg/L); LOQ, 0.001–0.010 (mg/L); linearity (R2), 0.9940; repeatability, 0.39–3.02%; and spiked recovery, 90.1–107%.

Conclusions

The proposed method is adequately linear, accurate, and repeatable. The 2D-IC method provides fast, high-resolution, and completely automated procedure for the simultaneous determination of anions and carbohydrates without co-elution compared to the 1D ion chromatography method. This study provides application perspectives for use in biotechnology and other research fields.

Highlights

An accurate and effective 2D-IC method was developed for determining anions and carbohydrates in cyanobacteria. The method includes pre-treating samples with graphitized carbon SPE cartridges.
Differentiation of Milk and Whey Protein Concentrates by Microbiome Profiling Using 16S Metagenomics
Authors: Thompson Christopher M , Gao Quanyin , Chang Peter , Swanson Gary
Published: November 2020

Background

Protein powder identification presents a challenge in quality control. There is current deliberation of the specificity of methods for the identification of milk proteins, and the consensus identification method of whey protein from the United States Pharmacopeia Food Chemical Codex relies on a combined analysis of the testing of ash, fat, lactose, loss on drying, and protein. These methods are non-specific. Milk and whey proteins both contain background DNA content. Both milk and whey proteins retain source DNA (cow), but also have bacterial DNA from natural flora, the dairy plant, and in whey protein, the cheesemaking process. The DNA in these materials is retained post-processing, even after the pasteurization process.

Objective

By utilizing 16S metagenomics, the bacterial DNA in protein powders can be sequenced and cross-referenced to a curated library to ultimately create a microbiome profile of these raw materials. This microbiome can be measured for alpha and beta diversity, specifically how many and which species of bacteria are present.

Method

Using 16S metagenomics, we measure alpha and beta diversity of the microbiome profile of each protein powder and use principle coordinate analysis to produce differential groupings, providing a novel identification method for raw materials.

Results

In this study, we demonstrate that the microbiome of cow proteins can be used for raw material identification, as the microbiome of milk and whey proteins differ significantly. We also demonstrate that the microbiome of whey protein concentrate can differ from supplier to supplier.

Conclusions

Microbiome profiling by 16S metagenomics can be an important forensic tool for quality control.

Highlights

Principle Coordinate Analysis can be used as a statistical tool for protein differentiation using the protein microbiome.
Teaching classics with objects? The acquisition of classical antiquities by British schools, 1860–1950
Authors: Croker Ollie
Published: November 2020

British secondary schools amassed collections of antiquities from the mid-nineteenth century onwards. These ordinarily contained classical objects, sometimes alongside Egyptian antiquities, and accompanied collections of natural history, geology and ethnography. This paper uses the collection formed by Bedford Modern School, now housed at the Higgins Museum, Bedford, to study the phenomenon of school classical collections. The analysis presented here places school collections within a wider history of ‘object lessons’, but suggests that these collections were more than merely teaching aids. School museums could act as signifiers of power and prestige, connection to alumni and wider local communities, and to a heritage of learning and scholarship embodied by classical antiquities. Furthermore, these collections illustrate the personalities and interests of individual collectors – usually the schoolmasters who were instrumental in their formation.
QKI-5 regulates the alternative splicing of cytoskeletal gene ADD3 in lung cancer
Authors: Wang Jin-Zhu , Fu Xing , Fang Zhaoyuan , Liu Hui , Zong Feng-Yang , Zhu Hong , Yu Yan-Fei , Zhang Xiao-Ying , Wang Shen-Fei , Huang Ying , Hui Jingyi
Published: November 2020

Accumulating evidence indicates that the alternative splicing program undergoes extensive changes during cancer development and progression. The RNA-binding protein QKI-5 is frequently downregulated and exhibits anti-tumor activity in lung cancer. Howeve-r, little is known about the functional targets and regulatory mechanism of QKI-5. Here, we report that upregulation of exon 14 inclusion of cytoskeletal gene Adducin 3 (ADD3) significantly correlates with a poor prognosis in lung cancer. QKI-5 inhibits cell proliferation and migration in part through suppressing the splicing of ADD3 exon 14. Through genome-wide mapping of QKI-5 binding sites in vivo at nucleotide resolution by iCLIP-seq analysis, we found that QKI-5 regulates alternative splicing of its target mRNAs in a binding position-dependent manner. By binding to multiple sites in an upstream intron region, QKI-5 represses the splicing of ADD3 exon 14. We also identified several QKI mutations in tumors, which cause dysregulation of the splicing of QKI targets ADD3 and NUMB. Taken together, our results reveal that QKI-mediated alternative splicing of ADD3 is a key lung cancer-associated splicing event, which underlies in part the tumor suppressor function of QKI.
“The Way of Progress and Civilization”: Racial Hierarchy and US State Building in Haiti and the Dominican Republic (1915–1922)
Authors: Pampinella Stephen
Published: November 2020

Racial stratification remains critically undertheorized in hierarchy studies. Postcolonial analyses demonstrate how diffuse systems of racial knowledge produce unequal subjectivities in world politics, but they are often criticized for making overdetermined explanations that do not account for agency or contingency. To rectify this theoretical lacuna, I develop a postcolonial-practice theory approach to explain variation in the intensity and duration of governance hierarchies. I argue that racialized discourses constitute the habitualized dispositions of dominant and subordinate actors and make possible specific governance practices. This approach can account for puzzling cases of successful resistance by some subordinates while others languish under intense domination. Two such cases are US state building interventions in Haiti and the Dominican Republic during the early twentieth century. By using a variety of primary archival and public sources, I demonstrate how ideas about racial differences among Anglo-Americans, Dominicans, and Haitians led US policymakers to enact a more long-term and domineering occupation of Haiti compared to the Dominican Republic. Once Dominican elites articulated a European–Spanish identity in opposition to Blackness, they mobilized support from other Latin American states and made US withdrawal practical. A postcolonial-practice explanation is useful because it addresses the limitations of both narrow and broad approaches to the study of hierarchy. Its focus on the contestation of US hierarchies further contributes to hegemonic-order theory while illustrating how the dynamics of inclusion and exclusion shape imperial rule and strategies of anti-imperial resistance.
Sector-Specific Associations, Trust, and Survival of PPPs: A Behavioral Experiment Based on the Centipede Game
Authors: Weißmüller Kristina S , Vogel Rick
Published: November 2020

Public-private partnerships (PPPs) have become widespread in the delivery of public services. This study explores behavioral mechanisms of building and eroding trust in partnering across sectors at the micro-level of interaction between public and private partners. Combining classic theoretical concepts on the development of interorganizational trust and administrative behavior, this study derives theory suggesting that partners’ sector affiliation may have adverse signaling effects on individuals’ intention to uphold effective partnerships over time, and that this intent may be moderated by sector-specific associations. Tested with a novel and dynamic multi-stage behavioral experiment based on the classic centipede game conducted with German graduate students (N = 482; Obs. = 4,338), results suggest that sector affiliation functions as a strong but potentially misleading signal for partners’ strategic behavior in PPPs and that sector-specific associations asymmetrically moderate respondents’ will to collaborate. These findings contribute to a more nuanced theoretical understanding of the micro-foundations of strategic behavior, particularly at nascent stages of PPPs, calling into question basic assumptions about coordination efficiency in cross-sectoral partnerships.
Upper Respiratory Microbiota in Relation to Ear and Nose Health Among Australian Aboriginal and Torres Strait Islander Children
Authors: Coleman Andrea , Bialasiewicz Seweryn , Marsh Robyn L , Grahn Håkansson Eva , Cottrell Kyra , Wood Amanda , Jayasundara Nadeesha , Ware Robert S , Zaugg Julian , Sidjabat Hanna E , Adams Jasmyn , Ferguson Josephine , Brown Matthew , Roos Kristian , Cervin Anders
Published: November 2020

Background

We explored the nasal microbiota in Indigenous Australian children in relation to ear and nasal health.

Methods

In total, 103 Indigenous Australian children aged 2–7 years (mean 4.7 years) were recruited from 2 Queensland communities. Children’s ears, nose, and throats were examined and upper respiratory tract (URT) swabs collected. Clinical histories were obtained from parents/medical records. URT microbiota were characterized using culturomics with Matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification. Real-time PCR was used to quantify otopathogen (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) loads and detect respiratory viruses. Data were analyzed using beta diversity measures, regression modeling, and a correlation network analysis.

Results

Children with historical/current otitis media (OM) or URT infection (URTI) had higher nasal otopathogen detection and loads and rhinovirus detection compared with healthy children (all P < .04). Children with purulent rhinorrhea had higher nasal otopathogen detection and loads and rhinovirus detection (P < .04) compared with healthy children. High otopathogen loads were correlated in children with historical/current OM or URTI, whereas Corynebacterium pseudodiphtheriticum and Dolosigranulum pigrum were correlated in healthy children.

Conclusions

Corynebacterium pseudodiphtheriticum and D. pigrum are associated with URT and ear health. The importance of the main otopathogens in URT disease/OM was confirmed, and their role relates to co-colonization and high otopathogens loads.
Jejunal diverticular disease: a report of three cases
Authors: Ghandour Richard , Khalifeh Georges , Orm Nasr Bou , Rakka Mohamad , Dbouk Samer , El Sahili Riad , Mcheimeche Hussein
Published: November 2020

Jejunal diverticula (JD) are a rare medical entity. They are often unnoticed, until complications occur. We report herein three cases of such diverticula, analyzed retrospectively, and depicting some of these complications: small bowel obstruction due to enterolith in a giant diverticulum treated surgically, incidental intraoperative finding on an anastomotic jejunal limb affecting the surgical plan and diverticulitis with anemia. In all three cases, the diagnosis of JD was unexpected, which illustrates the importance of being familiar with this disease for adequate management.
‘Arianism’ Ante Litteram in Origen’s Peri Archōn 4.4.1
Authors: Ip Pui Him
Published: November 2020

In Peri Archōn 4.4.1, Origen argues against a form of ‘Arianism’ ante litteram. Previous scholarship has suggested that the view targeted by Origen could be a form of Basilidean system. In this paper, I make a fresh attempt to identify the polemical context of this passage. I first identify a more reliable control for delimiting the possible targets using Origen’s classification of heresies reported in Pamphilus’ Apology and Book 32 of the Commentary on John. Synthesis of the two reports suggests that Origen is unlikely to have targeted Basilides’ teachings in Peri Archōn 4.4.1. I then analyse two further pieces of evidence to substantiate an alternative identification: psilanthropism or monarchianism. Where Origen explicitly rejects ἦν ποτε ὅτε οὐκ ἦν (or variants), one finds these two positions as the immediate polemical context. Further, analysis of Peri Archōn 1.2.1–4 reveals that, as in Peri Archōn 4.4.1, these positions are placed alongside Valentinian emanationism as the twin polemical targets of Origen’s Christology. This fresh identification opens up a new perspective for reassessing the development of the fourth-century ‘Arian’ controversy prospectively, that is, through the lens of the third-century polemical landscape.
APOBEC3 enzymes mediate efficacy of cisplatin and are epistatic with base excision repair and mismatch repair in platinum response
Authors: Conner Kayla L , Shaik Asra N , Marshall Katie A , Floyd Ashley M , Ekinci Elmira , Lindquist Jacob , Sawant Akshada , Lei Wen , Adolph Madison B , Chelico Linda , Siriwardena Sachini U , Bhagwat Ashok , Kim Seongho , Cote Michele L , Patrick Steve M
Published: November 2020

Identifying the mechanisms mediating cisplatin response is essential for improving patient response. Previous research has identified base excision repair (BER) and mismatch repair (MMR) activity in sensitizing cells to cisplatin. Cisplatin forms DNA adducts including interstrand cross-links (ICLs) that distort the DNA helix, forcing adjacent cytosines to become extrahelical. These extrahelical cytosines provide a substrate for cytosine deaminases. Herein, we show that APOBEC3 (A3) enzymes are capable of deaminating the extrahelical cytosines to uracils and sensitizing breast cancer cells to cisplatin. Knockdown of A3s results in resistance to cisplatin and induction of A3 expression in cells with low A3 expression increases sensitivity to cisplatin. We show that the actions of A3s are epistatic with BER and MMR. We propose that A3-induced cytosine deamination to uracil at cisplatin ICLs results in repair of uracils by BER, which blocks ICL DNA repair and enhances cisplatin efficacy and improves breast cancer outcomes.
Accelerating phylogeny-aware alignment with indel evolution using short time Fourier transform
Authors: Maiolo Massimo , Ulzega Simone , Gil Manuel , Anisimova Maria
Published: November 2020

Recently we presented a frequentist dynamic programming (DP) approach for multiple sequence alignment based on the explicit model of indel evolution Poisson Indel Process (PIP). This phylogeny-aware approach produces evolutionary meaningful gap patterns and is robust to the ‘over-alignment’ bias. Despite linear time complexity for the computation of marginal likelihoods, the overall method’s complexity is cubic in sequence length. Inspired by the popular aligner MAFFT, we propose a new technique to accelerate the evolutionary indel based alignment. Amino acid sequences are converted to sequences representing their physicochemical properties, and homologous blocks are identified by multi-scale short-time Fourier transform. Three three-dimensional DP matrices are then created under PIP, with homologous blocks defining sparse structures where most cells are excluded from the calculations. The homologous blocks are connected through intermediate ‘linking blocks’. The homologous and linking blocks are aligned under PIP as independent DP sub-matrices and their tracebacks merged to yield the final alignment. The new algorithm can largely profit from parallel computing, yielding a theoretical speed-up estimated to be proportional to the cubic power of the number of sub-blocks in the DP matrices. We compare the new method to the original PIP approach and demonstrate it on real data.
Detection capability of the Migdal effect for argon and xenon nuclei with position-sensitive gaseous detectors
Authors: Nakamura Kiseki D , Miuchi Kentaro , Kazama Shingo , Shoji Yutaro , Ibe Masahiro , Nakano Wakutaka
Published: November 2020

The Migdal effect is attracting interest because of the potential to enhance the sensitivities of direct dark matter searches to the low-mass region. In spite of its great importance, the Migdal effect has not been experimentally observed yet. A realistic experimental approach towards the first observation of the Migdal effect in the neutron scattering was studied with Monte Carlo simulations. In this study, the potential background rate was studied together with the event rate of the Migdal effect by a neutron source. It was found that a table-top-sized $\sim (30~\mbox{cm})^3$ position-sensitive gaseous detector filled with argon or xenon target gas can detect characteristic signatures of the Migdal effect with sufficient rates (O($10^2\sim10^3$) events per day). A simulation result of a simple experimental set-up showed two significant background sources, namely the intrinsic neutrons and the neutron-induced gamma-rays. It is found that the intrinsic neutron background rate for the argon gas is at an acceptable level and some future study of the reduction of the gamma-rays from the laboratory would make the observation of the Migdal effect possible. The background for the xenon gas, on the other hand, is found to be much more serious than for the argon gas. Future works on the isotope separation as well as the reduction of the gamma-rays from the detector and laboratory will be needed before the Migdal effect can be observed for the xenon gas case.
ASSESSMENT OF OCCUPATIONAL RADIATION DOSES OF MEDICAL RADIATION WORKERS IN TWO COMMUNITY HOSPITALS
Authors: Osei Ernest , Nuru Faiza , Moore Michael
Published: November 2020

The International Commission on Radiological Protection recommends the adoption of the linear, no-threshold model as a predictive risk model for radiation protection purposes since the relationship between low-dose radiation exposure and cancer risk is unclear. Medical radiation workers are subject to occupational exposures and differences in workload, area of work and types of exposure can lead to variations in exposures between different occupational groups. We investigated the occupational exposures of 572 workers from four departments in two community hospitals and stratified into 22 occupational groups in order to identify groups with the highest radiation exposure. The occupational doses from 2015 to 2019 were analyzed to identify the dose distribution of each occupational group, total number of monitored workers, annual and collective deep (Hp(10)), eye (Hp(3)) and shallow (Hp(0.07)) doses. We further determined the individual and occupational group lifetime doses as well as the probability that monitored workers’ lifetime doses will exceed a specified lifetime dose level. The occupational groups with the highest radiation exposures were the nuclear medicine technologists, diagnostic imaging radiologists and diagnostic cardiologists. Although our data suggest that occupational doses reported are low, it is essential that exposure of occupationally exposed personnel are always kept as low as reasonably achievable with an effective radiation protection program.
G Protein-Coupled Estrogen Receptor 1 (GPER) as a Novel Target for Schizophrenia Drug Treatment
Authors: Macêdo Danielle S , Sanders Lia Lira Olivier , das Candeias Raimunda , Montenegro Cyntia de Freitas , de Lucena David Freitas , Chaves Filho Adriano José Maia , Seeman Mary V , Monte Aline Santos
Published: November 2020

The observation that a person’s sex influences the onset age of schizophrenia, the course of the disease, and antipsychotic treatment response suggests a possible role for estrogen receptors in the pathophysiology of schizophrenia. Indeed, treatment with adjunctive estrogen or selective estrogen receptor modulators (SERMs) are known to reduce schizophrenia symptoms. While estrogen receptors (ER)α and ERβ have been studied, a third and more recently discovered estrogen receptor, the G protein-coupled estrogen receptor 1 (GPER), has been largely neglected. GPER is a membrane receptor that regulates non-genomic estrogen functions, such as the modulation of emotion and inflammatory response. This review discusses the possible role of GPER in brain impairments seen in schizophrenia and in its potential as a therapeutic target. We conducted a comprehensive literature search in the PubMed/MEDLINE database, using the following search terms: “Schizophrenia,” “Psychosis,” “GPER1 protein,” “Estrogen receptors,” “SERMS,” “GPER1 agonism, “Behavioral symptoms,” “Brain Inflammation.” Studies involving GPER in schizophrenia, whether preclinical or human studies, have been scarce, but the results are encouraging. Agonism of the GPER receptor could prove to be an essential mechanism of action for a new class of “anti-schizophrenia” drugs.
Posterior Ligament–Bone Injury Classification and Severity Score
Authors: Yang Jun-Song , Liu Peng , Liu Tuan-Jiang , Zhang Hai-Ping , Zhang Zheng-Ping , Yan Liang , Zhao Qin-Peng , He Bao-Rong , Tuo Yuan , Zhao Yuan-Ting , Huang Da-Geng , Hao Ding-Jun
Published: November 2020

Study Design.

Clinical case series.

Objective.

The aim of this study was to propose a novel posterior ligament-bone injury classification and severity (PLICS) score system that can be used to reflect the severity of subaxial cervical fracture dislocations (SCFDs) and predict the failure of anterior-only surgery; and to measure the intraobserver and interobserver reliability of this system.

Summary of Background Data.

The approach selection for SCFDs is controversial. Although the anterior approach is familiar for most surgeons, postoperative hardware failure and/or delayed cervical deformity is a nonnegligible complication.

Methods.

Ten patients were randomly selected for intraobserver reliability evaluation on two separate occasions, one month apart. Another 30 patients were randomly selected, and the interobserver reliability was measured by comparing results of each case between each reviewer and averaging. To analyze the difference in the PLICS score, 354 patients fulfilled the follow-up were divided into stable and unstable groups according to whether radiologically stable was observed during follow-up.

Results.

For the intraobserver reliability, the mean intraclass correlation coefficient for the 10 reviewers was 0.931. For the interobserver reliability, the mean interobserver correlation coefficient for the three elements was 0.863. Among 16 patients with PLICS score ≥7, two patients in the stable group manifested with severe injury of the posterior ligamentous complex (PLC); extremely unstable lateral mass fractures with or without severe injury of PLC were detected in the 14 patients of the unstable group.

Conclusion.

The proposed PLICS score system showed excellent intraobserver and interobserver reliability. When a PLICS score is >7 or 7 accompanied by extremely unstable lateral mass fractures, the risk of postoperative failure after an anterior-only reconstruction is high and supplemental posterior strengthening can be considered.

Level of Evidence: 4
The Correlation Between Facet Tropism and Intervertebral Disc Herniation in the Subaxial Cervical Spine
Authors: Wang Yu , Chen Guoliang , Lin Jiajin , Huang Weicheng , Wang Jing , Teng Honglin
Published: November 2020

Study Design.

A retrospective case–control study.

Objective.

Investigating the correlation between the facet tropism (FT) and subaxial cervical disc herniation (CDH).

Summary of Background Data.

Although debatable, it was widely reported that FT was associated with lumbar disc herniation. However, the exact correlation between FT and subaxial CDH is still unclear.

Methods.

Two-hundred patients with any disc herniation at C3/4, C4/5, C5/6, or C6/7 and 50 normal participants without CDH (normal control group) were included in this study. For patients, the cervical levels with CDH and the levels without herniation were classified into the “herniation group” and “patient control group,” respectively. Bilateral facet joint angles at C3/4, C4/5, C5/6, and C6/7 on sagittal, axial, and coronal planes were measured on computed tomography (CT). The disc degeneration at each level was assessed on magnetic resonance imaging (MRI).

Results.

Both the mean difference between left and right facet angles and tropism incidence in herniation group were significantly greater than those in two control groups whenever at C3/4, C4/5, C5/6, or C6/7 level and whenever on sagittal, axial, or coronal plane. The mean differences of angles and tropism incidences in most patient control groups were not significantly greater than those of corresponding normal control groups. The incidence of greater facet angle at the left or right side was not significantly different among the left, central, and right herniation groups. The mean disc degeneration grades in both herniation and patient control groups were significantly higher than those in normal control groups while no difference between herniation and patient control groups.

Conclusion.

The FT on the sagittal, axial, and coronal planes are all associated with CDH in the subaxial cervical spine. The greater facet angle at the left or right side does not affect the side of herniation. The severity of cervical disc degeneration is not associated with FT.

Level of Evidence: 3
Clinical Benefit of Rehabilitation Training in Spinal Cord Injury
Authors: Duan Ruimeng , Qu Mingjia , Yuan Yashuai , Lin Miaoman , Liu Tao , Huang Wei , Gao Junxiao , Zhang Meng , Yu Xiaobing
Published: November 2020

Study Design.

A systematic review and meta-analysis.

Objective.

This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury.

Summary of Background Data.

Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial.

Methods.

Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software.

Results.

Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls.

Conclusion.

Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.

Level of Evidence: 1
Efficacy and Long-term Effect of Radiofrequency Denervation in Patients with Clinically Diagnosed Cervical Facet Joint Pain
Authors: van Eerd Maarten , de Meij Nelleke , Kessels Alfons , Patijn Jacob , Weber Wim , Wintraecken Veerle , van Kleef Maarten , van Kuijk Sander M.J.
Published: November 2020

Study Design.

Multicenter double-blind randomized sham-controlled trial.

Objective.

To assess the efficacy of radiofrequency (RF) denervation of the cervical facet joints in chronic cervical facet joint pain.

Summary of Background Data.

One randomized controlled trial showed efficacy of RF denervation in whiplash-associated disease. There are no randomized controlled trials on RF denervation in patients with chronic cervical facet joint pain.

Methods.

Patients were randomized to receive RF denervation combined with bupivacaine (intervention group) or bupivacaine alone (control group). In the intervention group, an RF thermal lesion was made at the cervical medial branches after the injection of bupivacaine. The primary outcome was measured at 6 months and consisted of pain intensity, self-reported treatment effect, improvement on the Neck Disability Index, and the use of pain medication. Duration of effect was determined using telephone interviews.

Results.

We included 76 patients. In the intervention group, 55.6% showed > 30% pain decrease versus 51.3% in the control group (P = 0.711); 50.0% reported success on the Patients’ Global Impression of Change in the intervention group versus 41.0% (P = 0.435); the Neck Disability Index was 15.0 ± 8.7 in the intervention group compared with 16.5 ± 7.2 (P = 0.432), the need for pain medication did not differ significantly between groups (P = 0.461). The median time to end of treatment success for patients in the RF group was 42 months, compared with 12 months in the bupivacaine group (P = 0.014).

Conclusions.

We did not observe significant differences between RF denervation combined with injection of local anesthesia compared with local anesthesia only at 6 months follow-up. We found a difference in the long-term effect after 6 months follow-up in favor of the RF treatment.

Level of Evidence: 2
When Can One-level Pedicle Subtraction Osteotomy Obtain Satisfied Outcomes for Severe Thoracolumbar Kyphosis with Global Kyphosis ≥80° in Ankylosing Spondylitis
Authors: Huang Ji-chen , Qian Bang-ping , Qiu Yong , Wang Bin , Yu Yang
Published: November 2020

Study Design.

A retrospective study.

Objective.

The aim of this study was to make a thorough comparison of clinical and radiographic outcomes between ankylosing spondylitis (AS) patients with severe kyphosis who underwent one- or two-level pedicle subtraction osteotomy (PSO) and to determine the indications of one-level PSO.

Summary of Background Data.

Traditionally, one-level PSO was considered being able to obtain 35° to 40° correction. However, in our practice, one-level PSO might achieve satisfied clinical and radiographic outcomes in AS patients with severe thoracolumbar kyphosis defined as global kyphosis (GK) ≥80°.

Methods.

Fifty-five AS-related severe thoracolumbar kyphosis patients undergoing one- or two-level PSO from January 2007 to November 2016 were reviewed. The radiographic parameters included thoracic kyphosis (TK), lumbar lordosis (LL), GK, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), sagittal vertical axis (SVA), and femoral obliquity angle (FOA). Clinical outcomes were evaluated by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS).

Results.

The mean follow-up period was 39.7 ± 20.2 months (range, 24–120 months). Patients who underwent one-level PSO have significantly smaller preoperative GK, SVA, FOA, and larger preoperative LL and SS compared to those who underwent two-level PSO (P < 0.05). The optimal cutoff points of preoperative radiographic parameters for selecting one-level PSO were: GK <94°, SVA <18.0 cm, and LL <18°. No significant difference was observed between the two groups with regard to preoperative ODI and VAS (P > 0.05), and the improvement of ODI and VAS (P > 0.05). Significantly more operative time, blood loss, and fusion levels were found in two-level PSO group (P < 0.05).

Conclusion.

One-level PSO might be appropriate for selected severe AS-related kyphosis patients with GK <94°, SVA <18.0 cm, and LL <18°. This finding might be beneficial for surgical decision-making in performing one-level PSO, a relatively less risky procedure, to reconstruct the ideal sagittal alignment in AS patients with severe thoracolumbar kyphosis.

Level of Evidence: 2
Current Procedural Terminology-based Procedure Categorization Enhances Cost Prediction of Medicare Severity Diagnosis Related Group in Spine Surgery
Authors: Baum Griffin R. , Stricsek Geoffrey , Kumarasamy Mathu A. , Thirunavu Vineeth , Esper Gregory J. , Boden Scott D. , Refai Daniel
Published: November 2020

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to analyze how a Current Procedural Terminology (CPT)-based categorization method can predict cost variation in surgical spine procedures.

Summary of Background Data.

Neck and back disorders affect a majority of the adult population and account for tens of billions of dollars in health care spending each year. In the era of bundled payments and value-based reimbursement, it is imperative for surgeons to identify sources of cost variability across surgical spine procedures. Historically, this has been accomplished using Medicare Severity Diagnosis Related Group (MS-DRG) codes, but they utilize an overly simplistic categorization of surgical procedures. The specificity and familiarity of the CPT coding structure makes it a better option for categorizing differences in surgical decision making and technique.

Methods.

Hospital billing data for patients undergoing a surgical spine procedure requiring an overnight, in-patient stay was retrospectively collected over 4 fiscal years (2012–2016) from a single health care system. Linear regression analysis was performed to assess the correlation between cost variation and: spine-specific MS-DRG codes; a novel CPT-based categorization method; and the combination of MS-DRG codes and CPT-based categorization.

Results.

There were 5020 surgical procedures were analyzed with respect to 16 different MS-DRG codes and 30 distinct CPT-based surgical categories (CSCs). Linear regression results were: MS-DRG R

2
 = 0.6545 (P < 0.001); CSC R
2 = 0.5709 (P < 0.001); and R
2 = 0.744 for the combined MS-DRG and CSC methods (P < 0.05). Median difference between the actual and predicted cost for the combined model was −$261.00, compared with −$727.50 for the CSC model and −$478.70 for the MS-DRG model.

Conclusion.

Addition of the CPT-based categorization method to MS-DRG coding provides an enhanced method to evaluate the association between predicted and actual cost when using linear regression analysis to assess cost variation in spine surgery.

Level of Evidence: 3
Using technology to improve symptom management in ICU: a quality improvement study
Authors: Baker Timothy , Allan Katie , Surman Katy , Navapurkar Vilas
Published: November 2020

This year international interest in the intensive care unit (ICU) has focused on the COVID-19 pandemic. One area that has received limited attention is the impact of an ICU admission on the individual; posttraumatic stress disorder, anxiety, and depression are common in ICU survivors and patients described the most distressing experience being the inability to communicate. A discrepancy exists between the clinicians and patient perspective of the frequency and severity of symptoms patients experience while in ICU. We sort to better understand this problem and find a way to improve recognition of symptoms, then to address them as they occur and so attempt to diminish their consequence at follow-up. Sequential mixed methodologies were used in 3 development cycles to create and evaluate the tool reported in this paper—myICUvoice. The initial cycle revealed a spectrum of voicelessness described by patients. The second cycle demonstrated that myICUvoice improved the ability of patients unable to phonate, to communicate. It is now freely available to download for use in any ICU. It has also been used to provide a novel method for prospectively recording an otherwise unattainable insight into patient experience. The third cycle revealed that when patients could talk, nurses did not intuitively use myICUvoice’s self-reporting survey function. Patients had requested this use to enhance clinicians understanding of otherwise under-reported patient symptoms. It is possible that by improving our understanding of the symptoms patients experience and therefore provide treatments when needed, post-ICU morbidity may be reduced.
Assessment of a Novel Lens Surface Treatment for Scleral Lens Wearers With Dry Eye
Authors: Mickles Chandra V. , Harthan Jennifer S. , Barnett Melissa
Published: November 2020

Objectives:

To compare lens comfort and dry eye (DE) symptoms of DE scleral lens (SL) wearers fit with polyethylene glycol (PEG)-based surface-treated and untreated SLs. Dry eye signs, comfortable SL wearing time (WT), vision quality, and lens-related ocular surface changes were also assessed.

Methods:

Twenty-one SL wearers with DE and SL discomfort were enrolled in a double-masked crossover study. Participants were randomized to wear their untreated or PEG (Tangible Hydra-PEG, Tangible Science; Redwood, CA) surface-treated SL of the same parameters first for 30 days. Lens comfort, DE symptoms, and ocular surface assessments were measured at baseline, after the first test period, and after the crossover. Comfortable lens WT and frequency of foggy vision were recorded. Comparisons were assessed using paired t tests or Wilcoxon signed-rank tests.

Results:

Polyethylene glycol–treated SL wear resulted in significantly improved: lens comfort (P=0.003), DE symptoms (P=0.004), corneal sodium fluorescein staining (P=0.01), temporal conjunctival lissamine green staining (P=0.01), lid wiper epitheliopathy (P=0.002), conjunctival papillae (P=0.003), frequency of foggy vision (P=0.002), tear break-up time (TBUT) (P=0.01), and comfortable lens WT (P=0.002) compared with untreated wear. There were no significant changes between treated and untreated lens wear for TBUT over the SL (P=0.14) and nasal conjunctival lissamine green staining (P=0.06).

Conclusions:

Polyethylene glycol surface-treated SLs provided improved comfort, reduced DE symptoms, and reduced ocular surface compromise compared with untreated SLs for participants with DE.
Surgical Observations of the Levator Aponeurosis Fibrotic Changes in Simple Congenital Ptosis Suggest Complex Pathogenesis
Authors: Al-Faky Yasser H.
Published: November 2020

Purpose:

To shed light upon the possible role of the levator aponeurosis (LA) developmental fibrotic changes as an added etiology for simple congenital ptosis, which causes limitation of the levator function (LF).

Methods:

This retrospective cohort study included patients with simple congenital ptosis who underwent skin approach LA resection as a primary intervention with an intraoperative photographic documentation of LA fibrotic changes. Preoperative demographics and clinical data were reviewed. The effect of LA fibrotic changes on the LF was assessed in different LA fibrotic changes with or without levator palpebrae superioris (LPS) muscle fatty infiltration.

Results:

A total of 56 eyelids of 49 patients with a mean age (±SD) 6.7 (±3.2) years were enrolled in this study. The fibrotic changes of LA were observed as a sheet of fibrosis (19 eyelids) or fibrous bands (23 eyelids). Fatty infiltration of LPS was noticed in 28 eyelids, either with or without fibrotic changes of LA. Preoperative LF was diminished in LPS fatty infiltration compared with LA fibrotic sheets (P = 0.026). Postoperative LF improved significantly in both LA fibrotic sheets and LA fibrotic bands (9.4 ± 2.5 mm and 9.6 ± 2.8 mm, respectively) compared with LPS with fatty infiltration (6.4 ± 1.8 mm) (P = 0.004).

Conclusions:

Although our data are inconclusive due to lack of embryologic studies, the observed LA fibrotic changes may suggest a complex pathogenesis of simple congenital ptosis. The meticulous observation of the LA and the releasing of any adhesion or band to the surrounding structures could improve postoperative LF.